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Hippocratic betrayal in Gambia

Dr Tamsir Mbowe, a former Health Minister, was a highly expected witness before Gambia’s Truth, Reconciliation and Reparations Commission. In 2007 he was the director of former president Yahya Jammeh’s HIV/AIDS treatment programme, considered as a deadly hoax by all other witnesses. Dr Mbowe maintained the treatment was effective and took no responsibility. Has he breached medical ethics?

Hippocratic betrayal in Gambia
Contradicted by all, Dr Tamsir Mbowe did not acknowledge any harm or responsibility © Mustapha K. Darboe
4 min 40Approximate reading time

 “The treatment is true,” said Dr Tamsir Mbowe, a soviet-trained gynecologist and obstetrician, testifying before Gambia’s Truth, Reconciliation and Reparations Commission (TRRC) on October 21. “Why will someone have a viral load of 200 million copies [sic] and after two months of treatment, it is undetectable? It is because of the medication.”

In 2007, Gambian autocrat Yahya Jammeh announced that he had found a plant-based concoction that could cure AIDS within three days. Dr Mbowe became the director of Jammeh’s presidential HIV/AIDS treatment programme. In recent public hearings before the TRRC, 10 patients, 5 medical doctors including a scientist with specialty in HIV, 3 lab technicians and Jammeh’s former aide de camp – who all participated in Jammeh’s treatment – described Jammeh’s treatment as a “hoax”, a fake cure that cost the lives of a number of those who enrolled in the presidential programme.

Apart from Ansumana Jammeh, a brother of the former Gambian president with no medical background, Dr Mbowe is the only person who still seems to believe Jammeh’s treatment worked, despite overwhelming evidence to the contrary.

Truth and manipulation

His testimony before the TRRC put an end to the Commission’s inquiry into Jammeh’s deadly HIV/Aids treatment. But for Essa Faal, lead counsel of the TRRC, it was a frustrating end.

“You are the only doctor who appeared here and mistook undetectable viral loads with cure and this is a fundamental problem in your treatment,” Faal put to Dr Mbowe. 

“The treatment is true,” replied Dr Mbowe. 

“The truth is you don’t have any evidence of that.”

“The evidence is the viral load results.” 

“But how do we know that?” 

“Go to Dakar… [Samples of Dr Mbowe’s HIV patients were first sent to a lab in Dakar, Senegal, in 2007.] The virus has been eliminated because of the medication.” 

“Or manipulation.”

“No. I don’t think the labs in Egypt [where samples were sent later on] will manipulate the results.”

“Egypt will rely on what you take there. They have not seen the patients and they have not extracted the blood. Correct?”

“That is true.” 

Until now, not everything is known about Jammeh’s concoction. Even Dr Mbowe didn’t seem to know about the medication. And he confirmed that records for his treatment results are also not available. Curing HIV/AIDS was actually not the only medical claim of Jammeh. The former president also said he could conquer demons and could exorcise someone who is possessed. According to Dr Assan Jaye, a previous TRRC witness, Jammeh had expressed early in his presidency (1994-2017) that he had wanted to be a medical doctor. “It got to a point, I think he [Jammeh] wanted Gambians to think he was supernatural,” added Dr Adama Amadou Sallah, owner of one of Gambia’s leading private clinics Lamtoro, who appeared before the TRRC on October 19.

Dr Sallah: “It was an outright dangerous therapeutic intervention. Anybody who aided and abated [Jammeh] was also carrying out an unlawful activity." © Mustapha K. Darboe

Coercive methods, deadly results

Essa Faal counted 10 people who died during Jammeh’s AIDS treatment and several others who died immediately after they were discharged. Dr Mbowe claimed that in his records, there were about 4 deaths and that those were not in their hands when they died. 

All the experts who appeared before the Commission said Jammeh’s treatment was what led to the death of the patients. Dr Sallah’s own maid, an HIV patient, joined the presidential treatment at some point. She died after being discharged despite the fact that she got back to her antiretroviral drugs. “I am on the view that if she had continued with anti-retroviral drug, she could even have been around with us today,” Dr Sallah said. “The extent of the damage this treatment has done to some families and patients is really not quantifiable in terms of human suffering. It was a slow but sure dying process,” he said.

All former patients who testified before the Truth Commission painted a coercive environment where patients were denied visitors or leaving the center. They said they were under heavy guard. Dr Mbowe denied this. However, in a statement given to the Commission beforehand, this is what he wrote: “The session usually last for many hours per day. I barely had any sleep in the first six months of the first year because it was a marathon. The patients were not allowed any visitors from family or from anyone, hence the heavy security. They were really guarded just like presidents. If a person was not part of the treatment programme, they were not permitted to talk to the patients. It was really a heavily guarded place.”

“How do you reconcile [the fact that] what you said to the Commission and what you said in your statement are diametrically opposed?” asked Essa Fall.

“Yes,” Dr Mbowe replied as if he was a bit destabilized.

“And only one of them can be true.”

“What I meant here was the first six months of the treatment and not after the six months.”

Unlawful practice

It is the Gambia Medical and Dental Council that has the responsibility for determining the standard of knowledge and skills to be attained by persons seeking to become members of the medical or dental profession, and for reviewing those standards. “It should have been brought to the attention of the regulatory authorities and to the Medical Council for breach of medical conduct by doctors who participated in it,” said Dr Sallah. The problem at the time was that Dr Mbowe was the Health minister and Jammeh was the President. (Dr Mbowe served as Gambia’s Health minister from 2004 to November 2007 and as director of the HIV/AIDS presidential treatment from January 2007 to 2016.)

“Jammeh had no certified training in the practice of medicine, may be not even in customary therapeutics. Practicing in a manner which endangers people’s lives and health, to me, is by all definitions unlawful. If you look at the provisions of the law, it condemns that kind of behavior,” said Dr Sallah. But for him, the medical doctors who participated in the process carry some responsibility of the wrongdoing too. “It was an outright dangerous therapeutic intervention. Anybody who aided and abated him in what he was doing was also carrying out an unlawful activity. Professionally it constitutes an objectionable behavior that is not compatible with what the profession expects from any practitioner,” Dr Sallah concluded.

“Are you bound by the ethics of the medical profession?” asked Faal.

“I was given the medical certificate to restore the sick to health,” answered Dr Mbowe. “I was not given the certificate to practice medicine by the Medical and Dental Council but by my university.” 

“Are you serious?” 

“I am 100% serious.” 

“Are you suggesting that regardless of your university qualifications, you are not bound by code of ethics of the medical profession?” 

“Well, I am not registered there.”

“The question is not whether you are registered. Are you bound by the code of conduct of the medical profession in the Gambia?”