[When officials descended on Ratodero to investigate, they discovered that many of the infected children had gone to the same pediatrician, Muzaffar Ghanghro, who served the city’s poorest families and appeared to be at the center of the outbreak.]
By
Zia ur-Rehman and Maria Abi-Habib
 |
|
Four
of Imtiaz Jalbani’s six children contracted H.I.V. His two youngest,
14-month-old
Rida
and 3-year-old Sameena, have died. Credit...Mustafa Hussain for
The
New York Times
|
RATODERO,
Pakistan — Nearly 900
children in the small Pakistani city of Ratodero were bedridden early this year
with raging fevers that resisted treatment. Parents were frantic, with everyone
seeming to know a family with a sick child.
In April, the disease was pinned down, and
the diagnosis was devastating: The city was the epicenter of an H.I.V. outbreak
that overwhelmingly affected children. Health officials initially blamed the
outbreak on a single pediatrician, saying he was reusing syringes.
Since then, about 1,100 citizens have tested
positive for the virus, or one in every 200 residents. Almost 900 are younger
than 12. Health officials believe the real numbers are probably much higher, as
only a fraction of the population has been tested so far.
Gulbahar Shaikh, the local journalist who
broke the news of the epidemic to residents of his city and the nation in
April, watched as his neighbors and relatives rushed to clinics to line up and
test for the virus.
When officials descended on Ratodero to
investigate, they discovered that many of the infected children had gone to the
same pediatrician, Muzaffar Ghanghro, who served the city’s poorest families
and appeared to be at the center of the outbreak.
Mr. Shaikh panicked — that was his children’s
pediatrician. He rushed his family to be tested, and his 2-year-old daughter
was confirmed to have the virus, which is the cause of AIDS.
“It was devastating,” said Mr. Shaikh, a
44-year-old television journalist in Ratodero, a city of 200,000 whose
residents are some of Pakistan’s poorest, with high illiteracy rates.
Mr. Ghanghro was the cheapest option in this
city, charging 20 cents a visit for the many parents here who earn less than
$60 a month.
The pediatrician treated all six of Imtiaz
Jalbani’s children, four of whom contracted H.I.V. His two youngest,
14-month-old Rida and 3-year-old Sameena, have died.
Mr. Jalbani, a laborer, said he first grew
alarmed when he saw Mr. Ghanghro rummage through the trash for a syringe to use
on Ali, his 6-year-old son, who is also infected. When Mr. Jalbani protested,
he said, Mr. Ghanghro snapped at him and told him he was using an old syringe
because Mr. Jalbani was too poor to pay for a new one.
“He said, ‘If you don’t want my treatment, go
to another doctor.’” Mr. Jalbani said. “My wife and I had to starve ourselves
to pay for the medicine.”
Mr. Ghanghro was arrested and charged by the
police with negligence, manslaughter and causing unintentional harm. But he has
not yet been convicted, and in an interview with The New York Times, he
insisted he is innocent and has never reused syringes.
The doctor recently renewed his medical
certificate and now works as a general practitioner at a government hospital on
the outskirts of Ratodero, despite laws that make the reuse of syringes an
offense that is not eligible for bail.
Health officials now say that Mr. Ghanghro is
unlikely to be the sole cause of the outbreak. Visiting health workers saw many
cases of doctors reusing syringes and I.V. needles. Barbers take the same razor
to the faces of multiple customers, they said, and roadside dentists crack away
at patients’ teeth on sidewalks with unsterilized tools.
Such unhygienic practices are prevalent
across Pakistan and probably the leading cause of the country’s surging rates
of H.I.V. infection, according to health officials. But Ratodero is so poor
that such practices are likely to be much more common, as residents struggle to
make ends meet and scrimp wherever they can.
At first, the government was slow to respond
to Ratodero’s outbreak and barely had the resources to test residents and treat
the sick. Teams of international health workers from various countries came to
the city to help, and the World Health Organization donated hundreds of testing
kits.
Testing centers were set up in government
buildings, while dozens of yellow tents sprouted up across the city to deal
with the influx of terrified residents eager to be tested.
Still, with not even a quarter of the city’s
population yet tested for the virus, officials are dreading that the real
number of infected is much higher than the 1,112 confirmed cases so far.
The daughter of Mr. Shaikh, the journalist,
has become an outcast in the community, he said. Education about the virus is
sparse, and many fear contracting it by touch. Relatives won’t hug the girl,
and other children will not play with her.
At school, the sick children are segregated
from the healthy, forced to sit on one side of the classroom.
“My wife and I, fortunately, we are literate.
We hug and love our daughter. But our relatives stopped touching her and are
now reluctant to visit us,” said Mr. Shaikh, whose daughter is now responding
well to treatment.
Five months on, the panic of the outbreak
still hangs over Ratodero. Doctors and paramedics are struggling to cope with
the number of H.I.V.-positive patients, while residents are still lining up to
be tested.
Farzana Bibi was one of those waiting in a
long line that snaked hundreds of yards out the door of a government hospital.
She had just had her 3-year-old son tested after he had run a fever for three
months, and doctors had confirmed that he was H.I.V.-positive. She held his
hand as they waited in line to receive medicine for his treatment, a desperate
frown on her face.
“It seems it is God’s affliction on us,” she
said. “How could so many of our children have such a terrible disease?”
The outbreak in Ratodero reflects a
nationwide uptick in H.I.V. cases, despite a global decline of new infections.
From 2010 to 2018, the number of
H.I.V.-positive people in Pakistan nearly doubled, to about 160,000, according
to estimates by UNAIDS, the United Nations task force that specializes in
H.I.V. and AIDS. During that time, the number of new infections jumped 38
percent in those 15 to 24.
The real number is likely higher; much of the
population goes untested, while only about 10 percent of people thought to be
H.I.V.-positive are being treated.
The country spends very little on its efforts
to counter H.I.V. and AIDS and is nearly entirely dependent on support from
other countries for its programs, whether for funding to staff testing centers
or to provide retroviral drugs to counter the virus.
“With competing priorities, H.I.V. and AIDS
is at the back seat of the government’s agenda,” said Maria Elena
Filio-Borromeo, the UNAIDS director for Pakistan and Afghanistan.
Since 2003, there have been eight H.I.V.
outbreaks in Pakistan. And Ratodero had been the site of one before: In 2016,
an outbreak hit some 1,500 adult men who had engaged in sex with infected
prostitutes, officials said.
But this year’s outbreak in Ratodero is the
first time that children have been the most frequent victims on such a large
scale, Ms. Filio-Borromeo said.
To counter the outbreak, the Pakistani
authorities in May began shutting down the clinics of unqualified doctors and
illegal blood banks — many of which were found to be reusing syringes. Months
later, however, some of those clinics had since reopened, locals say.
“Unless these quack doctors, barbers and
dentists are not checked, the number of incidents of H.I.V. infection will
continue going up,” said Dr. Imran Akbar Arbani, a local doctor, who had tipped
off Mr. Shaikh about the outbreak as he also alerted government authorities.
In February, Dr. Arbani started noticing
dozens of children coming to his office with persistent fevers, from newborns
to 8-year-olds.
“In Pakistan, the government does not act
unless there is a national uproar sparked by media coverage,” Dr. Arbani said,
explaining why he was quick to tell Mr. Shaikh, the journalist, when he
realized the scale of infection.
At least 35 children have died in the area
since April 25, according to Dr. Arbani.
The effect on Ratodero’s social fabric has
been grim.
In May, one man strangled his H.I.V.-positive
wife to death.
And in June, residents in another town
discovered their neighbor tied to a tree by her family, after she had tested
positive for the virus. The family said they had bound her to prevent her from
spreading the virus to the rest of the town.
After public outcry and police intervention,
the family untied her. She now lives in an isolated room in the house, her
every movement monitored by her family.
Mr. Shaikh said he had sold all his wife’s
jewelry and borrowed money in order to afford the treatment his daughter needs.
“But how will the children from very poor
families live?” he asked. “At the beginning, there was attention and an outcry,
the patients were in the spotlight. Now, they are nearly forgotten.”
Mustafa Hussain contributed reporting.
