Ngaba Lisisipho Sobomi Okanye Lingunobangela Wokufa?
“Bangaphi abantu abamele bafe? Zingaphi izidumbu ozifunayo? Khawusiqinisekise ngezidumbu ozifunayo ukuze ukholelwe ukuba oku kuyenzeka.”
UDON FRANCIS, igosa leCDC (amaZiko Okuthintela Izifo aseUnited States), wabetha ngenqindi phantsi njengoko wayevakalisa la mazwi angasentla kwintlanganiso yabameli abaphambili bamashishini eendawo ekugcinwa kuzo igazi. ICDC yayizama ukubaqinisekisa abo basebenza kwiindawo ekugcinwa kuzo igazi ukuba uGawulayo wayesasazeka ngegazi elidluliselwa ebantwini beli lizwe.
Abo basebenza kwiindawo ekugcinwa kuzo igazi abazange beyiseke koku. Bathi obu bungqina babungaqinanga—le yayiyinto nje eyenzeke kwiimeko ezimbalwa—baza bagqiba kwelokuba bangabi ngqongqo ngakumbi kuvavanyo okanye kuhlolisiso lwegazi. Oku kwenzeka ngoJanuwari 4, 1983. Kwiinyanga ezintandathu kamva, umongameli woMbutho WaseMerika Weendawo Ekugcinwa Kuzo Igazi wavakalisa oku: “Incinane ingozi ekhoyo okanye ayikho nje kwaphela kubantu ngokubanzi.”
Kwiingcali ezininzi, kwakusele kukho ubungqina obaneleyo bokuba kuthatyathwe amanye amanyathelo. Yaye ukususela ngoko, ‘iimeko ezimbalwa’ zokuqala ziye zanda ngokoyikekayo. Ngaphambi kowe-1958, kunokwenzeka ukuba abantu abangama-24 000 batofelwa igazi elalingcoliswe yiHIV (Human Immunodeficiency Virus), ebangela uGawulayo.
Igazi elingcolileyo liyindlela eqiniseke gqitha yokusasaza intsholongwane kaGawulayo. Ngokutsho kweThe New England Journal of Medicine (kaDisemba 14, 1989), isixa esinye segazi sisenokuthwala iintsholongwane ezaneleyo ukwasulela abantu abasisigidi esisisi-1,75! ICDC yaxelela uVukani! ukuba ngoJuni 1990, kwiUnited States kuphela, abantu abangama-3 506 babesele benoGawulayo abamzuze ngenxa yokutofelwa igazi, iinxalenye zegazi, noqhaqho-fakelo lwamalungu athile.
Kodwa lawo ngamanani nje kuphela. Awanako ukuqalisa ukubonakalisa ubunzulu beentlekele zobuqu ezibandakanyekileyo. Ngokomzekelo, qwalasela intlekele eyehlela uFrances Borchelt, owayeneminyaka engama-71 ubudala. Engaguquki waxelela oogqirha ukuba wayengafuni ukutofelwa gazi. Sekunjalo watofelwa. Wafa ngokungcungcuthekisayo ngenxa kaGawulayo njengoko intsapho yakhe yayibukele ingenanto inokumnceda ngayo.
Okanye khawucinge ngentlekele eyehlela intombazana eyayineminyaka eli-17 ubudala eyathi, ngenxa yokopha gqitha ngoxa yayisexesheni, yanikwa izixa ezibini zegazi ukuze nje incedwe koko kungabi nagazi kwaneleyo kwayo. Xa yayineminyaka eli-19 ubudala kwaye ikhulelwe, yafumanisa ukuba utofelo-gazi lwaludlulisele kuyo intsholongwane kaGawulayo. Kubudala beminyaka engama-22 yagula ngenxa kaGawulayo. Ngaphandle kokwazi ukuba kungekudala yayiza kufa ngenxa kaGawulayo, yasala izibuza enoba yayingasidluliselanga kusini na esi sifo kusana lwayo. Iintlekele ezilolu hlobo ziqhubeka zisenzeka ukususela kwiintsana ukusa kwabakhulileyo, ehlabathini lonke.
Ngowe-1987 incwadi ethi Autologous and Directed Blood Programs yavakalisa intlungu yokuba: “Phantse ukuba akuba amaqela okuqala asengozini ecacile, kwenzeka okungacingelekanga: ubungqina bokuba esi sifo [uGawulayo] sasiza kubulala ngamandla babunokudluliselwa kwaye badluliselwa ligazi elalizuzwe kwabo babelinikele ngokuzithandela. Lo ngumphumo weyona mibi kuyo yonke imiphumo eyintlekele yezamayeza; ukuba isipho esixabisekileyo esinik’ ubomi segazi sibe sinokuguqukela ekubeni sisixhobo sokubulala.”
Kwanamayeza enziwa ngesiyilelo esi, aye anegalelo ekusisasazeni esi sifo siyingozi ehlabathini jikelele. Abantu abanesifo sokopha gqitha, inkoliso yabo esebenzise unyango lokuthintela oku olwenziwe ngesiyilelo ukunyanga ukugula kwabo, yathi yafa. EUnited States, abaphakathi kwama-60 nama-90 ekhulwini bafumana uGawulayo ngaphambi kokuba kusekwe inkqubo yokuba lisetyenzwe ukuze kupheliswe iHIV.
Sekunjalo, ukuza kuthi ga kulo mhla, igazi alikhuselekanga kuGawulayo. Ibe uGawulayo asikuphela kwengozi efumaneka ngotofelo-gazi. Akunjalo konke konke.
Iingozi Ezibangela Ukuba UGawulayo Abonakale Eyinto Encinane
UGqr. Charles Huggins wathi ngegazi, “Liyeyona nto iyingozi siyisebenzisayo kwezamayeza.” Ufanele azi; ungumalathisi kwisebe lotofelo-gazi kwisibhedlele saseMassachusetts. Abaninzi bacinga ukuba utofelo-gazi lulula njengokufumana othile onohlobo lwegazi olufanayo nolwakho. Kodwa ngaphandle nje kokufumana uhlobo lweABO nolweRh factor nto ezo elithi igazi ngokuqhelekileyo lithelekiswe ngazo, kusenokubakho izinto ezingama-400 okanye ezimalunga noko ezahlukeneyo elingenakungqinelana kuzo. Kunjengokuba ugqirha wotyando kwizinto eziphathelele intliziyo nemithambo yegazi uDenton Cooley esithi: “Utofelo-gazi lukukufakelwa kwelungu elithile. . . . Ndicinga ukuba kukho ukungangqinelani okuqinisekileyo phantse kulo lonke utofelo-gazi.”
Akumangalisi ukuba omnye ugqirha ekubeka ngokuthi, ukutofela into entsonkothe ngolo hlobo ‘kusenokuyidida’ inkqubo yomntu yokukhusela ukwasulelwa zizifo ezithile. Enyanisweni, utofelo-gazi lunokuyenza ingasebenzi kangangonyaka inkqubo yomntu ethintela ukwasulelwa zizifo ezithile. Kwabathile, le yeyona nkalo isongelayo kutofelo-gazi.
Kwandula ke kubekho nezifo ezasulelayo. Zinamagama angaqhelekanga, anjengesifo esiyiChagas necytomegalovirus. Imiphumo isusela kumkhuhlane neengqele ukusa ekufeni. UGqr. Joseph Feldschuh weYunivesithi Yezamayeza iCornell uthi umntu omnye kwabalishumi abatofelwa igazi kusenokwenzeka ukuba afumane uhlobo oluthile lwesifo. Oku kunjengokudlala umdlalo oyiroulette waseRashiya odlalwa ngevolovolo eneendawo zokufaka iimbumbulu ezilishumi. Uhlolisiso lwakutshanje lukwabonise ukuba utofelo-gazi ebudeni botyando lomhlaza ngokwenyaniso lusenokuyandisa ingozi yokuphinda ube nomhlaza.
Alithandabuzeki elokuba inkqubo yeendaba kamabonwakude isithi utofelo-gazi belunokuba ngowona mqobo mkhulu othintela ukuba uphile kolo tyando. Isifo sesibindi sasulela amakhulu amawaka kwaye sibulala abantu abaninzi ngakumbi abamkela utofelo-gazi kunokuba esenjenjalo uGawulayo, kodwa asaziwa kangako ngabantu. Akukho bani ulaziyo inani labo bafayo, kodwa ingcali kwezoqoqosho uRoss Eckert ithi lisenokulingana nelo likwinqwelo-moya eyiDC-10 ezele ngabantu newa nyanga zonke.
Ingozi Neendawo Ekugcinwa Kuzo Igazi
Iindawo ekugcinwa kuzo igazi ziye zasabela njani ekubhencweni kwazo zonke iingozi zemveliso yazo? Azisabelanga kakuhle, abagxeki babonisa njalo. Ngowe-1988 iReport of the Presidential Commission on the Human Immunodeficiency Virus Epidemic yayibek’ ityala amashishini “ngokucotha ngokungeyomfuneko” ekubonakaliseni intsabelo kwisisongelo sikaGawulayo. Iindawo ekugcinwa kuzo igazi zaye zabongozwa ukuba zingabakhuthazi abo kunokwenzeka ngakumbi ukuba babe banoGawulayo ukuba banikele ngegazi. Zaye zabongozwa ukuba zilihlolisise igazi, zikhangelisise imiqondiso enokubonisa ukuba lisuka kwabo abasenokuba banoGawulayo. Iindawo ekugcinwa kuzo igazi zazilazila. Zazibetha ngoyaba ezi ngozi njengento engekhoyo. Kutheni kunjalo nje?
Kwincwadi yakhe ethi And the Band Played On, uRandy Shilts uthi bambi kubantu abagcina igazi baluchasa uhlolisiso oluqatha “phantse ngenxa nje yemicimbi engokwemali. Nangona oku kuqhutywa ubukhulu becala ziintlangano ezingafanele zibe nangeniso ezinjengombutho Womnqamlezo Obomvu, ushishino lwegazi luthetha ngemali eninzi efikelela minyaka le [kwiirandi ezisi-2,6 samawaka ezigidi]. Ushishino lwazo olwenza kufumaneke igazi elitofelwa kubantu abazizigidi ezi-3,5 ngonyaka lwalusongelwa.”
Ngaphezu koko, ekubeni iindawo ekugcinwa kuzo igazi ezingenangeniso zixhomekeke ngokukhulu gqitha kwabo banikela ngokuzithandela, azizange zifune ukona namnye wabo ngokungabavumeli abathile abasenokuba banoGawulayo, ngokukodwa amafanasini. Abameli bamalungelo amafanasini balumkisa ngokungqongqo besithi ukuwalela ukuba anikezele ngegazi bekuya kuba kukwaphula amalungelo awo asemthethweni yaye bekuya kuba kukubuyisa indlela yokucinga esikelwe umda yelinye ixesha.
Ukulahlekelwa ngabo banikezela ngegazi nokongeza iintlobo ezintsha zohlolisiso nako bekuya kudla imali engakumbi. Entwasahlobo yowe-1983, isebe Lendawo Ekugcinwa Kuyo Igazi kwiYunivesithi yaseStanford laba lelokuqala ukusebenzisa indlela entsha yokuhlola igazi endaweni yaleyo yangaphambili eyayinokubonisa enoba igazi lalivela kubantu abanikezela ngegazi nekunokwenzeka ukuba babe noGawulayo. Abantu bezinye indawo ekugcinwa kuzo igazi basigxeka eso senzo njengesiliqhinga lezorhwebo lokutsala abaguli abangakumbi. Uhlolisiso luyawanyusa amaxabiso. Kodwa kunjengokuba esinye isibini, olwathi usana lwaso lwatofelwa igazi singazi, sikubeka ngale ndlela oku: “Ngokuqinisekileyo ngesasihlawule [ii-R13] ezongezelelekileyo [ngesiqingatha selitha] ” ngenxa yolo vavanyo. Usana lwaso lwafa ngenxa kaGawulayo.
Indlela Yokuzikhusela
Zimbi iingcali zithi iindawo ekugcinwa kuzo igazi azisabeli ngokukhawuleza kwiingozi zegazi ngenxa yokuba kungekho mfuneko yokuba ziphendule ngenxa yemiphumo yokusilela kwazo. Ngokomzekelo, ngokutsho kwengxelo eyayikwiThe Philadelphia Inquirer, iFDA (uMbutho Wokutya Neziyobisi waseUnited States) inembopheleleko yokubona ukuba iindawo ekugcinwa kuzo igazi zisemgangathweni, kodwa ubukhulu becala ijonge kwakwezo ndawo kugcinwa kuzo igazi ukuba zimisele loo mgangatho. Kwaye wambi kumagosa eFDA ayeziinkokeli kushishino lwegazi. Ngaloo ndlela, ukuhlolwa ngokuthe rhoqo kweendawo ekugcinwa kuzo igazi ngokwenene kwancipha njengoko kwathi kwavela iingxaki eziphathelele uGawulayo!
Iindawo ekugcinwa kuzo igazi zaseUnited States nazo ziye zaphembelela ukuba kuwiswe umthetho ozikhuselayo ekumangalelweni. Phantse kuwo onke amazwe, ngoku umthetho uthi ukudluliselwa kwegazi kuyinkonzo nje eyenziwayo, kungekhona ukuthengiswa kwemveliso ethile. Oku kuthetha ukuba umntu omangalela indawo ekugcinwa kuyo igazi umele anikele ubungqina ngokungakhathali kwezi ndawo ziligcinayo—umqobo onzima ngokwasemthethweni ke lowo. Imithetho enjalo isenokuzikhusela ngakumbi iindawo ekugcinwa kuzo igazi kwezi zimangalo, kodwa loo nto ayenzi ukuba igazi libe lelikhuseleke ngakumbi kubaguli.
Ngokwendlela ingcali kwezoqoqosho uRoss Eckert eqiqa ngayo, ukuba iindawo ekugcinwa kuzo igazi bezinembopheleleko ngegazi ezirhweba ngalo, beziya kwenza okungakumbi ukuqinisekisa ukuba elo gazi lisemgangathweni. Owayesakuba ngumsébenzi kwindawo ekugcinwa kuyo igazi ngoku odla umhlala-phantsi uAaron Kellner uyavuma esithi: “Ngekroba nje elincinane elivulwe ngumthetho, igazi laba kukunikelwa nje kwenkonzo ethile. Wonke umntu waqalisa ukungakhathali, oko kukuthi, wonke umntu ngaphandle kwexhoba elingenatyala, umguli.” Wongezelela ngelithi: “Ubuncinane sasinokubaxelela abantu ngeengozi zoku, kodwa asizange senjenjalo. Ekubeni sasixhalabele oko kwakunokusilahlekela; ucinga ukuba yintoni esasiyixhalabela ngomguli?”
Asinakuphetshwa isigqibo esisesi. Urhwebo olwenziwa ziindawo ekugcinwa kuzo igazi lunomdla ngokungakumbi gqitha ekukhuseleni lona ngokwasemalini kunokukhusela abantu kwiingozi zemveliso yalo. Bambi basenokuqiqa ngale ndlela, ‘Kodwa ngaba zonke ezi ngozi ngokwenene zinomsebenzi, ukuba igazi likuphela konyango ngokunokwenzeka olunokusetyenziswa ukusindisa ubomi? Ngaba iingenelo azizigqwesi iingozi?’ Le yimibuzo emihle. Kanye kanye ngaba kuyimfuneko kangakanani ukuba abantu batofelwe igazi?
[Amagama acatshulweyo akwiphepha 9]
Oogqirha benza konke abanokukwenza bezikhusela kwigazi labo babanyangayo. Kodwa ngaba abaguli bakhuselwa ngokwaneleyo kwigazi elitofelwayo?
[Ibhokisi/Umfanekiso okwiphepha 8, 9]
Ngaba Igazi Likhuselekile KuGawulayo Namhlanje?
“EZI Ziindaba Ezimangalisayo,” wawusitsho njalo umxholo wenqaku eliphambili elalikwiphephandaba laseNew York iDaily News kaOktobha 5, 1989. Eli nqaku lanikela ingxelo yokuba ngumntu omnye kwabangama-28 000 osenokufumana uGawulayo ngokutofelwa igazi. Kuthiwa inkqubo yokuthintela le ntsholongwane ingangeni kwigazi eligcinwayo, ngoku iphumelela kangangama-99,9 ekhulwini.
Inkolo efanayo inempembelelo kurhwebo olwenziwa ziindawo ekugcinwa kuzo igazi. Bathi, ‘Igazi eligciniweyo likhuseleke ngakumbi kunanini na ngaphambili.’ Umongameli Wombutho waseMerika Weendawo Ekugcinwa Kuzo Igazi wathi ingozi yokufumana uGawulayo ngegazi “phantse ibe yapheliswa.” Kodwa ukuba igazi likhuselekile, kutheni iinkundla noogqirha xa bethetha ngalo besebenzisa amabinzana anjengelithi “liyingozi” nelithi “alikhuselekanga ngokungaphephekiyo”? Kutheni bambi oogqirha betyanda benxibe into efana nesuti enxitywa ngoosomajukujuku nje, bafihle ubuso ngesigqubuthelo sabo baze bafake nezihlangu zerabha, konke oko bekwenzela ukuphepha ukuzidibanisa negazi? Kutheni izibhedlele ezininzi kangaka zicela abaguli ukuba batyobele ifomu ekhulula isibhedlele kwityala lemiphumo eyenzakalisayo yotofelo-gazi? Ngaba ngokwenene igazi likhuselekile kwizifo ezinjengoGawulayo?
Ukukhuseleka kwalo kuxhomekeke kwizinto ezimbini ezisetyenziselwa ukukhusela igazi: Ukuxilongwa kwalowo unikezela ngalo nokuxilongwa kwegazi ngokwalo. Uphando lwakutshanje luye lwabonisa ukuba phezu kwayo nje yonke imigudu yokuxilonga abo banikezela ngegazi abaphila ngendlela ebabeka esichengeni sokufumana uGawulayo, kusekho abasindayo xa bexilongwa. Banikela iimpendulo ezingachananga kulowo ubabuzayo baze banikezele ngegazi. Bambi bafuna nje ukufumanisa ngobulumko ukuba basulelekile kusini na.
Ngowe-1985 iindawo ekugcinwa kuzo igazi zaqalisa ukuvavanya igazi ukuze zifumanise ubukho bezinto ezilwa neentlungu zomzimba eziveliswa ngumzimba ukulwisana nentsholongwane kaGawulayo. Ingxaki ngolu vavanyo ikukuba umntu usenokwasulelwa yintsholongwane kaGawulayo kuze kudlule ithuba elithile ngaphambi kokuvelisa naziphi na izinto ezilwa neentlungu zomzimba ebeziya kufunyaniswa kolo vavanyo. Eli kroba libalulekileyo libizwa ngokuba lithuba elivulekileyo (window period).
Imbono yokuba kukho ithuba elinye kwangama- 28 000 lokufumana uGawulayo ngokutofelwa igazi ivela kwingxelo eyapapashwa kwiThe New England Journal of Medicine. Elo phephancwadi limisela ithuba elivulelekileyo elinokubakho njengelisenokuba ziiveki ezisibhozo. Noko ke, kwiinyanga nje ngaphambili, ngoJuni 1989, lo lindixesha ukwamnye wapapasha ingxelo equkumbela ngelokuba ithuba elivulekileyo linokuba lelidana ngakumbi—iminyaka emithathu okanye ngaphezulu. Le ngxelo ichazwe ngaphambilana yacebisa ukuba loo mathuba made avulekileyo asenokuba ngaqheleke ngakumbi kunendlela ekwakha kwacingwa ngayo, yaye yathelekelela ukuba, okubi ngakumbi kukuba, abanye abantu abasulelekileyo basenokungaze bavelise izinto ezilwa neentlungu ezisemzimbeni eziza kulwisana nale ntsholongwane! Noko ke, ingxelo egqibelele ngakumbi, ayizange ivisisane nezi zinto zafunyaniswayo, izibiza ngokuba zizinto “ezingaqondwa kakuhle.”
Alimangalisi elokuba uGqr. Cory SerVass weBhunga LasebuRhulumenteni Eliphanda ngoGawulayo wathi: “Iindawo ekugcinwa kuzo igazi zisenokuqhubeka zixelela abantu ukuba igazi eligcinwayo likhuseleke gqitha, kodwa abantu abasakukholelwa oko kuba bakufumanisa kungeyonyaniso.”
[Inkcazelo]
CDC, Atlanta, Ga.
[Ibhokisi ekwiphepha 11]
Igazi Elitofelweyo Nomhlaza
Izazinzulu zifumanisa ukuba igazi elitofelwayo linokuyenza buthathaka inkqubo yomzimba yokuzikhusela kwizifo ezithile nokuba ukuba buthathaka kwale nkqubo yomzimba yokuzikhusela kusenokuwanciphisa amathuba okusinda kwabo baye batyandwa ngenxa yomhlaza. Kwinkupho yakhe kaFebruwari 15, 1987, ulindixesha iCancer unikela ingxelo ngohlolisiso oluneenkcukacha olwenziwa eNetherlands. Lo lindixesha wathi: “Kubaguli abanomhlaza kubhobhosi, ukutofelwa igazi kuye kwabonakala kunomphumo ombi xa kukhangelwa amathuba okusinda ixesha elide. Kweli qela ukusinda kangangethuba leminyaka emihlanu eyongezelelekileyo kwakungama-48 ekhulwini kwabo bathi batofelwa igazi nama-74 ekhulwini kubaguli abangazange batofelwe gazi.”
Oogqirha beYunivesithi yaseSouthern California bakwafumanisa ukuba abaguli abaninzi ngakumbi ekwenziwa kubo utyando lomhlaza baphinda babe nomhlaza ukuba babetofelwe igazi. IAnnals of Otology, Rhinology & Laryngology, kaMatshi 1989, yanikela le ngxelo kuhlolisiso olulandelanayo olwenziwa kubaguli abalikhulu ngaba gqirha: “Amathuba okuphinda kubekho umhlaza wengqula ayeli-14 ekhulwini kwabo bangazange bamkele gazi yaye ungama-65 ekhulwini kwabo balamkelayo. Kumhlaza womlomo, owamakrini nowempumlo okanye owemingxuma esethanjeni, umlinganiselo wokuphinda kwawo wawungama-31 ekhulwini kwabo bangazange batofelwe gazi waza wangama-71 ekhulwini kwabo babetofelwe igazi.”
Kwinqaku lakhe elithi: “Utofelo-gazi Notyando Lomhlaza,” uGqr. John S. Spratt waqukumbela ngelithi: “Ugqirha otyanda umhlaza kusenokufuneka abe ngugqirha otyanda ngaphandle kwegazi.”—The American Journal of Surgery, kaSeptemba 1986.
[Imifanekiso ekwiphepha 10]
Kuphikiswana ngelokuba igazi liliyeza elisindis’ ubomi kodwa ukuba libulala abantu akunto kuphikiswana ngayo leyo