An article in the news today reported concern among AIDS organisations and Doctors without Borders about a worrying new trend where people are neglecting to take life-saving medication in order to qualify for government subsidies.  In South Africa, the government pays a special disability grant to people living with HIV.  The problem seems to be that there is no standard set of guidelines as to determining who qualifies for the subsidy and who doesn’t.  Some doctors are basing their recommendations in terms of who qualifies for the subsidy on the CD4 levels of the patients, i.e. to qualify for the subsidy, you need to stay sick or get worse.  If you get better, i.e. your CD4 count improves; you no longer have access to the extra money from government.  People need to re-apply for the subsidy every 6 months, so there seems to be a definite incentive to remain ill.

Although it’s difficult for me to understand how someone would risk their life to receive a subsidy, I guess it becomes a moot point when that money is the only means I have to feed my family.  It seems that short-sighted thinking on the part of doctors and government regulators are leading to some serious unintended consequences.

It reminds me of a story I heard recently while conducting research into the current state of mine health and safety in South Africa …

A worker accidentally got his arm caught in a conveyor belt, where it got mangled to such an extent that he could no longer continue working and the company had to pay out disability compensation to him.  This lump sum put him in the position to buy a car and other nice-to-haves like a new television set, and he soon became the envy of his peers.  Most of them grew up together, went to work for the same company and had the same life-style, but now this injury caused the man to suddenly be in a different league than his friends.  

One of his colleagues saw this as an opportunity and three months later put his arm into the same machine intentionally – having decided that an arm was a reasonable sacrifice if he could also get a car.  (Un)fortunately when he cried out due to the pain of having his arm mangled, another worker heard his screams and activated the emergency stop on the machine.  The worker’s arm was badly injured, however after several months of therapy, it was determined that he could go back to work, and no compensation would be paid.  

The only reason why we know about this story is because the worker confronted his colleague who acted to save him, very unhappy because this person caused him to lose out on the opportunity to get the payout and therefore lose out on the car.

Most reasonable people would not stop taking life-saving medicine or sacrifice a limb for financial gain, but obviously circumstances can lead individuals to do so.  This is just one reason why Health and Safety is such a complex problem, and why we feel so passionate about finding new ways to address these issues, without creating even more unintended consequences that make and already bad situation even worse!