Isipho Sokuphila Noma Uju Lokufa?

“Bangaki abantu okumelwe bafe? Nifuna kufe abangaki? Sinikezeni isilinganiso sokufa enisidingayo ukuze nikholelwe ukuthi lokhu kuyenzeka.”

UDON FRANCIS, isikhulu seCDC (U.S. Centers for Disease Control [IziKhungo Zokulawula Izifo ZaseU.S.]) washaya itafula ngenqindi njengoba ayememeza amazwi angenhla emhlanganweni ayenawo nabameleli abaphambili bemboni yendawo yokugcina igazi. ICDC yayizama ukubonisa abagcini begazi ukuthi ingculaza yayisakazwa igazi lesizwe.

Abagcini begazi abazange bakholiseke. Babiza lobufakazi ngokuthi obungaqinile—amacala ambalwa nje—futhi banquma ukungakuthuthukisi ukuhlola igazi. Lokho kwakungoJanuary 4, 1983. Ezinyangeni eziyisithupha kamuva, umongameli weNhlangano Yezindawo Zokugcina Igazi yaseMelika wagomela: “Incane noma ayikho nhlobo ingozi emphakathini uwonke.”

Ngokwezazi eziningi, base bukhona kakade ubufakazi obanele bokuqinisekisa ukuthi kumelwe kuthathwe isinyathelo. Futhi kusukela ngalesosikhathi, “lawomacala ambalwa” asekuqaleni aye anda ngendlela eshaqisayo. Ngaphambi kuka-1985, mhlawumbe abantu abangu-24 000 bampontshelwa igazi elalonakaliswe iHIV (Human Immunodeficiency Virus [Igciwane Elilwisana Nokuzivikela Komzimba Womuntu]), ebangela ingculaza.

Igazi elingcolile liyindlela ephumelela ngokushaqisayo yokusakaza igciwane lengculaza. NgokweNew England Journal of Medicine (kaDecember 14, 1989), isilinganiso esisodwa segazi singase sithwale amagciwane anele okubangela izifo ezifinyelela ezigidini ezingu-1,75! ICDC yatshela iPhaphama! ukuthi ngoMarch 1990, eUnited States kuphela abantu abangu-3 506 base benayo kakade ingculaza ababeyithola ngokumpontshelwa igazi, izakhi zegazi, nasezithweni ezithathwe kwabanye abantu.

Kodwa lawo amanani amancane kakhulu. Ayinakulokotha ichaze ukujula kosizi lwabantu ngabanye oluhilelekile. Ngokwesibonelo, cabangela usizi lukaFrances Borchelt, oneminyaka engu-71 ubudala. Wabatshela ngokungayekethisi odokotela ukuthi wayengakufuni ukumpontshelwa igazi. Nokho bampompela. Wafa kalusizi ebulawa ingculaza njengoba umkhaya wakhe wawubukela ungenakumsiza.

Noma cabangela usizi lwentombazane eneminyaka engu-17 ubudala eyayiphethwe ukopha okukhulu kokuba sesikhathini eyanikezwa izilinganiso ezimbili zegazi ukuze nje kulungiswe ukuncipha kwegazi layo. Lapho isineminyaka engu-19 ubudala futhi ikhulelwe, yathola ukuthi lokho kumpontshelwa igazi kwakuyinikeze igciwane lengculaza. Lapho isineminyaka engu-22 yayisinengculaza. Ngaphandle kokwazi ukuthi yayizofa ngokushesha ibulawa yingculaza, yasala izibuza ukuthi kazi yayingayidluliselanga yini ingculaza kumntwana wayo. Uhlu lwezinsizi alupheli, kusukela kubantwana kuya kwabadala, kuwo wonke umhlaba.

Ngo-1987 incwadi iAutologous and Directed Blood Programs yakhalaza: “Cishe ngokushesha ngemva kokuba amaqembu okuqala ezingozi echaziwe, okungacatshangwa kwenzeka: ukubonisa ukuthi lesifo esibulala ngamandla [ingculaza] sasingadluliselwa futhi sasidluliselwa ngegazi elinikelwe ngokuzithandela. Lena kwakungebuhlungu kunazo zonke izinto ezihlekisayo kwezokwelapha; ukuthi isipho esiyigugu esinikeza ukuphila esiyigazi kwakungatholakala ukuthi siyithuluzi lokufa.”

Iplasma nayo futhi yayithwala lomqedazwe, eqinisweni yasiza ekuwusakazeni emhlabeni wonke. Abaphethwe izifo zokopha, abaningi babo abasebenzisa imithi yokushubisa igazi eyenziwe ngeplasma ukuze belaphe ukugula kwabo bangenwa izifo eziningi. EUnited States, amaphesenti abo aphakathi kuka-60 no-90 athola ingculaza ngaphambi kokuba kumiswe inqubo yokuhlola lomuthi ngokuwushisa ukuze kususwe iHIV.

Namanje, kuze kube kulolusuku, igazi alilondekile engculazeni. Futhi ingculaza ayikhona ukuphela kwengozi ebangelwa ukumpontshelwa igazi. Lutho neze.

Izingozi Ezenza Ingculaza Ingabi Yilutho Uma Iqhathaniswa Nazo

“Liyinto eyingozi kunazo zonke esizisebenzisayo ekwelapheni,” kusho uDkt. Charles Huggins ngegazi. Kufanele azi; ungumqondisi wenkonzo yezokumpontshelwa igazi esibhedlela saseMassachusetts. Abaningi bacanga ukuthi ukumpontshelwa igazi kumane nje kuwukuthola othile onohlobo lwegazi oluhambisanayo. Kodwa ngaphandle kohlobo lweABO neRh factor ngokuvamile igazi elibonwa ngakho ukuthi liyahambisana yini, kungase kube nokunye ukwehluka okulinganiselwa ku-400 elingase lingahambisani ngakho. Njengoba isazi sokuhlinzwa kwemithambo yegazi uDenton Cooley siphawula: “Ukumpompela igazi kuwukufakela isitho somunye umuntu. . . . Ngicabanga ukuthi kukhona ukungafanelani okuthile cishe kukho konke ukumpompela igazi.”

Akumangalisi ukuthi ukumpompela into eyinkimbinkimbi kangaka, njengoba kwasho omunye udokotela ohlinzayo, kungase “kudide” isimiso somzimba sokuzivikela. Eqinisweni, ukumpompela igazi kucindezela isimiso sokuzivikela isikhathi esingangonyaka. Kwabanye, lesi isici esiwusongo kakhulu sokumpontshelwa igazi.

Bese kuba khona futhi izifo ezithathelwanayo. Zinamagama angajwayelekile, njengeChagas’ disease necytomegalovirus. Imiphumela isukela emfiveni nasemkhuhlaneni kuya ekufeni. UDkt. Joseph Feldschuh waseYunivesithi Yokwelapha yaseCornell uthi kunengozi eyodwa kweziyishumi yokuthola uhlobo oluthile lwesifo ekwamukeleni ukumpontshelwa igazi. Kufana nokudlala iroulette yaseRashiya (umdlalo oyingozi) ngevolovolo elinezimbobo eziyishumi. Ukuhlola kwamuva nakho futhi kuye kwabonisa ukuthi ukumpontshelwa igazi phakathi nesikhathi sokuhlinzwa komdlavuza empeleni kungase kwandise ingozi yokuqhubeka komdlavuza.

Akumangalisi ukuthi kungani uhlelo lwezindaba zethelevishini lwathi ukumpontshelwa igazi kungase kube isithiyo esikhulu kunazo zonke sokululama ekuhlinzweni. Isifo sokusha kwesibindi singena amakhulu ezinkulungwane futhi sibulala abantu abaningi kakhulu abamukela ukumpontshelwa igazi kunokuba kwenza ingculaza, kodwa asaziwa umphakathi. Akekho owazi isilinganiso sokuthi kufa abangaki, kodwa isazi sezomnotho uRoss Eckert sithi singase sifane nendiza iDC-10 egcwele abantu ephahlazeka nyanga zonke.

Ingozi Nezindawo Zokugcina Igazi

Izindawo zokugcinwa kwegazi ziye zasabela kanjani ekudalulweni kwazo zonke lezingozi emkhiqizweni wazo? Azizange zisabele kahle, kusola abagxeki. Ngo-1988 iReport of the Presidential Commission on the Human Immunodeficiency Virus Epidemic yasola lemboni ngokuba “eyenza kancane ngokungadingekile” ekusabeleni osongweni lwengculaza. Izindawo zokugcina igazi ziye zanxuswa ukuba zingawakhuthazi amalungu amaqembu ayingozi kakhulu ekunikeleni ngegazi. Ziye zanxuswa ukuba zilihlole igazi ngokwalo, zilihlolisise ukuze zithole izimpawu zokuthi livela kubanikeli begazi abayingozi kakhulu yini. Izindawo zokugcina igazi zathatha kancane. Babonisa ukungazinaki izingozi njengokungathi kumane kungukwesaba okungadingekile. Ngani?

Encwadini yakhe ethi And the Band Played On, uRandy Shilts usola ngokuthi abanye abagcini begazi bamelana nokwenza ukuhlola okwengeziwe “cishe ngaphansi kwezizathu ezingokwezimali ngokuphelele. Nakuba iqhutshwa ikakhulukazi izinhlangano ezingafuni nzuzo njengesiPhambano Esibomvu, imboni yegazi inemali eningi, njengoba minyaka yonke yamukela [amarandi ayizigidi eziyizinkulungwane ezingu-2,6.] Ibhizinisi labo lokulungiselela igazi lokumpontshelwa okuyizigidi ezingu-3,5 ngonyaka lalisongelwa.”

Ngaphezu kwalokho, njengoba izindawo zokugcina igazi ezingafuni nzuzo zithembele kakhulu kubantu abanikela ngegazi ngokuzithandela, zangabaza ukucasula noma imuphi wabo ngokwenqaba amaqembu athile awusongo oluyingozi, ikakhulukazi ongqingili. Abameli bamalungelo ongqingili baxwayisa ngasese ukuthi ukubenqabela ukuba banikele ngegazi kuyokwephula amalungelo abo angokwenhlalo futhi kuvuse ukugula ngengqondo kwasemakamu okuhlushwa kwenye inkathi.

Ukulahlekelwa abanikela ngegazi nokunezela ukuhlola okusha kuyobiza enye imali eyengeziwe. Entwasahlobo ka-1983, Indawo Yokugcina Igazi YaseYunivesithi YaseStanford yaba ngeyokuqala ukusebenzisa indlela ehlukile yokuhlola igazi, eyayingabonisa ukuthi igazi lalivela kubantu abayingozi kakhulu abangadlulisa isifo sengculaza noma cha. Abanye abagcini begazi basigxeka lesosinyathelo njengesiyithuluzi lezomnotho lokudonsa iziguli ezengeziwe. Ukuhlola kuyawandisa amanani. Kodwa njengoba omunye umbhangqwana, ongane yawo yampontshelwa igazi ngaphandle kokwazi kwawo, ukubeka: “Ngokuqinisekile besiyokhokha [u-R13] ngaphezulu [ingxenye yelitha]” ngokwenza ukuhlola okunjalo. Ingane yabo yafa ibulawa yingculaza.

Isici Esizilondolozayo

Ezinye izazi zithi izindawo zokugcina igazi ziyephuza ukusabela ezingozini ezisegazini ngenxa yokuthi akumelwe zilandise ngenxa yemiphumela yokwehluleka kwazo. Ngokwesibonelo, ngokombiko kuyiPhiladelphia Inquirer, iFDA (U.S. Food and Drug Administration [Umnyango Wezokudla Nezidakamizwa waseU.S.]) inomthwalo wemfanelo wokuqikelela ukuthi izindawo zokugcina igazi zisendinganisweni efanele, kodwa uthembele kakhulu ezindaweni zokugcina igazi ukuba zimise lezozindinganiso. Futhi ezinye zezikhulu zeFDA zazingabaholi embonini yegazi. Ngakho-ke, ukuhlolwa njalo kwezindawo zokugcina igazi eqinisweni kwehla ngokuphindaphindiwe njengoba inkinga yengculaza yayembuleka!

Izindawo zokugcina igazi zaseU.S. ziye futhi zafuna igunya ezikhulwini zomthetho elizivikela engalweni yomthetho. Cishe kuwo wonke amazwe, umthetho manje uthi igazi liyinkonzo, hhayi umkhiqizo. Lokho kusho ukuthi umuntu omangalela indawo yokugcina igazi kumelwe anikeze ubufakazi bokuyekelela ngasengxenyeni yayo—isithiyo esiqinile esingokomthetho. Imithetho enjalo ingase yenze izindawo zokugcina igazi zibe ezilondeke ngokwengeziwe ekubekweni amacala angokomthetho, kodwa ayilenzi igazi libe elilondekile ezigulini.

Njengoba isazi sezomnotho uRoss Eckert sibonisa, uma izindawo zokugcina igazi zazibekwa icala ngegazi ezihweba ngalo, zaziyokwenza okuningi ukuze ziqinisekise ukuba lisezingeni eliphakeme. Isisebenzi esingumgcini wegazi esesathatha umhlala phansi uAaron Kellner siyavuma: “Ngokuthuthukisa okuncane okungokomthetho, igazi laba inkonzo. Wonke umuntu wayekhululeke njengasekhaya, wonke umuntu, okungukuthi, ngaphandle kwesisulu esingenacala, isiguli.” Uyenezela: “Okungenani ngabe siye saveza ukungalungi, kodwa asizange. Sasikhathazeke ngokuvulekela kwethu engozini; Kwakukuphi ukukhathazeka kwethu ngesiguli?”

Lesiphetho sibonakala singenakubalekelwa. Imboni yokugcina igazi inesithakazelo kakhulu ekuzivikeleni ngokwezimali kunokuba inaso ekuvikeleni abantu ezingozini zomkhiqizo wayo. ‘Kodwa ingabe zonke lezingozi ngempela zinendaba,’ abanye bangase babuze, ‘uma igazi liwukuphela kwendlela yokwelapha ekhona yokusindisa ukuphila? Ingabe izinzuzo zibaluleke kunezingozi?’ Umbuzo omuhle. Konke lokho kumpontshelwa igazi kudingeke kangakanani ngempela?

[Amazwi acashunwe esihlokweni ekhasini 9]

Odokotela bathatha izinyathelo ezinkulu ukuze bazivikele egazini leziguli zabo. Kodwa ingabe iziguli zivikeleke ngokwanele egazini ezilimpontshelwe?

[Ibhokisi/Isithombe ekhasini 8, 9]

Ingabe Igazi Livikelekile Engculazeni Namuhla?

“KUYIZINDABA Ezinhle Zegazi,” kwamemezela isihloko esiphambili kuyiDaily News yaseNew York kaOctober 5, 1989. Lesihloko sabika ukuthi ingozi yokuthola ingculaza ekumpontshelweni igazi yinye kwezingu-28 000. Lathi inqubo yokukhipha leligciwane egazini manje isiphumelela ngamaphesenti angu-99,9.

Umbono oqondile ofanayo uyatholakala embonini yokugcina igazi. ‘Igazi elikhona lilondeke kakhulu kunanini ngaphambili,’ bayasho. Umongameli WeNhlangano Yezindawo Zokugcina Igazi YaseMelika wathi ingozi yokuthola ingculaza egazini iye “yasuswa cishe ngokuphelele.” Kodwa uma igazi lilondekile, kungani kokubili izinkantolo nodokotela beye bayibiza ngamagama anjengokuthi “ingozi” nokuthi “alilondekile ngokungenakugwemeka”? Kungani abanye odokotela behlinza begqoke okubukeka njengamasudi asemkhathini, amasudi avala umzimba wonke anezifihla-buso namabhuthi amade, konke okwenzelwe ukuvimbela ukuthintana negazi? Kungani izibhedlela eziningi kangaka zicela iziguli ukuba zisayine ifomu lokuzibopha elikhulula izibhedlela ekubeni necala ngemiphumela eyingozi yokumpontshelwa igazi? Ingabe ngempela igazi livikelekile ezifweni ezinjengengculaza?

Ukuvikeleka kuxhomeke ezindleleni ezimbili ezisetshenziswayo ukuze kuvikelwe igazi: ukuhlola abantu abanikela ngegazi nokuhlola igazi ngokwalo. Ukuhlola kwamuva kuye kwabonisa ukuthi naphezu kwayo yonke imizamo yokuhlola abantu abanikela ngegazi abandlela yabo yokuphila ibabeka esimweni sokuba abasengozini yokuba nengculaza, kusenabathile abaphunyukayo ekuhlolweni. Banikeza izimpendulo ezingezona emibuzweni abayibuzwayo futhi banikele ngegazi. Abanye bafuna nje ukuthola ngokuhlakanipha ukuthi banaso yini lesifo ngokwabo.

Ngo-1985 izindawo zokugcina igazi zaqala ukuhlola igazi ukuze zithole ukuthi akhona yini amangqamuzana umzimba owakhiqizayo ukuze alwisane negciwane lengculaza. Inkinga ngalokhu kuhlola ukuthi umuntu angase abe negciwane lengculaza isikhathi esithile ngaphambi kokuba abe nanoma imaphi amanye amangqamuzana alwisana nezifo obekungawabona. Leligebe elibucayi libizwa ngokuthi iwindow period.

Umbono wokuthi kunengozi eyodwa kwezingu-28 000 zokuthola ingculaza ekumpontshelweni igazi uvela ekuhloleni okwakhishwa kuyiNew England Journal of Medicine. Lelophephabhuku lalinganisela ukuthi iwindow period enokwenzeka kakhulu ithatha isilinganiso samasonto ayisishiyagalombili. Nokho, ezinyangeni ezimbalwa nje ngaphambili, ngoJune 1989, leliphephabhuku elifanayo lakhipha ukuhlola okwakuphetha ngokuthi iwindow period ingase ibe yinde kakhulu—iminyaka emithathu noma ngaphezulu. Lokhu kuhlola kwasekuqaleni kwasikisela ukuthi amawindow period amade kanjalo angase abe ngavame kakhulu kunokuba kwake kwacatshangwa, futhi kwalinganisela ukuthi okubi ngokwengeziwe, abantu abangenwe yilesifo bangase bangaphinde babe nawo lamangqamuzana okulwisana naleligciwane! Nokho, ukuhlola okunombono oqondile akuzange kukuhlanganise lokhu okwatholwa, kuthi “akuqondakali kahle.”

Akumangalisi ukuthi kungani uDkt. Cory SerVass wePresidential Commission ephathelene nengculaza athi: “Izindawo zokugcina igazi zingaqhubeka zitshela umphakathi ukuthi igazi elikhona lilondeke ngangokunokwenzeka, kodwa umphakathi awusalithengi ngoba uyezwa ukuthi akulona iqiniso.”

[Umthombo]

CDC, Atlanta, Ga.

[Ibhokisi ekhasini 11]

Igazi Elimpontshelwe Nomdlavuza

Izazi zesayensi zithola ukuthi igazi elimpontshelwe lingacindezela isimiso sokuzivikela nokuthi ukuzivikela okucindezelwe kungase kulithinte kabi izinga lokusinda kwalabo abahlinzwayo ngenxa yokuba nomdlavuza. Iphephabhuku likaFebruary 15, 1987 elithi Cancer, libika maqondana nokuhlola okwakunokwaziswa okuningi okwenziwa eNetherlands. Leliphephabhuku lathi, “ezigulini eziphethwe umdlavuza ethunjini elikhulu, kwabonakala umphumela ophawulekayo oyingozi wokumpontshelwa ophazamisa ukuphila isikhathi eside. Kuleliqembu kwakukhona amaphesenti angu-48 okuphila eminye iminyaka emihlanu ezigulini ezimpontshelwe namaphesenti angu-74 ezigulini ezingampontshelwe.”

Odokotela eYunivesithi yaseNingizimu California bathola futhi ukuthi ezigulini ezahlinzwa ngenxa yokuba nomdlavuza eziningi kakhulu umdlavuza wazo uphinde uvele uma zamukela ukumpontshelwa igazi. IAnnals of Otology, Rhinology & Laryngology, kaMarch 1989, yabika ngokuphathelene nokuhlolwa okwalandelelwa kweziguli eziyikhulu okwenziwa yilabodokotela: “Izinga lokuvela futhi kwayo yonke imidlavuza yomphimbo lalingamaphesenti angu-14 kulabo ababengazange balamukele igazi namaphesenti angu-65 kulabo abalamukela. Ngomdlavuza wasemlonyeni, emankankeni, ekhaleni noma embotsheni engenhla kwekhala, izinga lokuvela futhi lalingamaphesenti angu-31 kwezingazange zimpontshelwe igazi namaphesenti angu-71 kwezampontshelwa igazi.”

Esihlokweni sakhe esithi “Ukumpontshelwa Igazi Nokuhlinzwa Umdlavuza,” uDkt. John S. Spratt waphetha ngokuthi: “Udokotela ohlinza umdlavuza kungase kudingeke ukuba abe umhlinzi ongalisebenzisi igazi.”—IAmerican Journal of Surgery, kaSeptember 1986.

[Izithombe ekhasini 10]

Ukuthi igazi liwumuthi osindisa ukuphila kuyimpikiswano kodwa ukuthi libulala abantu akuyona impikiswano