Afghanistan and Central Asia

Kyrgyzstan has recently reported that nine out of the eleven cases of HIV in the Osh district are children who contracted the virus during regular medical treatment.  Yesterday, President Bakiev ordered an investigation of this horrifying situation.

The pain of this to individuals and their families is enormous and so unnecessary.  The suffering from this radiates outward to society as a whole.  Speaking at an Open Society Institute Conference, Els Klinkert said:

The effects of the epidemic become more and more apparent. HIV/AIDS affects entire families and households in the most direct way. The families of AIDS victims are faced with high medical expenses, funeral costs and loss of human resources. But AIDS not only strikes at household level, the epidemic will also negatively effect the workplace, schools and national economic development. The epidemic will form an additional burden on the public health and other services sector, education, agricultural and economic sector.

Not again
In Kazakhstan, a similar discovery of negligence in terms of child medical care leading to HIV infection first began to be uncovered in May, 2006.  Subsequent investigation found that 118 children were HIV-infected during medical treatment in any of three hospitals in the Shymkent area.  Ten of those children have already died.  New cases are also being discovered.

A little over a year later, many facts came forward, and all of them are ugly.  Contaminated blood was used for transfusions on some children, and then the equipment (needles, etc) used for these transfusions were not sterilized properly, and then re-used on other children.  For this reason, many health-care practitioners are at fault.  But the main fault appears to be in the purchasing departments of those hospitals, i.e., the administration.

The contaminated blood in Shymkent was part of an illegal blood trade, where un-certified blood is collected (most likely from street addicts or other poor persons) and sold to hospitals at a lower price than blood collected and certified under HIV-prevention guidelines.  Hospital administrators could purchase this cheaper blood and pocket the difference in price.   What this is: not criminal negligence, but murder, and conspiracy to commit murder.  It is the same as if someone knowingly allows a bomb to sit in the middle of a populous building, knowing that it will go off and kill a large number of people.

In the trials, sentences for health-care clinicians ranged from 9 months to three years.  But the administrators responsible for the purchase of bad blood, or for administering clinic safety, or for providing proper sterilization equipment, received suspended sentences:

Marpiya Butabaeva, chairwoman of Ghibrat (Wisdom), the Shymkent-based Center for the Protection of the Mother and Children’s Rights, told RFE/RL’s Kazakh Service: “The bosses at the top got lenient sentences, while those who were under them got tougher sentences…. There is nothing new in this, it has happened before and it is happening now again. Of course it’s unfair.”

The sentences are not the end of the story in Shymkent. As Altynbekova said, new HIV/AIDS cases among the children of Shymkent are discovered every month.

After news of the first cases broke last year, President Nursultan Nazarbaev ordered an overhaul of the health-care system and better checks on the quality of blood in the country’s blood banks.

Such moves as Mr. Nazarbaev made to ensure blood safety are not recorded here, but they should include a. closing down any street-corner blood-buying facility; initiating a readily-visible and un-counterfeitable seal on packets of approved blood and new, clean needles; and a check, during hospital inspections, of all blood-related and sterilization-related protocols.  I’m sure there’s more, but that’s a start.  Check references 2 through 5 below, relating to blood safety and HIV clinical guidelines. 

Likewise, there isn’t any excuse for a health clinician to not know about safe blood and needle protocols: they are available on the Internet: see references 2 through 5 below.  As for a health administrator, one can also add reference number 6. 

But in a climate of corrupt hospital practice, one guard is increased consumer awareness.   The use of transfusions should not be accepted without questions from patients and/or the parents of patients.  For injections and inoculations, there are practices that can be viewed by the patient or parent that help make the clinician aware that the patient wants the best treatment, and insists upon it.  As the Shymkent case and the new, unfolding Osh case make clear, health care providers are not immune to mistakes, or outright criminality; or, they may be forced through circumstance / corruption to use blood or equipment that looks right but isn’t right.

Desperate times call for desperate measures: and to me, a good public health awareness positively affects the moral choices of a society as a whole.  As long as narcotrafficking from Afghanistan and an illegal blood trade adversely affect Central Asian states, then people need to be made aware of their choices.  A lot of innocent people are getting hurt, and these same innocent people need to become more aware of their own power–the power of knowledge.  This does not shift the responsibility of health-care providers and administrators to provide clean resources: it only helps patients escape infection in a bad system.

The Patient Must Insist Upon Good Treatment:
What people need to know, in Central Asia and, for that matter, around the world, who live in or travel to less-wealthy countries:

A. Needles need to come out of the sealed wrapper In Front of the Patient or their Parents before being used for medical treatment.  If we teach every patient and every parent to insist upon this, then medics cannot use an old and possibly infected needle on their children.

B. If a state’s medical budget obviates the purchase of a new needle for each inoculation, then the second-best choice (this is not as safe as a new needle) is as follows:

1. The patient or parent of a patient needs to insist that the needle be inspected and cleaned In Their Presence before use. 

2. According to reference 7 below:
Inspection should show no clotted blood on or inside the needle.   If there is, then that needle should be instantly rejected, subsequently cleaned or not.  
Needle cleaning involves the use of two applications of undiluted disinfectant and two applications of sterile water, for 30 seconds each.  In place of bleach, undiluted vodka can supposedly be substituted.  Bring your own bleach and distilled water if necessary. However, at some point, cleaning compromises the rubber on a syringe and also dulls the needle, so in general, a new needle for each person for inoculations of any sort is recommended. 

Tourists should get their own needles by prescription at home, leave them in their packages with prescription clearly labelled, and take them to the doctor in the event of any medical treatment.

3. And since clotted blood is harder to clean out of a syringe unless it is done immediately, these same patients or their parents should watch afterward to be sure that the needle, which will inevitably be used upon another person, is cleaned after their own inoculation as well–for the good of others and society at large.

4. You have to do this Every Time: you can’t forget, not once.

References:
1. Kazakhstan HIV trials: Arthur at NewEurasia.net: Doctors Jailed, Bosses Walk

2. TB/HIV Portal Page at the UN’s World Health Organization in English and not in Russian–excuse me, why the hell not?
3. TB/HIV Clinical Guidelines Manual from the World Health Organization, available in English, Russian, French, and Portuguese
4. UNAIDS portal page for ‘Best Practices’: downloadable documents in more than one language.
5. HIV medical/clinical practice guidelines at the portal page of AIDSInfo, the (U.S.) National Institute of Health Web site
6. Eurasianet’s HIV/AIDS Health Security in Central Asia portal page
7. Reconditioned needles: The San Francisco AIDS foundation has a Web site entitled “The Body” which discusses how to clean needles that are shared.  This information is aimed at IV drug users, but it may serve against a corrupt medical practice. (See disclaimer below.)  In the U.S., such programs or knowledge is frequently frowned upon under moral grounds, but surely the infection of children makes this information important to society at large.  Making bleachworks available in Kyrgyzstan’s prisons might also help cut down on HIV transmission rates.  (It would also help in the United States with the same problem, but we don’t do it here either.)

Disclaimer:
Just in case anyone is unsure: I am not a medical expert.  The Foreign Policy Association and the Great Decisions blogs are not medical resources.   I am not a medical practitioner, and my advice should not be relied upon in making medical decisions.  The Foreign Policy Association does not constitute a body which is expert about medical practice, and this venue should not be relied upon in making medical decisions.  Please seek experts to verify this information.  This advice was obtained by public safety messages issued by others and that I have referenced above.

This entry was posted on Tuesday, July 31st, 2007 at 8:44 am and is filed under Kazakhstan, Kyrgyzstan, Central Asia General, Human Rights, Economy, Public Health, Children. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.