The Ratodero mystery

The outbreak of HIV infection in the Ratodero subdivision in Sindh presents a strange case. Out of 700 people who have tested positive for AIDS, 576 are children, most of them aged between two and five years. There is also a high distribution of HIV infection amongst children aged from five to 15. Their parents are not HIV positive. This raises all kinds of questions about how the children, some of them mere infants, became infected and what factors are at work. Not satisfied with an internal inquiry being conducted by two Karachi based hospitals, the WHO, with Pakistan’s federal ministry of health, has decided to bring in a team of some 15 experts from the Centers of Disease Control in the US, USAIDS, Unicef and the WHO itself.

The key question is as follows: if the HIV infection was indeed spread through medical malpractice including the re-use of syringes and other equipment, why is it restricted to Ratodero alone? Such violation of prescribed medical protocols is commonplace across Pakistan, and quacks operate outside Sindh as well. The findings by Sindh AIDS control teams and local medical inspectors are therefore under scrutiny. Suspicion again falls on a Ratodero based physician who is accused of having deliberately infected children. The fact that he is a paediatrician and in fact the only child specialist in Ratodero inevitably adds weight to this possibility. But if this is indeed found to be the case, it is the flaws in the healthcare system that need to be probed rather than an obviously unhinged individual alone. Why is there only one paediatrician in Ratodero? Why are there no checks and balances which could have detected wrongdoing before so wide an outbreak?

We hope the expert team put together by the WHO will be able to resolve these questions. But we need to ask questions ourselves as well. The discovery of so many HIV positive children has naturally created panic in the community. Bilawal Bhutto Zardari on a visit to the area attempted to put this at some ease by pointing out that HIV is not the same as AIDS and that it can be treated. He also promised that every victim would receive free care. Like many political promises, we do not know if this one will be kept. We also do not know how many people understood and believed Bilawal’s assurances. But it is obvious we need to go beyond them and beyond changed laws that the PPP chairperson suggested could be on the anvil. We need to discover precisely what caused the HIV in Ratodero and the many weaknesses in our system which allow these to occur over and over again. The HIV tests may have made national headlines. But there are many other cases which do not. We need to ensure that the loopholes are plugged and people are safe when they seek medical help or other kinds of care.