Wherever the art of medicine is loved, there is also a love of humanity

Abdulai Mansaray: 11 April 2020:

In a WhatsApp message, purported to have been written by Dr Sylvia Blyden, (Not verified), she appears to praise President Maada Bio “for many aspects of this fight against the outbreak of the Covid-19 in Sierra Leone”.

She praises the government’s “proactiveness, farsightedness and alacrity” as great on many counts. interestingly, she “categorically asserts” that the government’s “non-transparent policies may hasten the spread of the virus instead of slowing it down”. At this point, it is worth noting that the excerpts quoted above are from a WhatsApp message attributed to Sylvia Blyden, but I have very little reason to doubt the veracity.

Dr Blyden takes issue with the government for allegedly withholding the identities of the initial cases; and that by so doing allows further contacts with others; hence more infections. In order to back up her assertions, she employs the national constitution that “states clearly under chapter 3, that in the interest of public health, there are no limitations to human rights including all rights to privacy: She finds the government’s alleged “non transparency” as “destructive”. You be the judge.

She says that if Mayor Aki-Sawyerr was indeed a Mayor in a “civilised western country, she will be ethical enough to respect the citizens of her city”. There you have it. According to Dr Blyden, the citizens of Freetown are not civilised; she never ceases to insult the intelligence of this nation.

The Hippocratic Oath is one of the oldest binding documents in history written by Hippocrates and still held sacred by physicians: to treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation, and so on.

This oath is observed along the lines of autonomy (respecting patient’s choice), beneficence (doing what is in the best interest of your patient), non-maleficence ( do no harm) and justice ( doing what’s best for society as a whole). A close inspection of these naturally presents some ethical gymnastics. It is obvious to see the kind of ethical headache and conundrum that medics and health professionals face; especially in this case. There is a potential for a clash between doing justice and respecting the patient’s autonomy here.

Dr Blyden rightly quoted the interest of the public, which at face value overrides the patient’s autonomy in this case. But by doing so, is there not the risk of maleficence, if justice is to be done?

It is true that there are no limitations to human rights, including all rights to privacy. This means that in some cases and especially this one, the rights of the public can override that of the individual’s rights. Unfortunately, Dr Blyden, the interest of the public does not mean the right to publicise. The interest of the public does not mean that the identities of the individuals must be made public; because doing so may put the lives of the individuals in harm’s way; hence maleficence.

There is no doubt that the individuals that Dr Blyden is alluding to, if true, pose a significant risk of transmitting the disease, if the usual measures are not meted. What she should be asking the authorities is whether such measures have been taken to identify them, whether there has been some contact tracing, isolation and if required, treatment.

As a medical professional, and in line with the Hippocratic oath, this is where the expectation is to contact the relevant authorities (medical) to address the situation as mentioned above. One cannot  justify publicising their identities on Facebook or WhatsApp as in the public’s interest. That does not in any way minimise the potential risk factors of protecting their identities.

What would be wrong is, if the government fails to take the necessary steps to address the risks.  When it comes down to it, such justifications, criticisms or ethical considerations should be taken along what is or has been done to address the issues.

Our nation, like all others is facing difficult times. The situation is drastic and as such may require drastic solutions. Thankfully, we have an unenviable experience with a similar situation, from which we expect lessons to have been learned.

Like I said in my last article, if our country is to stand any chance of surviving the ravages of this pandemic, much of that will be rooted in the preventive measures we will have to take. Considering that our ability for contact tracing is next to nil, much of these preventive measures will be about “lockdowns”. That is a drastic measure  but we are facing drastic times.

However, this is not an excuse to disown common sense which is not common.  Nevertheless, we should not take the concept of “lockdown” as a vaccine, a cure or insulation for complacency.

Lockdowns are simply to slow down the rate of infection, and as such increase the chances of identifying and treating the afflicted. Lockdowns are not the answer but part of the answer, especially where our medical facilities themselves require vaccination.

That is even more reason for implementing this with common sense. The government has recently issued a further two-week lockdown. It is going to be hard, painful and sometimes near impossible to manage.  But one cannot argue with the rationale. When you consider that the shopping habits of the majority is not a weekly chore, and that 99.2 percent of the population have a loose relationship with refrigeration; notwithstanding the lack of a viable system for drinking water and electricity, the issues become more compounded and bordering on human rights abuses.

Unfortunately, it seems this is a bitter pill that we may have to swallow to save lives. We hope that in its bid to address this national issue, the government  will consider making a very painful situation less painful. But that should not blind us to the very serious, unforgiving and deadly nature of Covid-19.

I understand that Dr Blyden is a medical doctor, and it is understandable to ask such questions and bring such concerns into the narrative. What some of us are not sure of is which hat she is wearing here; the politician’s or the medic’s. Don’t answer that.

It is worrisome that someone who it is hoped, had taken the Hippocratic oath is advocating for the identities of the afflicted to be made public. What does Dr Blyden hope the public will do for these victims, if they know their identities? Oh, I forgot, we will have an avalanche of blood donors.

There is a strong temptation to conclude that the oxygen (pardon the pun) for this scrutiny is dyed in political persuasion. There is no way that Dr Blyden can convince the majority that her stance is from purely a medical point of view. At face value, it appears well meaning. Sadly, such thoughts seem to be adulterated and lost in translation; thanks to the undesirability of politics.

These are difficult times for all of us. Our politicians should try and resist the temptation to weaponise this pandemic. If we needed to live and act as one, there could be no better time to promote national cohesion. We are all in this together. Making political capital out of the misery of the public is not only insulting but gnawingly abhorrent.

There is a follow up WhatsApp message allegedly from Dr Blyden also, in which she does not understand why “First Lady Fatima is struggling to justify why the identities of the patients are kept quiet”. I hope this message is not true. Why some people celebrate and glorify the afflictions of others is beyond comprehension.

For discussion sake, since Dr Blyden was one of the bastions of the former Koroma government, can she give us a list and biography of all those that suffered from, died and were killed by the Ebola virus?

Talking about Ebola, here is a brain teaser. A: Who contracted and died from the Ebola disease? B: What happened to the Ebola funds? Please send all answers to the Commission of Inquiry.

At a time, when the whole country is required to act and live as one, in the face of a common enemy, it is really unfortunate  to see a self -anointed champion of the people, driven by everything that is wrong in politics, putting party interest in the guise of public interest.

No one is questioning Dr Blyden’s right to criticise, scrutinise or otherwise of the government’s handling of the situation. But in doing so, just to score cheap political points, at the expense of her sacred medical oath is nothing short of bringing the profession into disrepute.

Has Dr Blyden even thought of the repercussions of naming and in effect shaming the victims? Has she considered what the reaction of society and their family members will be if these people were named? Has Dr Blyden forgotten how many people and especially children were disowned, abandoned and ostracised by family members when their only crime was unfortunately being Ebola victims?

I hope that Sierra Leoneans will remember that one finger does not kill a louse; for no matter how beautiful and well-crafted a coffin might look, it will not make anyone wish for death.

Don’t forget to turn the lights off and wash your hands.

4 Comments

  1. A very well balanced piece. Although it avoids the complex legal arguments involved in disclosure of patient information in a health emergency setting, nevertheless the author presents his layman’s views very well.

    • Yes indeed well written! The writer could not be a medics but is able to pinpoint a vital principle of the medical Ethics, The Hippocratic Oath. He also further explains the dynamics of the Oath, e.g. “autonomy” “beneficence”, “non-maleficence” etc.
      This makes it easy for all, including Dr. Blyden, to understand why publishing names of Patients is unethical.

      The writer is gifted and talented in the art of writing. Thanks very much Mr. Mansaray, keep it up; Do no forget…

  2. Sylvia is calling for open identification or publication of the personal information of those infested with COVID-19. Like HIV/AIDS, Corona is a notifiable disease, but the Prevention and Control of HIV/AIDS Act 2007 prohibits such practice. This law is recent. The doctrine of implied repeal should apply, even if that’s what the 1960 law says.

    The right to privacy remains extant… it’s the general rule, and not the exception.

    Aside of that, the Public Health Emergency Act 1960 does not in any way say we should disclose, openly identify, or publicize personal information of those with identifiable diseases. Sections 2, 37 and 42 she quoted are complete mismatch of legal authorities as to what she wants to achieve, even with their literal interpretation.

    The courts have interpreted the concept of ‘private life’ or ‘right to privacy’ very broadly. This right means that the media and others can be prevented from interfering in your life. It also means that personal information about you (including official records, photographs, letters, diaries and medical records) should be kept securely and not shared without your permission, except in certain circumstances, such as to protect national security, protect public safety, protect the economy, protect health or morals, etc.

    When disclosing information about a patient you must:

    1. Use anonymised information if it is practicable to do so and if it will serve the purpose.

    2. Be satisfied the patient has access to information explaining how their personal information will be used for their own care or local clinical audit, and that they have the right to object.

    3. The patient has not objected.

    4. Get the patient’s explicit consent if identifiable information is to be disclosed for purposes other than their own care or local clinical audit, unless the disclosure is required by law or can be justified in the public interest.

    5. Keep disclosures to the minimum necessary for the purpose.

    6. Follow all relevant legal requirements, including the common law and data protection law, as in section 251 of the National Health Service Act 2006 (in force in England).

    The above was posted in one of the Sierra Leone chat forums.

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