WPC  #<mdFծ)͍$ Á[ y#IWQxTLLe)V6QͅYY\(z [9 oPS-oHQ(kCno,:R}G-GORQa]"B:WJ|ƴu;ySg6b22ԭh09[8[6U*# RRX%ѻqIվOUvj2'D W!;}d2' ;<t '?>kwWWػO]-9:`J~zC0|㰀-t^'3r죓SzɃE@`BFΚT"Applicants   and MINISTEROFHEALTHANDOTHERS ="Respondents  A& ) xdEbA  @ a AFFIDAVIT:PROFPACOOPER  H A& ) xdEDbA E  I    theundersigned@{{ a PETERALLANCOOPER ["*  herebymakeoathandsay: U% .              j"   j"2DD  1  3  0    Ihavepreviouslymadeanaffidavitinthismatter.j" ݌)%%4"" Ќ   j"   j"2DD  2  3  0    IwishtoreplyasfollowstothosepartsoftheaffidavitofDrAyandaNtsaluba ,%(8 whichdealwiththeaffidavitwhichIpreviouslymade.j"݌ "" Ќ   /%+<   Adpara212  d  j"   j"s 2DD  3  3  0    Itisindeedwithinmypersonalknowledgeandexpertise,gainedasaProfessorof a  PaediatricsandSecretaryoftheSouthAfricanPaediatricAssociation,thatobstetriciansandpaediatriciansintheprivatesectornowregularlyprescribeNevirapineforpregnantwomenwithHIVandtheirinfants,whenintheirviewthisisclinicallyindicated.j"s ݌ "" Ќ   j"   j" 2DD  4  3  0    Itwouldbeverysurprisingiftheydidnotdoso,giventhatintrapartum a  transmissionofHIVcarriesahighriskofleadingtodeath,andNevirapineisaninexpensivemeansofpreventingorreducingintrapartumtransmission.j" ݌ "" Ќ   j"   j"Q 2DD  5  3  0    Thisisamatterwhichisregularlydiscussedatprofessionalmeetingsof a paediatricians.j"Q | ݌ "" Ќ  Adpara213  }  j"   j"2DD  6  3  0    AsIhavesaid,thisisamatterwithintheexperienceoftheExecutiveCommittee z" ofSAPA,whichrepresentsabouthalfofthepaediatriciansinSouthAfrica,includingmanypaediatriciansinthepublicsector.j"݌ "" Ќ   j"   j"H2DD  7  3  0    Itisalsowithinmypersonalknowledge,fromdiscussionsandmeetingswith %z* colleaguesattheJohannesburghospitalandatotherhospitals,thatmanyofthemwishtoprescribeNevirapinefortheirpatients.j"Hs݌ "" Ќ  Adpara216  +z%2  j"   j"2DD  8  3  0    Myaccountofwhatmedicalpractitionersinthepublichealthsectoraredoingis .w(6 derivedfrommyownexperienceasaspecialistpaediatricianinthatsector,my [0)8 knowledgeandexpertiseasProfessorofPaediatrics,myknowledgeandexpertiseacquiredthroughmyworkassecretaryoftheSAPaediatricsAssociation,andmeetingsanddiscussionswithprofessionalcolleagues.j"<݌ "" Ќ   j"   j"m2DD  9  3  0    The  obstetriciansandpaediatricians      at    theJohannesburgHospitalwishedto d  prescribeNevirapinefortheirpatients,topreventintrapartumtransmissionofHIV,  where    intheirprofessionaljudgmentthiswasmedicallyindicated.Wewishedtodothisbecauseofthepotentiallylifesavingqualityofthismedicine.j"m݌ "" Ќ   j"   j"2DD  10  3  0    However,theGautengHealthDepartmentrefusedtomakeNevirapineavailable   totheJohannesburgHospital.j"݌ "" Ќ   j"   j"2DD  11  3  0     The    packagingsystemforNevirapine(andinparticularthesuspensionwhichis d requiredforthebabies)issuchthatitis  generallynot    possibletoobtainsingledosesthroughpharmacies.  Most    ofourpatientsarepoor,and  could    notaffordtobuythemedicineforthemselvesinthe  volumes    inwhichitisavailablefrom  pharmacies.  j"B݌ "" Ќ   j"   j"2DD  12  3  0    WewerefortunatethattheAnglicanChurchcametoourrescue,andtotherescue d!$ ofourpatients.TheAnglicanChurchmadeadonationtoenableusto  provide    Nevirapine  to    ourpatients.We  prescribed    itandadministereditwheninourprofessional  judgment,aftervoluntarytestingandcounsellinghadbeencarriedout,    thiswasmedicallyindicatedunderallofthecircumstances.j"݌ "" Ќ   j"   j"2DD  13  3  0    Wedidthisonthebasisthatourprofessionalethicsrequiredustodoso.Itwas d*$0 inthebestinterestsofourpatients.j"݌ ""    d-'4  j"   j".2DD  14  3  0    Since  1October  2001,theGautengHealthDepartmenthasmadeNevirapine  tothe   d JohannesburgHospital.Itisthereforenolongernecessaryforusorourpatientstorelyondonations.j".Y݌ ""    j"   j" 2DD  15  3  0    ThepaediatriciansattheJohannesburgHospitalarecontinuing,asbefore,to d  prescribeandadministerNevirapinewheninourprofessional  judgment    thisismedicallyindicatedunderallofthecircumstances.Asbefore,wedothiswhereinourprofessionaljudgmentitisinthebestinterestsofourpatients.j" !݌ "" Ќ   j"   j"#2DD  16  3  0    ThepaediatriciansintheDepartmentarefullyabletoexerciseaproper   professionaljudgmentastowhenNevirapineshouldbeprescribedandadministered.j"#E#݌ "" Ќ   j"   j"$2DD  17  3  0     Wewere    abletomakethesameprofessionaljudgmentwhenwewererelianton  donationsfromtheAnglicanChurch.j"$$݌ "" Ќ   j"   j"%2DD  18  3  0    TheJohannesburgHospital  has    notbeengivenanyadditionalstaffresourcessince d  theGautengHealthDepartmentdecidedtomakeNevirapineavailableattheJohannesburg  Hospital.Iamawarethatatsomeofthepilotsites,arrangementshavebeenmadeforvolunteerstoassistwithcounselling.ThiswasnotnecessaryinthecaseoftheJohannesburgHospital,becausewewerealreadydoingthiswithourexistingstaff.    j"%&݌ "" Ќ   j"   j"(2DD  19  3  0    IdonotbelievethatwhenwehaveprescribedoradministeredNevirapineforour (". patients,wehaveacted  irresponsibly.    Wehaveactedinamannerwhichourpatientsandourprofessionalethicsrequireofus.ThisappliesbothtotheperiodwhentheGautengHealthDepartmentrefusedtomakeNevirapineavailabletotheJohannesburgHospital,andafteritdecidedtodo  so.    j"((݌ "" Ќ   d0*8  Adpara218  d  j"   j"i+2DD  20  3  0    OnthebasisoftheknowledgeandexperiencewhichIhavedescribedabove,Ican a  saywithcompleteconfidencethatverymanymedicalpractitionersinthepublichealthsectorwouldwelcomebeinggiventheopportunitytoprescribeandadministerNevirapinewhereintheiropinionthisismedicallyindicated.Theywouldnotregardthisasaburden.Onthecontrary,theywouldwelcomethisasanopportunitytogivetheirpatientsthetreatmentwhichtheyneed.j"i++݌ "" Ќ   0  0` ""0 ` "` "0 " "0h""0h"h"0""򀀀}"" 0  0` ""0 ` "` "0 " "0h""0h"h"0"" PETERCOOPERa""     SIGNEDANDSWORNTOBEFOREMEATJOHANNESBURGONNOVEMBER2001,THEDEPONENTHAVINGTAKENTHEOATHINTHEPRESCRIBEDMANNER/0  0` ""0 ` "` "0 " "0h""0h"h"0""򀀀^$'"" Л//////^$'"" 0  0` ""0 ` "` "0 " "0h""0h"h"0""   COMMISSIONER  OFOATHS