From HIV to monkeypox

Recently, BBC London broadcasted a documentary showing how hundreds of young children were infected with HIV in a public sector hospital in Punjab. Their undercover video footage showed staff reusing syringes and other lax infection control practices. It is deeply problematic that this outbreak was reported a year ago and the Punjab government had promised to make changes so that it never happens again. The Department of Health responded by doubling down and refusing to accept that this has happened recently, while BBC stands by its claim that the footage is current. In Sindh, more than 100 people - predominantly children - were reported with Mpox (popularly called monkeypox). Around 30 patients were lab-confirmed, with nine deaths. Most cases came from Khairpur in Sindh and could be traced back to some public healthcare facilities. A high fatality Mpox outbreak is perplexing, but once you put the pieces of the jigsaw puzzle together, it becomes clear that the lack of infection control practices in our healthcare facilities has a major responsibility for this outbreak. It is not just the total lack of infection control; unsafe blood transfusions are another major factor behind the spread of HIV and hepatitis. Even qualified doctors and consultants often do not give the needed emphasis to properly sanitising their equipment and procedures. Similarly, injectable drug use and unsafe sexual practices remain important sources of HIV and hepatitis transmission. And it is not just HIV and hepatitis, serious diseases like Crimean Congo Hemorrhagic Fever (CCHF) infect and kill multiple people every year. We investigated a major HIV outbreak in Jallal Pur Jattan (JPJ) in 2009. For the first time, we identified that finding multiple HIV cases in a locality through screening does not necessarily mean it is a recent outbreak; rather, it may be an endemic disease that has been transmitted in the area for over a decade. We also reported, again for the first time, that HIV was spilling over from high risk groups (injectable drug users, sex workers, etc) into the general population. Third, we found a significant number of infected children. These three findings were extremely alarming, but no one took notice - even after our huge hue and cry at all forums. Ten years later, when we were investigating the largest HIV outbreak in Larkana, Sindh in 2019, I realised it was the same situation as JPJ but on a ten times bigger scale. Now we had more than 1,000 HIV infected children, with only a fraction – less than 10% – infected through their mothers. That means unnecessary use of injections in children and unsafe injection practices in healthcare settings could be a major cause. When the Punjab government is sending every grade 17 officer to inspect government hospitals and publicly berate senior healthcare professionals on social media over minor administrative issues, why are we still facing such scenarios? If the government is not satisfied with any MS, then the question must be asked about the criteria for their selection - and who made those selections. I do not want to single out the Punjab government; this is a systemic issue across Pakistan and requires systemic corrective measures. We need to bring in top healthcare professionals and give them financial and administrative freedom. Even being a doctor does not mean I can handle every branch of the health system. We need to start giving respect to subject matter experts and listen to them in a meaningful way. Many HIV infected children will not see their fifth birthday. According to a senior health journalist, out of the 1,000 HIV infected children in Larkana, nearly 300 have already died. Who is responsible for our children's deaths? In today's age, our children should not be dying of preventable diseases - and certainly not at this scale. It is not just about children in Khairpur, Larkana or Taunsa Sharif; you will find the same situation in most of Pakistan as soon as we start looking. Ignorance is bliss, but here it is costing lives.

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