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HIV-1 infection puzzles Denmark
THE LANCET
POLICY AND PEOPLE
he quality of mercy has been strained in Canada recently. In a precedent ruling, a Saskatchewan judge ruled on Dec 1 that a mandatory life sentence would be a cruel and unusual punishment for a farmer who killed his 12-year-old daughter with cerebral palsy, to relieve her of a lifetime of unremitting pain. Angry spokesmen for disabled groups say the ruling is tantamount to “open season” on the debilitated. But, Justice Ted Noble said that the homicide was commited for “caring and altruistic reasons” because Robert Latimer was motivated “solely by his love and compassion for Tracy and the need—at least in his mind— that she not suffer any more pain”. Latimer was sentenced to 1 year in prison plus 12 months house arrest. The Crown may appeal the sentence.
T
Wayne Kondro
HIV-1 infection puzzles Denmark
A
6-year-old girl has contracted HIV-1 while being treated for leukaemia at a hospital in Aalborg, Denmark. Experts are considering the case as perhaps the first patientto-patient transmission of HIV-1. The national Statens Serum Institut has compared the genetic fingerprint of the girl’s virus with that of another known HIV-1-posiitive child on the ward, and found a 97% similarity. So, it seems clear that the girl must have been infected from the other child. What remains uncertain is how the virus was transmitted. Hospital authorities claim that all procedures were strictly followed, and that they have no reason to suspect staff malpractice. Transmission via donated blood products has been excluded. “Maybe one child bit the other during play”, says hospital manager Jesper Christensen. No incidence of biting or scratching has, however, been recorded, and specialists elsewhere suspect a staff error— perhaps a dirty syringe. Hints from hospital management that this could be an example of a hitherto unknown means of transmision have been met with absolute disbelief from experts outside Aalborg. Kaare Skovmand
1758
Israeli medics must show their credentials he Israel Medical Association is on the verge of creating a new status for doctors similar to the US “Board eligible”. This change will retrospectively recognise hundreds of immigrant physicians who trained and practised as specialists in the former Soviet Union but have only passed the first Israeli medicallicensing examinations. Currently, Israeli-licensed doctors may work in all areas of medicine except surgery and orthopaedics, for which full residency is required. But on Nov 11, Iris Kraus, correspondent for the daily newspaper Ha’aretz, exposed that health funds are taking advantage of the law by not displaying doctors’ certificates in a manner that clearly differentiates between trained specialists and general practitioners. The Ministry of Health has now ordered all funds to post credentials of physicians in their employ, and the funds are trying to comply.
T
Overall, the “non-specialist specialists” in health funds include: 30% of paediatricians; 10% of gynaecologists and dermatologists; 8% of neurologists; and 5% of cardiologists. “It is not illegal, but this deceit is a violation of prior agreements, and it is certainly not ethical to give a false impression. On the other hand, most of these physicians practised their specialty for years, even decades before coming to Israel”, said Yoram Blachar, IMA chairman. “The big dilemma is how to absorb all of the immigrant MDs and still maintain the high medical standards practised in Israel . . . to allow the newcomers to practise but not to take away any credit from MDs who went through the full modern specialisation programmes here. The ‘Board eligible’ classification would help make that distinction”, said Blachar. Rachelle H B Fishman
Nurses strike threatens health care in Kenya of 40 children are born every day, strike by 40 000 nurses pressing suspended admissions immediately for higher wages and better and called for volunteers to assist. terms of service has paralysed health Health facilities in the slums were services in public hospitals, health also closed. centres, and dispenSo far, the nurses saries in Kenya. have defied the director As the strike entered of medical services its second week on James Mwanzia, who Dec 5, public hospitals has ordered them back were forced to suspend to work while the major operations as government looks into clinical officers and their demands. The laboratory technicians nurses say they will joined the nurses only return when their in their demand salaries are increased to for 400–500% salary between KSh30 000 increases. Patients have (about US$500) and been left unattended as Strike collapses care KSh54 000 per month. doctors cannot cope Nurses and other paramedics curwith the large numbers of patients. rently earn KSh6000 ($100) per Other patients are being discharged month. The demands also include prematurely or transferred to private special allowances for those working health facilities. in intensive care units and in The situation is worse in the rural HIV/AIDS wards. areas where there are no alternatives The strike is likely to take a wider to government-run health services. dimension, with doctors threatening Reports indicate that public-health to down tools by the end of the week. facilities are in bad shape and Doctors’ representatives said that patients are dying for lack of medical their colleagues were in effect on care—especially hard hit are the strike since they could not work cholera-endemic western and coastal effectively without support from districts. In Nairobi, nurses nurses and paramedics. The nurses employed by the city council joined have appealed to President Daniel the strike on Dec 3 and paralysed arap Moi to help to resolve the crisis. more than 50 health units. Pumwani Maternity Hospital, where an average
A
Panos
Reduced sentence for “mercy killing”
Vol 350 • December 13, 1997
POLICY AND PEOPLE
he quality of mercy has been strained in Canada recently. In a precedent ruling, a Saskatchewan judge ruled on Dec 1 that a mandatory life sentence would be a cruel and unusual punishment for a farmer who killed his 12-year-old daughter with cerebral palsy, to relieve her of a lifetime of unremitting pain. Angry spokesmen for disabled groups say the ruling is tantamount to “open season” on the debilitated. But, Justice Ted Noble said that the homicide was commited for “caring and altruistic reasons” because Robert Latimer was motivated “solely by his love and compassion for Tracy and the need—at least in his mind— that she not suffer any more pain”. Latimer was sentenced to 1 year in prison plus 12 months house arrest. The Crown may appeal the sentence.
T
Wayne Kondro
HIV-1 infection puzzles Denmark
A
6-year-old girl has contracted HIV-1 while being treated for leukaemia at a hospital in Aalborg, Denmark. Experts are considering the case as perhaps the first patientto-patient transmission of HIV-1. The national Statens Serum Institut has compared the genetic fingerprint of the girl’s virus with that of another known HIV-1-posiitive child on the ward, and found a 97% similarity. So, it seems clear that the girl must have been infected from the other child. What remains uncertain is how the virus was transmitted. Hospital authorities claim that all procedures were strictly followed, and that they have no reason to suspect staff malpractice. Transmission via donated blood products has been excluded. “Maybe one child bit the other during play”, says hospital manager Jesper Christensen. No incidence of biting or scratching has, however, been recorded, and specialists elsewhere suspect a staff error— perhaps a dirty syringe. Hints from hospital management that this could be an example of a hitherto unknown means of transmision have been met with absolute disbelief from experts outside Aalborg. Kaare Skovmand
1758
Israeli medics must show their credentials he Israel Medical Association is on the verge of creating a new status for doctors similar to the US “Board eligible”. This change will retrospectively recognise hundreds of immigrant physicians who trained and practised as specialists in the former Soviet Union but have only passed the first Israeli medicallicensing examinations. Currently, Israeli-licensed doctors may work in all areas of medicine except surgery and orthopaedics, for which full residency is required. But on Nov 11, Iris Kraus, correspondent for the daily newspaper Ha’aretz, exposed that health funds are taking advantage of the law by not displaying doctors’ certificates in a manner that clearly differentiates between trained specialists and general practitioners. The Ministry of Health has now ordered all funds to post credentials of physicians in their employ, and the funds are trying to comply.
T
Overall, the “non-specialist specialists” in health funds include: 30% of paediatricians; 10% of gynaecologists and dermatologists; 8% of neurologists; and 5% of cardiologists. “It is not illegal, but this deceit is a violation of prior agreements, and it is certainly not ethical to give a false impression. On the other hand, most of these physicians practised their specialty for years, even decades before coming to Israel”, said Yoram Blachar, IMA chairman. “The big dilemma is how to absorb all of the immigrant MDs and still maintain the high medical standards practised in Israel . . . to allow the newcomers to practise but not to take away any credit from MDs who went through the full modern specialisation programmes here. The ‘Board eligible’ classification would help make that distinction”, said Blachar. Rachelle H B Fishman
Nurses strike threatens health care in Kenya of 40 children are born every day, strike by 40 000 nurses pressing suspended admissions immediately for higher wages and better and called for volunteers to assist. terms of service has paralysed health Health facilities in the slums were services in public hospitals, health also closed. centres, and dispenSo far, the nurses saries in Kenya. have defied the director As the strike entered of medical services its second week on James Mwanzia, who Dec 5, public hospitals has ordered them back were forced to suspend to work while the major operations as government looks into clinical officers and their demands. The laboratory technicians nurses say they will joined the nurses only return when their in their demand salaries are increased to for 400–500% salary between KSh30 000 increases. Patients have (about US$500) and been left unattended as Strike collapses care KSh54 000 per month. doctors cannot cope Nurses and other paramedics curwith the large numbers of patients. rently earn KSh6000 ($100) per Other patients are being discharged month. The demands also include prematurely or transferred to private special allowances for those working health facilities. in intensive care units and in The situation is worse in the rural HIV/AIDS wards. areas where there are no alternatives The strike is likely to take a wider to government-run health services. dimension, with doctors threatening Reports indicate that public-health to down tools by the end of the week. facilities are in bad shape and Doctors’ representatives said that patients are dying for lack of medical their colleagues were in effect on care—especially hard hit are the strike since they could not work cholera-endemic western and coastal effectively without support from districts. In Nairobi, nurses nurses and paramedics. The nurses employed by the city council joined have appealed to President Daniel the strike on Dec 3 and paralysed arap Moi to help to resolve the crisis. more than 50 health units. Pumwani Maternity Hospital, where an average
A
Panos
Reduced sentence for “mercy killing”
Vol 350 • December 13, 1997