KARACHI, Pakistan, Aug 19 2009 (IPS) – Dr Saleem Azam cannot get MN and FM off his mind. These two died recently in two of Karachi s government-run hospitals, unable to get timely medical treatment and denied the compassionate attention that they desperately needed.
Injecting drug users in Pakistan comprise a huge number of individuals with HIV/AIDS. Credit: Fahim Siddiqi/IPS
MN and FM, who were both under Azam s care, were injecting drug users (IDUs) until they acquired HIV/AIDS. (Azam declined to disclose their identities, opting to refer to them by their initials.)
They died due to the criminal negligence of health care providers, said Azam, putting the blame squarely on the doctors on duty. They were blatantly denied life-saving interventions, because they were HIV-positive, he recalled. For how long will these people die a voiceless death? he asked. Somebody should be held accountable.
Azam runs a non-government organization, Pakistan Society (PS), which works with IDUs, mostly living on the streets. PS currently has more than 3,000 IDUs registered with it; 500 of them have HIV/AIDS.
According to the World Health Organization, some 33 million people now live with HIV, approximately 90 percent of whom are found in low- and middle-income countries. In Pakistan, an estimated 85,000 people are afflicted with the disease, according to the National AIDS Control Programme (NACP). Of these, 21 percent are IDUs.
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Azam still vividly recalls what happened to 38-year-old MN. On being found lying comatose on a footpath, he was readily brought to the emergency ward of Civil Hospital, a government-run hospital, by PS ‘s outreach workers.
The doctor on duty put a drip on him without doing any proper investigation, said Mohammad Raisuddin, the outreach worker who found MN. On learning he was HIV-positive, the doctor on duty had him taken to another ward.
We kept shifting the poor fellow from one ward to the other, but he was refused admission everywhere, on one pretext or another, said Raisuddin. Two days later, MN was taken to Jinnah Hospital. After much pleading and cajoling, and many phone calls later , MN was finally admitted to the hospital, where he soon died.
Azam considers the lack of awareness and training among the medical community as one of the biggest barriers to controlling the incidence of AIDS in Pakistan, and these often result in stigma and discrimination against people with HIV and AIDS.
We have the problem right under our nose, but we can t see it, he said. At times the doctors don t even know the mode of transmission.
This became evident in the case of FM, 58. He had been on antiretroviral therapy (or ART, which is generally used for patients with AIDS) when he developed shortness of breath, prompting Azam and his staff to get him the medical attention that he badly needed.
What followed was a series of consultations with different doctors, coupled with hospital confinements, none of which helped. At one point, according to Azam, FM was prescribed Viagra at the Karachi Institute of Heart Diseases, where he was discharged even before his condition could stabilize. (Sildenafil is the generic name for Viagra, which, research shows, is used for life-threatening heart and lung conditions.)
FM s next stop was the National Institute of Cardio-Vascular Diseases, from where he was then taken to a multidisciplinary hospital. Civil Hospital was the only choice left for him, only to be denied treatment there. Before he could be moved to Jinnah Hospital, he gave up all desire to live, according to Azam.
They are clueless about the disease and treat it wearing moral lenses, said Azam of the medical professionals whose services he and his staff had sought. FM and MN s deaths could have been prevented had the doctors shown a sense of responsibility, empathy and respect for human life, said Azam.
These are not isolated cases, he said. Last year, 12 people under the care of PS met the same fate at these hospitals, having been refused treatment on what to Azam were flimsy grounds. Either the emergency ward does not have a bed to spare, or the doctor is not on duty, or he [the patient] has to be shifted to another ward, and then another. They just dash around till they die, he added.
Syed Tariq Zafar, who heads Nai Zindagi, an NGO in the Punjab province working with IDUs and people living with HIV/AIDS, said the lack of information, knowledge and experience often translates into fear, which experts brand as discrimination. Addressing this kind of situation is paramount, he said.
Azam believes it is not always money that is needed to keep those living with HIV/AIDS alive in a dignified manner. Sometimes simple compassion can ease the pain, he said. The world of science may have made advances on the medical and therapeutic side of the pandemic, but the social aspect remains woefully neglected, he said.
Dr Azra Ghias, who heads one of the Centres of Excellence (CoE) set up by the NACP, admitted that stigma and discrimination hound people with HIV/AIDS. Even health professionals view them as untouchables, she said.
She quickly pointed out, however that there has been a noticeable shift in attitude among some paramedics and doctors where individuals with HIV/AIDS are concerned. These people can now access treatment in hospitals, she said, which was impossible some three years ago. The change is there, but slow.
Azam countered, however, that until we make the junior doctors and the newer lot of paramedics aware of the (disease), we will not be able to win the battle. He said there are glaring gaps in government-run HIV/AIDS programmes. Most AIDS patients suffer from multiple complications, which require not just a battery of expensive tests but immediate treatments, he said, assuming they can even be provided.
The CoE should be a place where those infected with AIDS can go and be provided with the needed services under one roof , he said. These people are not just poor but also weak and sick and have no idea where to go and how to seek help. They have to run from pillar to post, stand in long queues when their health does not permit (it), he explained.
Ghias disagrees. That is exactly what we don t want to do, she said. Why should we have separate services for them and isolate them when the whole idea of intervention is integration?
Let s not be over-sensitive about those infected with HIV/AIDS. All the sick need to be treated with compassion and provided succor. The healthcare system and policy needs overhauling and the healthcare providers need to understand their roles and responsibilities, she said.
