Dear Editor,
THE Guyana Human Rights Association (GHRA) yesterday addressed a letter to the Minister of Health, setting out concerns over certain measures adopted with respect to testing, confidentiality and decision-making around COVID-19. The substance of the letter is set out below.

After acknowledging its appreciation for the Minister’s response to an earlier GHRA press release, the GHRA re-iterated its awareness that “the overall goal of keeping Guyana as safe as possible from the COVID-19 virus may entail restrictions on movements and lifestyles, as well as administrative procedures, which would not be acceptable in normal circumstances. Notwithstanding, we wish to bring to your attention the following concerns which were received by the GHRA in the form of complaints:

Confidentiality of testing procedures
In normal circumstances, we understand that approval for medical tests lies with the examining physician or the management team of which she or he is a part. Similarly, test results are returned directly to the physician or managing team from the lab. At no point in the process is personal medical information shared with non-medical staff. This procedure has been varied in two important ways with respect to COVID-19. We understand that now the decision over whether a test should be performed no longer rests with the medical management team, and, secondly, that the results of the test are sent directly to yourself, as Minister, rather than to the physician/management team.

These changes result in personal information becoming available to non-medical decision-makers, and constitute a breach of confidentiality. While you have given assurances that test results getting to the management team are not delayed as a result of the new procedure, the need for this new arrangement has not been adequately explained or justified. A related consideration is that persons presenting themselves for tests have every right to expect the confidentiality of their personal details being respected; i.e. only available to relevant medical personnel.”

The letter addressed the importance of maintaining clear distinctions of decision-making authority between medical staff and policy-makers. “While priorities can be set by policy-makers, decisions over the use of scarce equipment and supplies must ultimately be a medical rather than a  political  responsibility. Inserting a layer of political decision-making into this long-respected arrangement is a recipe for serious dislocation even in normal times. It is particularly hazardous in the midst of a crisis, when the medical community is under the unprecedented stress of Covid-19.”

Quarantine Procedures
The letter raised concerns over the implementation of quarantine procedures which the GHRA believes are not well understood.  “They are perceived as authoritarian, and inclined to create panic and suspicion, an impression created by the inhumane manner in which the early cases were quarantined. It is important that such restrictions be proportionate to needs and applied evenly, reasonably and ultimately under medical rather than security authority. The rules and procedures should also, to the extent possible, be self-evidently justified.”

“Furthermore, strategies employed to confront the pandemic are not immune from the pall of suspicion and uncertainty pervading the national life over the unresolved results of national elections. The manner in which this context will impact on people’s decisions as to where and how to reveal their symptoms must be taken into account. For this reason alone it would be incumbent to ensure that medical and political decision-making paths be as transparent as possible.”

The letter ends by encouraging strategies in which all people feel confident to approach health services. “The over-all goal is surely to create as conducive an atmosphere as possible, in which potential cases of Covid-19 are not discouraged from revealing their symptoms or presenting for treatment  until they are seriously in need of medical care and possibly infecting others. Similarly, it is important that the medical community feel themselves validated by and enjoy the confidence of the political authorities and seen to do so by the population at large.”

In concluding the letter the GHRA requested that procedures adopted for Covid-19 “continue to be informed by guidance from WHO/PAHO while also reflecting the realities of life in Guyana at the present time.”

Regards,
Executive Committee
Guyana Human Rights Association (GHRA)