Springtime of 2019 will go down in the history books of Ratodero, a poor neighborhood in the city of Larkana in southern Pakistan, as one of the most tragic and devastating of all time. An HIV outbreak is sweeping the area, affecting mostly children, some as young as two months. What’s going on?
It all started in early 2019 when several children from Ratodero were found to be running a fever. After taking them to their pediatrician, Dr. Muzaffar Ghanghro, the fevers were unresponsive. So they sought a second opinion from another clinic. That’s when the horrifying news came back that these children were HIV positive. But it would be a long road ahead, as the depth and breadth of the issue were just coming to light.
An HIV Positive Epidemic
As of May 20, 2019, more than 10,000 people had been screened as part of the government effort to isolate and contain the problem. At the time, 607 were HIV positive: 113 adults and 494 children. In most cases, the parents of the infected children are not HIV positive.
A large number of Ghanghro’s patients tested positive for HIV, and it wouldn’t take long for public outcry to result in the arrest of the doctor and his subsequent testing too. He was found to carry the virus as well, believing he may have contracted the disease through a blood transfusion after a serious car accident a number of months back.
Blame was initially placed squarely on the doctor. But as the investigation deepens and more details come to light, it’s very difficult to pin this on just one person. There are grave issues and dangers in every part of day to day life in this region.
Problems On All Fronts
It is estimated that 200,000 people are practicing medicine in the province of Sindh without a license, according to the Pakistan Medical and Dental Council. Doctors have been found to be essentially “loaning” their credentials to staff in their clinics. The unlicensed personnel pay a fee to the doctor for use of their medical knowledge, but the doctor is not even on the premises most of the time.
Worse than that, the supply chain is affected too. Even doctors who do everything by the book may be unwittingly spreading disease. Initial investigations have turned up people who repackage needles that have been disposed of selling them back to clinics as new equipment. (1)
Hundreds of clinics have been shuttered and hundreds more have received warnings for unsafe practices.
Attention has turned to barbershops too, and not for the first time. A study was published in 2014 highlighting unsafe barbering practices. (2) It is very common to reuse razor blades without sterilization, and it is also common for the poor parents in these areas to take their baby boy to a barbershop for circumcision.
New System Needed
Though Dr. Ghanghro is likely responsible for the infections of many, many children, it is impossible to say that he is the cause of the entire outbreak. As you might imagine, it has people in the whole region on edge, even affecting the social habits of some. Education is necessary, not just in the medical community but throughout the population. People need to know how to protect themselves, they need empowerment. Hopefully, this outbreak will be under control soon, and infrastructure put in place ensuring safe practices throughout the medical supply chain and anywhere there is potential for infection.
