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President Thabo Mbeki of South Africa last week fired his outspoken deputy minister of health, Nozizwe Madlala-Routledge. The sacking unleashed an unusually vigorous wave of support for her among opposition parties, trade unions, doctors, and AIDS activists as well as a torrent of criticism against the minister of health, Manto Tshabalala-Msimang, and the president.
Ms Madlala-Routledge had flown to an AIDS conference in Madrid in June, which Mr Mbeki says she did not have permission to attend. She told a radio station after being sacked that she had been invited to address the International AIDS Vaccine Initiative (IAVI) meeting and believed she had permission to go before leaving. When told she did not have permission she flew back to South Africa without delivering her speech.
Much of the criticism of the sacking has its background in the president's views on HIV and AIDS—he has questioned the link between the virus and AIDS (bmj.com, 14 Oct 2006, News Extra doi: 10.1136/bmj.333.7572.774-b). Dr Manto Tshabalala-Msimang has promulgated the president's view that eating certain vegetables would fight the disease effectively while downplaying the role of more conventional medicine.
The president, clearly stung by the level of support for the dismissed deputy, was eventually forced to release the letter of dismissal to her giving reasons for her firing. It referred to her previous stint as deputy minister of defence and said, in part, “I have, during the period you served as deputy minister of defence, consistently drawn your attention to the concerns raised by your colleagues about your inability to work as part of a collective, as the constitution enjoins us to.” It continued: “You travelled to Madrid despite the fact that I had declined your request to undertake this trip. It is clear to me that you have no intention to abide by the constitutional prescriptions that bind all of us.”
By the end of the week the unseemly spat found the government once more on the receiving end of international criticism for what seemed to many as evidence that the president's much ridiculed policies on HIV and AIDS would be revived.
The relationship between Dr Tshabalala-Msimang and her deputy was strained from the start of Ms Madlala-Routledge's tenure in 2004, but the problem became more visible to the public when the minister was taken ill and spent several months off work after a liver transplantation. Ms Madlala-Routledge has reportedly been urging a different and more conventional approach to the AIDS pandemic as a new policy and treatment protocols were put into place.
Ms Madlala-Routledge, however, continued to speak out on the AIDS problem. She took on the parlous state of public hospitals, with their high infection rates, largely blamed on ineffective policy. When a newspaper in the Eastern Cape town of East London published facts and figures from one hospital in the town, Frere Hospital, with a high mortality among newborn babies, she paid an unannounced visit to the hospital and described conditions there as a “national emergency.” After this incident, officials sent to the hospital by the health minister gave an “authorised” version of its conditions, and Dr Tshabalala-Msimang later said that its infant mortality was in line with national statistics.
Ms Madlala-Routledge has claimed that the visit to Frere Hospital had contributed to her dismissal, although Mr Mbeki did not refer to it in his letter.