Karabus saga raises wider issues
The founder of Red Cross
Children’s Hospital’s cancer unit in Cape Town, and respected
veteran of public paediatric oncology and haematology,
forcefully confined in the United Arab Emirates (UAE) –
including 57 days in jail – underwent a bewildering 9-month
trial (sans translator) for manslaughter
and forgery charges. He finally boarded a flight home in
mid-May after his acquittal, a failed State appeal and
painfully drawn-out bureaucratic return clearance procedures.
The charges related to his treatment of a 3-year-old Yemeni
patient, Sara Al Ajaily, for pancytopaenia (a leukaemia-linked
condition), at the Shiek Khalifa Medical Centre in Abu Dhabi.
The child died of a cerebral haemorrhage on 19 October
2002, and a grieving father and nurse together alleged – with
an ultimately gross lack of substantiation – that Karabus
failed to give her vital platelets and falsified the recording
of her platelet administration after her death. Totally
unaware that for 10 years he was regarded as a fugitive from
UAE justice, and convicted in absentia of manslaughter and
forgery and sentenced to 3 years in jail (plus a R250 000
fine), Karabus was en route home from his son’s wedding in
Canada when he was arrested at the Abu Dhabi International
Airport during an overnight stopover on 18 August last year.
The only prior inkling Karabus had that something might be
amiss was when he boarded the Emirates Airline plane in Canada
and ground staff told him there was an ‘alert’ on his
passport, but failed, or were unable, to elaborate. After
rapid liaison with his attorney in Cape Town and the deposit
of R1 million in legal surety, a UAE lawyer took on his case
and had the charges suspended – on condition he agree to a
Professor Cyril Karabus back at home with his wife Jen (photo by Fran van Rooyen).
SAMA waves the red flag
Dr Mark Sonderup, Vice-Chairperson of the South African Medical
Association (SAMA), which played hardball with the World Medical
Association (WMA) to secure an unprecedented resolution warning
healthcare workers off the UAE (SAMA called for a complete
economic and healthcare worker boycott of the UAE), says a core
issue was lost in the media frenzy. This was ‘the
criminalisation of medical practice anywhere’ (no automatic peer
review mechanism to deal with the multi-faceted medical
environment and complex nature of a job with ‘so many
variables’). Sonderup adds: ‘The automatic criminalisation of
any professional conduct is anathema to us. Even with our
challenged judicial system here, the first charge if a child
with advanced leukemia died from a cerebral bleed would not be
manslaughter – and certainly not in absentia. At least our
processes are correct (professional conduct hearings before the
Health Professions Council (HPCSA)’s relevant professional body
– which can forward the outcome of its hearings for criminal
investigation if deemed necessary.’ Sonderup says that, for the
UAE, whose healthcare workforce is 93% foreign, ‘to behave with
such impunity (in the face of a global outcry from human rights
and healthcare organisations) is either completely stupid or
completely arrogant – if you’re dependent on the rest of the
world to run you, you can’t behave like that’.
Boycott ‘selective and emotional’ – ethicist
The SAMA boycott kicked in with the UAE-linked Africa Healthcare tradeshow in Gauteng from 6 - 8 May this year, with local healthcare regulators – the HPCSA withdrawing in solidarity. Some stakeholders argued this was inappropriate as the conference organisers were Swiss-based. One of the most vociferous critics of the conference boycott was Professor Sylvester Chima, Head of Bio and Research Ethics and Medical Law at the Health Sciences Faculty, University of KwaZulu-Natal in Durban. He charged that SAMA doctors were ‘being unethical, misinformed, misguided and therefore becoming emotional, unprofessional and applying double standards with or without being aware of it.’ Chima said that none of the many big South African companies doing business in Dubai had ‘been instructed or told to get involved in trying to secure the release of Cyril Karabus; neither have their businesses been boycotted’. He said pressure should be applied ‘across the board, not against one organisation which is simply carrying out its business like everyone else’. ‘It will be a dark day for all if justice is allowed to be applied unequally, so that if you are a famous doctor and have friends in high places, then your case should be tried quickly without regards to due process, while if you are poor, or perhaps a sick child with cancer, then neither you nor your parents should be given all the benefits provided for in law, including the rights of appeal’.
SAMA responded that the Karabus case was one of several
involving healthcare professionals in the UAE, and repeating
that the conference was organised from Dubai. Calling Chima’s
remarks ‘startling, coming from an ethicist,’ it said his
comments showed he was out of touch with the realities of the
case, especially the global outcry from the WMA, the BMA, the
AMA (who complained to Secretary of State John Kerry), Amnesty
International, Human Rights Watch and several others.
Compassionate colleagues transcend culture/religion
Two of several Muslim doctors outraged by the UAE’s behaviour inadvertently fell under the media spotlight in their bids to help Karabus. Dr Asad Bhorat, a Soweto GP, walked out of the Africa Healthcare Conference where he was chairing a programme after the organisers refused to allow him to put a motion to the floor condemning the UAE’s treatment of Karabus.
Having originally helped to prepare the programme for the Family Practitioners section of the conference, Bhorat had just returned from a Gift of the Givers charity mission to war-torn Syria and was totally unaware of the boycott controversy. He told Izindaba that on learning of the boycott and with the organisers ‘adamant’ that they were Swiss-based with no UAE links, he ‘decided to test them’ by proposing his motion. ‘They absolutely refused me permission, which pretty much exposed their interests, so I pulled out,’ he said.
The other was
philanthropist and founder of the Sekunjalo Group, Dr Iqbal
Surve, whose historical business ties with the UAE Royal
Family ultimately speeded up Karabus’ acquittal and the
grindingly slow bureaucracy clearing him to fly home. Surve
flew twice to Abu Dhabi, the first time meeting with the Royal
Family as part of a 3-person SA business delegation to
complain about the 7-month inaction of the court’s medical
advisory committee (the committee met the next day and
exonerated Karabus, resulting in his acquittal the following
day). The second time was after the court dismissed an appeal
by a seemingly obdurate prosecution which then dragged its
heels in providing a written undertaking that it would not
appeal a second time, effectively delaying his return by 2
extra months. Izindaba sources said Surve’s second
royal supplication followed Karabus’ frustrated criticism of
the UAE in a television interview that led to a fierce
internal debate among the country’s political ‘hawks and
doves,’ the former arguing for ‘full application of the law
(i.e. a second appeal)’ and the latter (read: top Royal Family
members) pleading for compassion.
Dr Iqbal Surve.
A life interrupted – wrapping up unfinished business
Karabus, back in his Kenilworth home with his relieved but
still-outraged wife Jen, was looking forward to the simple
pleasures: ‘gardening, walking on the mountain and doing the odd
(local) locum, if it’s on offer’. With a local State pension of
R15 000 per month, he’s putting off a decision on suing either
the UAE or the hospital owners in favour of full recuperation,
going for a check-up with his cardiologist (he has a stent and
pacemaker), filling in his taxes and ‘doing right’ by his
erstwhile UAE host of 7 months and compatriot, urologist Elwyn
Buchel. He still has to ‘balance the books’ on R1 million in
outstanding legal, transport and logistical costs. An
international fund-raising appeal and 2 of his children bonding
their homes paid the initial legal bills of another R1 million.
How much the fund will ultimately mitigate his financial worries
(his 2002 UAE locum was meant to supplement his meagre State
pension), only time and his paediatrician/fund-manager and
daughter, Sarah, will eventually tell.
S Afr Med J 2013;103(7):442-443.
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