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For many years, bonfires were lit in the small towns and villages of Sindh; Bonfires turned into bush fires, and bush fires now engulf the forest quickly. Brave firefighters fight against the conflagration. Fires characterize the three deadly viruses: Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV), and occasionally, the bacteria that causes syphilis . All are likely to be transmitted through almost similar pathways, namely bad, blood and pregnancy to the child.
Until recently, Pakistan was considered a low burden of HIV (0.1%), but with the recent recognition of the outbreak in Sindh, statistics are likely to move to unacceptable numbers. Unfortunately, Pakistan also ranks first in the world in terms of the burden of hepatitis, with some regions reporting that 25% of the population is infected with the hepatitis virus.
Pakistanis tend to prefer injections and infusions instead of healthy eating and healthy living, encouraged and encouraged by licensed and unlicensed doctors. The messengers of death do not hesitate to reuse needles and syringes, razors, scalpels, dental equipment or instruments to pierce the ears or nose contaminated by the virus. Even a tiny drop of fresh or dried blood can transmit millions of viral particles. Transfusion of a single unit of infected blood will inevitably accelerate the onset of the disease.
There are many lessons to be learned from this scandalous negligence in health care in Sindh.
For decades, Larkana has been a hotbed of injecting drug users (IDUs), of whom 27% are infected with HIV. In addition, unaccredited and unsupervised blood banks in the city do not test donors' blood or use inferior kits for testing, thus avoiding the true state of infection. The deadly combination of UDI and their blood donated to commercial blood banks is one of the bridges allowing the infection to be transmitted to the general population.
The recent wave of HIV cases emerged when HIV-trained pediatricians learned that an unusually high number of children – whose mothers were not infected – were referred to their centers. This caused an uproar among infectious disease (ID) experts who contacted the chain of command of the National AIDS Control Program in Islamabad, mandated by the Global Fund to provide diagnostics and treatment to HIV patients delivered through provincial programs in centers in high-burden areas.
The AIDS program in Sindh came into action and, in urgent meetings with local Larkana and Ratodero officials, organized a joint survey team with Sindh's Health DG, PNLS, WHO , UNICEF, Popular Public Health Initiative, Expanded Program on Immunization, Lady Health workers and clinical identification experts of the Pakistan Society of Microbiology and Infectious Diseases (MMIDSP) to investigate and control the epidemic . A short and long-term strategy has been deployed to suggest and implement interventions.
Community leaders and the media were mobilized and invited to report on HIV with humanity and empathy. The media were asked to contribute to the destigmatization of the disease and the respect of victims' privacy by not sharing names, photographs and medical reports. The video of the concerned doctor that was broadcast on social media was declared reprehensible and contrary to human rights, and the culprits were duly reprimanded.
The purpose of the EEC is to identify the epidemiological factors of the epidemic (demographic and risk factors, suspected exposure and badual behavior) that would make it possible to estimate the magnitude and determinants of HIV; explore other contacts and sites for its transmission potential; determine the chain of transmission of the infection; and make appropriate and effective recommendations for interrupting transmission.
Blood screening in parts of the high-risk population was conducted at Taluka Hospital in Ratodero. A preliminary report from the Sindh Health Services Directorate survey looked at 4,656 people and identified HIV in 186 people in just 12 days – a shocking rate of 3.9%. Of these, 108 (58.4%) were men; children aged two to five were unfortunately the highest at age 102 (54.8%). Treatment centers are in sight; unauthorized laboratories, blood banks and blood clinics were closed; and the public follows awareness sessions on disease prevention. Screening camps have been set up to detect more hidden diseases in other towns and villages. This is only the visible part of the iceberg.
There are many lessons to be learned from this scandalous negligence in health care in Sindh.
First, knowledge of the cause is the best way to prevent any disease. Registered and non-registered health care workers should refrain from injections and infusions to benefit from them, and patients should understand the serious consequences of receiving unnecessary blows. Health authorities should strictly monitor blood screening in blood banks. People should be informed about how risky badual activities increase the risk of getting a badually transmitted infection.
Secondly, early diagnosis of any disease improves treatment outcomes. Stigma, lack of confidentiality and (as we have seen in several studies), the diagnosis forgotten by inexperienced doctors worsen the prognosis and results. Medical programs in most "specialized" medical schools do not include the subject of identification that is so essential in Pakistan. Thus, HIV, its diagnosis, its prevention and the many badociated complications are neglected until the terminal stage of the disease. The specialty of ID includes the broadest spectrum of clinical diseases and infection control. PIDIM is a strong organization that has played a central role in managing the current epidemic; its members are ready, able and eager to help the government rewrite the identification program and hold educational sessions throughout the province to train doctors who have never benefited of didactic and practical training.
Finally, it is the responsibility of local municipalities throughout Pakistan to improve the management of wastewater and solid waste, which are at the root of Pakistan's health problems. We must stop fighting fires. We must instead prevent fires. Our people deserve good health care, no sickness and misery.
The author is a specialist in infectious diseases.
Posted in Dawn, May 13, 2019
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