L'Express (Port Louis)

19 August 2014

Mauritius: 'There is a 'Window Period' During which a Patient May be Tested Negative Though he has the HIV Virus'

interview

In light of the recent headlines concerning health-related issues, Weekly speaks to Minister of Health and Quality of Life Lormus Bundhoo about what he plans to do about the cases, and how Mauritius can protect itself from the threat of Ebola.

Your ministry has been in the limelight for a while recently. Before you recovered from the Avastin episode, you have been swamped by the case of the young boy who allegedly was contaminated with the AIDS virus through transfusions at the hospital. Are you the minister of health or the minister of sickness?

As the minister of health one of my main responsibilities is to provide care for the sick and prevent the healthy from falling sick. That's what we do on a 24/7 basis. Every year, we have eight million attendances at our hospitals and health centres, 200,000 admissions and some 45,000 surgical operations are carried out. In fact, 80% of our national health budget is used for curative services; that is care for the sick. And the service is free to the public.

You talked about preventive medicine. How are we faring in that?

We have been very active on that front and our national immunisation programme covers over 90% of children. Our screening and counselling service reaches some 45,000 people yearly that include students from Form III to Lower VI, people at community level and at places of work. There are also five health tracks which are functional and five outdoor gymnasiums will be made available soon to enhance the health of the population.

All this sounds nice but when someone goes blind in our hospitals because of an Avastin injection, that is bad news, isn't it?

Very bad news of course! We have initiated an inquiry and it is on-going. Once the report is out, I can assure you that it will not be kept secret and that the necessary action will be taken. In the meantime, I'd like to stress that Avastin that is used at Moka Eye Hospital is an original product from the highly respected pharmaceutical firm - Roche. During the period that we were dealing with the issue of Avastin in Mauritius, the French government amended its legislation to allow the use of Avastin for eye treatment. Avastin is widely used in ophthalmology in many countries.

Why was it banned before?

Avastin is widely used in many countries such as the US, the UK, France and other European countries, India, Pakistan, Chinaand other Asian countries. It is used as an off-label product.

The leader of the opposition talks of a real mafia operating in the supply of medicines to the hospital. How far is that true?

For many years, we have had problems with the supply of medicines to our hospitals. I am informed that this is due to a number of factors ranging from the delay in approval of awards and absence of quotes on annual tenders to late deliveries and price deviations. However, I have set up an independent inquiry on this matter. The public in general is invited to submit any information to the committee. Again, subject to the report, necessary action will be taken.

You say yourself that there have been problems with the supply of medicines for years and it is only now that you are setting up a committee? 'Après la mort, la tisane'?

At least, I am honest in acknowledging that there is an issue with regard to the supply of medicine. And having recognised the issue, I have set up a committee composed of officers of various ministries, including officers from the Procurement Division of the Ministry of Finance to identify all the shortcomings and to propose solutions to ensure that this does not happen in the future.

By buying medicines from private suppliers, according to your own admission, aren't you increasing our bill as taxpayers?

We cannot attach a price to the health of our people.

That does not justify inflating our health bill, surely?!

Under the circumstances and as has been the practice for many years, we have no alternative but to have recourse to purchases on the local market pending replenishment of our stocks in order for there to be no interruption in the treatment being provided to our patients.

Coming back to the sad story of the boy contaminated with AIDS allegedly in our hospitals, what explanation do you have for that?

I agree that it is a sad case and I would like to express my sympathy to the patient and his family. What has happened is unfortunate. My ministry will make sure that the patient is provided with the required treatment and counselling.

OK, but that does not answer the question of how it happened, does it?

With regard to how it happened, I have set up a committee to enquire into the facts. Right now, we are in the presence of two different versions. On one side, we have done all the required tests that clearly indicate that the blood used during transfusion was not contaminated while, on the other side, we have the father of the patient who is pointing the finger at our health system.

Another committee?

Yes. Another committee has been set up to ensure transparency and to safeguard the interests of all those concerned.

Is it possible that a blood donor could be tested negative at the time s/he donates blood but may develop the virus later?

Yes, I am being informed that it is possible. However, tests are carried out each time prior to a donor giving blood - a protocol which is established by the World Health Organisation (WHO) and all our stakeholders, whether in the private or NGO sectors.

Would a person living with the virus be contagious at any stage before s/he is tested negative?

This is a highly technical question. I understand that there is a "window period" during which a patient may be tested negative though he has the HIV virus.However, if you are asking this question in relation

In light of the recent headlines concerning health related issues, Weekly speaks to Minister of Health and Quality of Life Lormus Bundhoo about what he plans to do about the cases, and how Mauritius can protect itself from the threat of Ebola.

The leader of the opposition talks of a real mafia operating in the supply of medicines to the hospital. How far is that true ?

For many years, we have had problems with the supply of medicines to our hospitals. I am informed that this is due to a number of factors ranging from the delay in approval of awards and absence of quotes on annual tenders to late deliveries and price deviations. However, I have set up an independent inquiry on this matter. The public in general is invited to submit any information to the committee. Again, subject to the report, necessary action will be taken.

You say yourself that there have been problems with the supply of medicines for years and it is only now that you are setting up a committee? 'Après la mort, la tisane' ?

At least, I am honest in acknowledging that there is an issue with regard to the supply of medicine. And having recognised the issue, I have set up a committee composed of off cers of various ministries, including officers from the Procurement Division of the Ministry of Finance to identify all the shortcomings and to propose solutions to ensure that this does not happen in the future.

Apart from Avastin and the contaminated boy, you have a bigger problem on your hands: Ebola seems to be the biggest threat to the world currently. Political talk apart, how safe are we ?

The WHO in its wisdom has declared Ebola as a public health threat of international concern. That must automatically include Mauritius. The Ebola virus is highly virulent and has a high fatality rate varying from 60 to 90%. At present, four countries are affected by the Ebola Virus Disease (EVD), namely: Liberia, Sierra Leone, Guinea and Nigeria.

Do you think the number of Africans coming to Mauritius, particularly to study, may one day bring the virus to our shores?

Any person who has been in contact with a confirmed case can bring the virus to our shores. We are a major tourist industry, many of our citizens work in Africa and we trade with several African countries. The risk therefore does not come only from African students but from any source. And the risk that the virus reaches our shores is real. However, all measures, as recommended by the WHO have been implemented to prevent the introduction of EVD in Mauritius.

So what are you doing to reassure us?

Please rest assured, many steps are being taken. We have strengthened our control both at the port and airport and we have refurbished the wards at Souillac Hospital to cater for the isolation of six male and six female patients and we have also set up an annexed laboratory to this new quarantine unit. We are now finalising a National Preparedness Plan for Ebola. So we are doing our best to keep you safe. We have also requested a WHO consultant to visit Mauritius to provide us with technical expertise and to validate the action we have taken.

When you are no longer minister of health, what would you like to be remembered for?

I would like to be remembered for setting up the foundation for a Family Doctor/General Practitioner Scheme, decentralising chemotherapy services for our cancer patients, taking bold measures at the level of the Medical Council to address the quality of care...

Ok. Ok. I should never have asked this question...

But you have so please allow me to add the upgrading of nurses' qualifications from certificate to diploma, recruiting some 1,000 student nurses and 600 doctors, decentralising ophthalmology services, containing and eliminating the spread of Dengue from the Triolet region within a very short period, halting and reversing the spread of HIV/AIDS, changing in a significant way the infrastructural manner and landscape of health services...

This article appeared in Weekly's edition of 14th to 20th August.

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