Section: Science Life
Chloramphenicol controversy between the WHO and Beat Richner|
Antibiotics with secondary effects
Beat Richner, alias "Beatocello", physician from Zurich, fights for the children in his hospitals in Cambodia, a country torn apart by civil war and against international organisations. Starting with the antibiotic chloramphenicol an ETH student examined the work of the paediatrician in her diploma thesis. Her conclusion is that Richner offers unique medical assistance but that it is neither sustainable nor adapted to the economic reality of the country.
By Christoph Meier
"Beat Richner is finished" was the headline in "Blick", Switzerlands leading tabloid, at the beginning of March this year. The hospital of the paediatrician and music clown Beat Richner, alias "Beatocello", in Phnom Penh, Cambodia, was being destroyed by termites and donations were urgently needed to save the life's work of the citizen voted "Swiss of the Year 2003", the paper went on to say. In the meantime a charity drive has been set up, supported by a number of public figures and newspapers in order to ward off the eminent closure of the hospital conjured up by the appeal. Owing to Richner's wide popularity it is quite likely that the drive will raise the required sum of 40 million Swiss francs.
But what will happen eventually, when the paediatrician can no longer drum up funds himself? It would probably ring the knell of Richner's project, thinks Martina Furrer. Furrer, who is studying pharmaceutical sciences at ETH, reaches this conclusion in her recently published (SGGP series (1)) diploma thesis on the subject of Richner's work in Cambodia. The point of departure for the thesis, which she wrote following impetus from Georg Schönbächler from the team around ETH Professor Gerd Folkers, was the controversy surrounding chloramphenicol, an antibiotic.
Chloramphenicol was isolated in the middle of the 20th century and produced synthetically soon after. Owing to low production costs, its broad spectrum and other positive characteristics this drug came to be prescribed for numerous diseases. It quickly became clear, however, that it can also causes serious secondary effects. It disappeared from the pharmaceutical markets in Europe and the USA. Following the problems posed by antibiotic resistance in the 1970s chloramphenicol gained significance once again. The World Health Organisation (WHO) assigned the substance to the category of reserve antibiotics and put it on the list of "essential Drugs". This means that chloramphenicol is prescribed to a majority of the populations in developing countries.
"Crime against humanity"
This policy of WHO's is a thorn in the side of Beat Richner. For more than ten years he has voiced his criticism of this organisation, but also of UNICEF, with newspaper advertisements, amongst other things. In 1999 he brought an action against the United Nations organisations WHO and UNICEF before the International Court for Human Rights in Den Haag, as well as against numerous non-governmental organisations (NGOs) and private citizens citing crimes against humanity and the violation of the Children's Charter. In the indictment Richner also reproaches the international organisations for not reacting to the Japanese encephalitis virus and said that UN-soldiers were responsible for the AIDS epidemic in Cambodia.
In an interview with Martina Furrer Richner pointed out that chloramphenicol is still being used in the Asian country even though resistance to less dangerous, alternative drugs rarely occurs, especially amongst children. Asked about the work WHO and UNICEF do in Cambodia he said, "As far as pharmaceuticals are concerned, it's a catastrophe for the children." The consequence that "Beatocello" drew from this is that he cannot work together with the aid organisations who "don't do anything worthwhile", including NGOs.
Big problems in the private sector
According to statistics from the Central Medical Store, the responsible body for the distribution of medication to public health facilities in Cambodia, Furrer concludes that chloramphenicol represents more than a reserve antibiotic in Cambodia. She was told, by a representative of the aid organisation "Care", that chloramphenicol is the drug of choice when it comes to treating injuries.
But after all her research the biggest problem regarding the antibiotic for the ETH student is not in the public health sector, which is advised by the WHO, but in the unmonitored private market for drugs. In addition Furrer learned that a host of counterfeit drugs also had to be taken into the equation.
In her investigations on the perilousness of chloramphenicol Furrer was confronted with wide fluctuations in the respective studies carried out on the drug. In many cases it wasn't clear whether the perceived health problems can be aetiologically connected with the antibiotic. This also seemed to be true in the studies into the secondary effects of chloramphenicol that Richner himself had documented. In response to her request to the paediatrician to be given access to other studies on the resistance to chloramphenicol the ETH student had to content herself with an oral assurance and the statement that the laboratories in his hospitals were very well equipped.
Split opinions on development aid
In talks with representatives from the WHO and an NGO, for instance, Furrer ascertained that the bitter controversy was not exclusively about the diversity in handling chloramphenicol but also that very different conceptions of humanitarian aid clash head-on. On one side stands Richner, who offers a unique medical care. In hospitals, kitted out with modern infrastructures, children are treated free of charge. Thanks to the good salaries paid to the employees there seemed to be hardly any trouble with corruption. Richner's project is financed exclusively by donations.
Many NGOs also depend on donations, but, like the WHO, they stipulate and foster projects that are integrated within the structures of the given country, which, eventually, can finance the projects themselves. In her thesis Furrer points out that very few development projects can work without financial support. But she believes that when all is said and done, projects that focus on sustainability make better sense in the long run that Richner's. The pediatrician counters this with: "For these children who we are saving now it doesn't matter whether the project will still be running in two years' time or not. Sustainability, from the point of view of the individual, is nonsense."
Controversial basic medicine
As valuable as the children's lives who have been saved are, Furrer says that one shouldn't let this blind one to the fact that it is not possible to implement medical treatment in Richner's style in hospitals all over Cambodia. The ETH student is of the opinion that the polemical character of statements, such as "If one can bomb the surface of a country on a wide scale, with far, far less money one can realise wide scale provisions," should not lead to a situation where the provision of basic medical services are hindered. Such a provision should be able to protect people from falling ill in the first place, for example by educating them about the dangers of contaminated drinking water. But Richner was opposed to basic medicine as "medicine for poor people". Furrer finds it especially problematic when "Beatocello" builds a children's hospital in places where children's wards are plannedin public hospitals. And she cannot reconcile herself to the fact that the paediatrician diffuses his own, unconfirmed, theories on the Japanese encephalitis virus and tuberculosis.
Asked whether she would still donate to Richner's project after her work on the chloramphenicol controversy, Furrer says, "No". The main reason was the lacking sustainability of the hospitals. In addition she was disappointed by a certain benefice campaign of Richner's, which she witnessed in Cambodia. What "Beatocello" offered to the tourists there hardly came up to the standards that people in the western world would expect from such an event.
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