- Email: [email protected]
TORTURE IN TURKEY
866 WORLD MEDICAL ASSOCIATION AND SOUTH AFRICA
SIR,-As chairman of the Belgian Medical Association, which has been a member of the World Medical Association (WMA) since its foundation, and secretary general of the WMA, I cannot accept what is said by Dr Beck, chairman of the German Verein Demokratischer Arztinnen und Arzte (June 24, p 1441). The Medical Association of South Africa (MASA), a cofounder of the WMA, has closely cooperated in formulation of the Association’s philosophy and code of medical ethics. The MASA opposes discrimination on grounds of race, religion, social origin, or political persuasion, and has always been active in working against racial
Such deviations from fact are commonly accepted when planning film for popular appeal but the most surprising alteration was the total exclusion of any reference to Dr Robert Collis. This remarkable paediatrician initiated and controlled Brown’s therapy. He later guided Brown to write My Left Foot as well as other books and poems. His omission is all the more remarkable because "Bob" Collis was an exceptional person in so many respects. He wrote his own biography The Silver Fleece when thirty-three years old, covering his childhood and student years. He could have added an even more interesting second volume for his later years. Perhaps there is room for only one big personality in any film. a
Santa Barbara,
Killmey,
policies. What Beck says against his "colleagues" of the German Medical Association is unfair, not only in itself but also because the criticism is indirectly addressed to international colleagues sharing with the German Medical Association its WMA membership. If he utilises such argument, he should know that, like that of many WMA colleagues, I was a political prisoner in the nazi concentration camp of Buchenwald and this entitles me to say that I have no lesson to receive about racism and nazism. To get the necessary changes in the policy of South Africa, the MASA needs more the help of the world medical profession than the criticisms of the German Verein Demokratischer Arztinnen und Arzte, which has close links with politicians of East Germany where the respect of human rights is far from their concerns. World Medical Association, 28 Avenue des Alpes, 01210 Femey-Voltaire, France
ANDRÉ WYNEN
LATE ABORTIONS
SIR,-An aspect overlooked in your Aug 21 editorial and by Mr Paintin (Sept 2, p 563) is that most late terminations are done for medical indications following recognition of an abnormal fetus. Destructive surgical termination largely precludes later pathological investigations to substantiate the prenatal diagnosis and assess the genetic implications. Modem prenatal investigative techniques may allow accurate diagnosis in a high proportion of cases but pathological examination adds information in many instances and lead to a revision of the diagnosis. Termination by surgical means denies to the parents this important form of audit, quite apart from any influence that the lack of a whole fetus may have on a subsequent grief reaction. Department of Histopathology, Royal Postgraduate Medical School, Hammersmith Hospital,
TORTURE IN TURKEY
SIR,-A letter about torture in Turkish Kurds (June 10, p 1319) was criticised by Turkish correspondents in your issue of July 22 (p 220). 260 members of the Medical Association of Istanbul have
signed a petition requesting a professional investigation of these correspondents, on the grounds that their statements constituted a violation of medical ethics. As in most other countries, traditional methods are being used in Turkish police stations and prisons. Numerous officials have been sued in court for practising torture and many of them have been convicted. In the last couple of years, I have examined and treated some ex-prisoners. Many prisoners who report being tortured show objective physical sequelae-most commonly the scars of falaka over the feet, disorders of muscles and joints, wound scars, mishealed bone fractures, peripheral nerve impairment, and nail abnormalities. Recognition of post-torture syndrome and knowledge of its consequences are important in the struggle to end these breaches of human rights. When treatment is attempted, extraordinary efforts are required both from the clinicians and from the patients. Among the difficulties is that of overcoming the victims’s mistrust of the therapist and medical institutions. At every stage of therapy, the medical team has to offer reassurance, and the ability to inspire trust requires experience. Therefore, it is appropriate to have a rehabilitation centre specialising in this subject. There are few such centres in the world. An independent rehabilitation centre in Turkey could directly collect information from torture victims and begin the process of rehabilitation. Department of Psychiatry, University of Istanbul, Faculty of Medicine, Topkapi-Istanbul, Turkey
D. K. O’DONOVAN
Co Dublin, Ireland
SAHIKA YÜKSEL
ANGLE ON DISABILITY
SIR,-Dr Hollins in her review of the film My Left Foot (Sept 2, p 553) gives a clear account of how the director envisaged the rehabilitation of the patient Christy Brown for cerebral palsy. The realities of life in Dublin in about 1950 and the facts recorded in Brown’s autobiography, on which the film is based, are very different: there was no provocative speech-therapist, and a sympathetic almoner played a prominent role. How the news of the diagnosis was broken to Brown’s father was not true.
London W12 0HS
J. S. WIGGLESWORTH
CLOSTRIDIUM DIFFICILE INFECTION IN HEALTHCARE WORKERS
SIR,-Several workers have recorded nosocomial acquisition of Clostridium difficile.1,2 Both environmental contamination and carriage of the organism on the hands of health-care workers have been implicated in the transmission of the infection.24 We report transmission of C difficile infection from a patient to three nurses. The index case was a 19-year-old paraplegic man from a chronic care facility, who had been admitted to the Johannesburg Hospital with meningitis. Treatment with intravenous chloramphenicol and penicillin was begun on admission. 3 days later he had severe watery diarrhoea. No micro-organisms were found in stools but assay for C difficile cytotoxin was positive. Enteric isolation precautions were instituted and treatment with oral vancomycin 500 mg 6 hourly was begun. The patient responded and symptoms resolved within a week. About 7 days after the onset of diarrhoea in the patient, three nurses caring for this patient reported ill. Two complained of severe diarrhoea and abdominal pain and the third had only diarrhoea. C difficile cytotoxin was isolated from the stools of all three nurses and no other micro-organisms were seen. All were treated with oral vancomycin and responded within days. The nurses, aged 23, 28, and 37 years, had all been well and none had received antibiotics or other medication in the preceding 6 months. They had not worked in other wards or associated with other people with diarrhoea. Because of the patient’s paraplegia, soiling of bed linen was excessive, which necessitated frequent contact between these nurses and the patient. Diarrhoea did not develop in anyone else on the ward. Stool specimens and cultures from the hands of all health-care workers and from many environmental sites within the ward were negative for C difficile and its cytotoxin. Although spontaneous C difficile-associated enteric disease without antibiotic use has been reported in healthy adults,5-7 cross-infection is more likely in the context of this outbreak. It is possible that one or more of the nurses were carriers of the organism, but the facts that the patient had been in a chronic-care facility8 and had received antibiotics, and that environmental contamination was not found, as well as the time sequence of
SIR,-As chairman of the Belgian Medical Association, which has been a member of the World Medical Association (WMA) since its foundation, and secretary general of the WMA, I cannot accept what is said by Dr Beck, chairman of the German Verein Demokratischer Arztinnen und Arzte (June 24, p 1441). The Medical Association of South Africa (MASA), a cofounder of the WMA, has closely cooperated in formulation of the Association’s philosophy and code of medical ethics. The MASA opposes discrimination on grounds of race, religion, social origin, or political persuasion, and has always been active in working against racial
Such deviations from fact are commonly accepted when planning film for popular appeal but the most surprising alteration was the total exclusion of any reference to Dr Robert Collis. This remarkable paediatrician initiated and controlled Brown’s therapy. He later guided Brown to write My Left Foot as well as other books and poems. His omission is all the more remarkable because "Bob" Collis was an exceptional person in so many respects. He wrote his own biography The Silver Fleece when thirty-three years old, covering his childhood and student years. He could have added an even more interesting second volume for his later years. Perhaps there is room for only one big personality in any film. a
Santa Barbara,
Killmey,
policies. What Beck says against his "colleagues" of the German Medical Association is unfair, not only in itself but also because the criticism is indirectly addressed to international colleagues sharing with the German Medical Association its WMA membership. If he utilises such argument, he should know that, like that of many WMA colleagues, I was a political prisoner in the nazi concentration camp of Buchenwald and this entitles me to say that I have no lesson to receive about racism and nazism. To get the necessary changes in the policy of South Africa, the MASA needs more the help of the world medical profession than the criticisms of the German Verein Demokratischer Arztinnen und Arzte, which has close links with politicians of East Germany where the respect of human rights is far from their concerns. World Medical Association, 28 Avenue des Alpes, 01210 Femey-Voltaire, France
ANDRÉ WYNEN
LATE ABORTIONS
SIR,-An aspect overlooked in your Aug 21 editorial and by Mr Paintin (Sept 2, p 563) is that most late terminations are done for medical indications following recognition of an abnormal fetus. Destructive surgical termination largely precludes later pathological investigations to substantiate the prenatal diagnosis and assess the genetic implications. Modem prenatal investigative techniques may allow accurate diagnosis in a high proportion of cases but pathological examination adds information in many instances and lead to a revision of the diagnosis. Termination by surgical means denies to the parents this important form of audit, quite apart from any influence that the lack of a whole fetus may have on a subsequent grief reaction. Department of Histopathology, Royal Postgraduate Medical School, Hammersmith Hospital,
TORTURE IN TURKEY
SIR,-A letter about torture in Turkish Kurds (June 10, p 1319) was criticised by Turkish correspondents in your issue of July 22 (p 220). 260 members of the Medical Association of Istanbul have
signed a petition requesting a professional investigation of these correspondents, on the grounds that their statements constituted a violation of medical ethics. As in most other countries, traditional methods are being used in Turkish police stations and prisons. Numerous officials have been sued in court for practising torture and many of them have been convicted. In the last couple of years, I have examined and treated some ex-prisoners. Many prisoners who report being tortured show objective physical sequelae-most commonly the scars of falaka over the feet, disorders of muscles and joints, wound scars, mishealed bone fractures, peripheral nerve impairment, and nail abnormalities. Recognition of post-torture syndrome and knowledge of its consequences are important in the struggle to end these breaches of human rights. When treatment is attempted, extraordinary efforts are required both from the clinicians and from the patients. Among the difficulties is that of overcoming the victims’s mistrust of the therapist and medical institutions. At every stage of therapy, the medical team has to offer reassurance, and the ability to inspire trust requires experience. Therefore, it is appropriate to have a rehabilitation centre specialising in this subject. There are few such centres in the world. An independent rehabilitation centre in Turkey could directly collect information from torture victims and begin the process of rehabilitation. Department of Psychiatry, University of Istanbul, Faculty of Medicine, Topkapi-Istanbul, Turkey
D. K. O’DONOVAN
Co Dublin, Ireland
SAHIKA YÜKSEL
ANGLE ON DISABILITY
SIR,-Dr Hollins in her review of the film My Left Foot (Sept 2, p 553) gives a clear account of how the director envisaged the rehabilitation of the patient Christy Brown for cerebral palsy. The realities of life in Dublin in about 1950 and the facts recorded in Brown’s autobiography, on which the film is based, are very different: there was no provocative speech-therapist, and a sympathetic almoner played a prominent role. How the news of the diagnosis was broken to Brown’s father was not true.
London W12 0HS
J. S. WIGGLESWORTH
CLOSTRIDIUM DIFFICILE INFECTION IN HEALTHCARE WORKERS
SIR,-Several workers have recorded nosocomial acquisition of Clostridium difficile.1,2 Both environmental contamination and carriage of the organism on the hands of health-care workers have been implicated in the transmission of the infection.24 We report transmission of C difficile infection from a patient to three nurses. The index case was a 19-year-old paraplegic man from a chronic care facility, who had been admitted to the Johannesburg Hospital with meningitis. Treatment with intravenous chloramphenicol and penicillin was begun on admission. 3 days later he had severe watery diarrhoea. No micro-organisms were found in stools but assay for C difficile cytotoxin was positive. Enteric isolation precautions were instituted and treatment with oral vancomycin 500 mg 6 hourly was begun. The patient responded and symptoms resolved within a week. About 7 days after the onset of diarrhoea in the patient, three nurses caring for this patient reported ill. Two complained of severe diarrhoea and abdominal pain and the third had only diarrhoea. C difficile cytotoxin was isolated from the stools of all three nurses and no other micro-organisms were seen. All were treated with oral vancomycin and responded within days. The nurses, aged 23, 28, and 37 years, had all been well and none had received antibiotics or other medication in the preceding 6 months. They had not worked in other wards or associated with other people with diarrhoea. Because of the patient’s paraplegia, soiling of bed linen was excessive, which necessitated frequent contact between these nurses and the patient. Diarrhoea did not develop in anyone else on the ward. Stool specimens and cultures from the hands of all health-care workers and from many environmental sites within the ward were negative for C difficile and its cytotoxin. Although spontaneous C difficile-associated enteric disease without antibiotic use has been reported in healthy adults,5-7 cross-infection is more likely in the context of this outbreak. It is possible that one or more of the nurses were carriers of the organism, but the facts that the patient had been in a chronic-care facility8 and had received antibiotics, and that environmental contamination was not found, as well as the time sequence of