The fragility of our system

A country where HIV is mostly associated with promiscuous behavior, who will protect these children

The first carefully analysed study of the HIV outbreak in Sindh came out a week ago in the journal, Lancet Infectious Diseases. The results are very difficult to swallow. The outbreak is worse than many had predicted. The team of doctors analysed the data between April and July of this year from 31,239 patients — out of which 930 were tested positive. This rate of nearly 3% is unprecedented in the country. Worse, nearly 79% of these HIV-positive cases were children under five years of age. In a country where the general understanding of medicine is poor and the society leaves no opportunity to stigmatise those who are suffering — imagine what would happen to these children! A country that struggles to stock its hospitals, and where HIV is mostly associated with promiscuous behaviour, who will protect these children? How likely are we to give them a life of dignity and hope and not make them pay for a crime they did not commit? I really hope that I am wrong, and our history of abandoning our weak is not a predictor of our future.

Let’s not forget this is not the entire HIV affected population. This is just one study from one region that we know about. There is reason to believe that the medical malpractice is far more pervasive than a single district in Sindh.

Today, HIV is no longer the complete mystery that it was in the 1980s. True, we may not have a vaccine or some aspects of the host immune response may be unknown, but what happened in Larkana (and possibly other places) has nothing to do with the biological mysteries of the virus. This was not a situation where a new mechanism of the disease surfaced in ways that baffled the medical practitioners. Instead, it was perpetuated by supposed medical guardians. It was completely avoidable; a scenario that should have never played out. Reusing syringes should not happen in any health system and we have known this for decades. How could this happen? How do we know what else has been passed to the sick through unsafe medical practices? How weak is our system that it is so easy for an individual and his practice to put the lives of thousands at risk without impunity? Perhaps this is where we ought to think about our system beyond medical practice. How easy it is for an individual in a position of immense power and authority to discard all rules and regulations, laws and guidelines, and in the name of offering cure, make us sicker and more vulnerable. What is worse is that many think that rules and regulations matter little and there is no reason for any accountability.

In the medical report there is plenty to depress and frustrate us. But there is also a ray of hope. The study was led by our own experts from Aga Khan University with partnership from colleagues in the health ministry in Sindh, Dow University, Sindh AIDS Control Programme and the London School of Tropical Medicine and Hygiene. Given the opportunity, there is reason to be optimistic that we are capable of conducting high quality research and get to the core of complex, high priority issues in a rigorous and systematic fashion. There is ample talent to make a positive impact but as long as important leadership positions remain in the hands of those with no capacity or competence that ray of hope is unlikely to create any real change. Our system as a whole will remain fragile, and continue to fracture at the whims of individuals as long as those in charge are appointed on the basis of fraternity and political connections, and not intellectual capital.

Published in The Express Tribune, December 24^th, 2019.

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