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Kyrgyzstan: HIV Infections Highlight Systemic Hospital Breakdown

It is one of the most tragic stories in contemporary Kyrgyzstan: nearly 200 children from the country’s impoverished south in recent years allegedly have been infected with HIV in hospitals. For over three years, dozens of mothers of infected victims have demanded government compensation, as well as called for the prosecution of medical personnel for negligence.

The mothers’ most recent protests in the center of the capital Bishkek have drawn government promises of greater assistance and vigorous denunciations of doctors. But, as counter-protests by doctors and nurses have highlighted, there is growing concern that ordinary medical personnel are being scapegoated for what many describe as systemic problems in Kyrgyzstan’s hospitals.

Small numbers of children with nosocomial, or hospital-acquired, HIV infections began appearing in Osh Province in 2004. Their numbers grew rapidly in 2007 and 2008. According to the Ministry of Health, 191 children under 10 have now been infected with HIV in hospitals, out of 283 total HIV-positive children in the country. Experts say there is no way to know whether the numbers are reliable.

One mother, who said her child was infected in 2008 in an Osh hospital, is bitter, but determined. Her husband blamed her for infecting the child, even though she tested negative, she said. He abandoned them and sends no money for support. Day-care facilities will not accept her child. She asked that her name not be used because of the prospect of discrimination. “It’s just terrible to lose everything all of a sudden,” she told EurasiaNet.org in a telephone interview. First among her demands, she said, was that “those who are guilty should be punished. No one else.”

Some doctors have indeed been punished. But advocates for medical personnel contend that so far, justice has not been served.

Prosecutors brought cases against 14 doctors, nurses, and administrators; the names of the accused were published in local media. Three were convicted of negligence in the execution of official duties and sentenced to 4-5 years imprisonment. Ten more were charged with demanding payment in exchange for medical services – an illegal but common practice in Kyrgyzstan – or not fulfilling professional duties. Of those 10, six were convicted and received suspended sentences. The case against one was dropped.

Erik Iriskulbekov, a lawyer who worked on several of the cases for the legal-support non-profit Adilet, characterized prosecutors’ investigations as “unprofessional” and “superficial.” In cases where criminal charges relating to infections were brought, prosecutors did not establish how the virus entered the hospital, or was transmitted: “Through what instrument, when, who – none of this was established,” Iriskulbekov said.

Damira Imanalieva, a testing specialist with the Ministry of Health, said that the ministry is now conducting an epidemiological investigation. She also noted that the infections had been deemed hospital-acquired because the children’s mothers had not tested positive, a conclusion that may be suspect in a country where testing is not always conducted correctly.

The last straw for doctors was a scene in the country’s parliament in late November, when deputies, including then-Speaker Akmatbek Keldibekov, denounced medical personnel and called for them to receive the same punishment reserved for murderers. “When I heard what they were talking about in the Jogorku Kenesh [parliament], saying that all the doctors were guilty, that they should be sentenced to 20 years in prison, I was offended,” said Mamasobyr Burkhanov, who worked as a doctor in Osh for 30 years, and knows many of the doctors involved. “It’s inappropriate.”

On November 29, hundreds of medical personnel protested in Osh, threatening to walk off the job if the government did not change course.

“We wish they had quit their jobs,” said the mother. “Unfortunately, they didn’t do it.”

Instead, the Ministry of Health sent a deputy minister to Osh to negotiate. The doctors dispersed, but promised to walk out again if their demand for a fair investigation were not met.

A government commission has been formed to investigate the cases. Some public health professionals hope the commission will force prosecutors and deputies to accept international expertise and training.

Ultimately, the infection cases may be focusing attention on deeper issues in Kyrgyzstan’s hospitals. Several public health professionals working in Kyrgyzstan said that the issues described in the hospitals where the infections allegedly occurred – inadequate supplies of basic items like gloves and goggles, reuse and overuse of catheters and syringes, and insufficient training – were common to hospitals all over the country.

On December 5, Burul Makenbaeva, a member of the civil society advisory committee to the Ministry of Health, issued a call for the resignation of two deputy health ministers. The HIV infections, Makenbaeva told EurasiaNet.org, are “symptoms of a systemic crisis” in the Ministry of Health, and she laid blame for the infections at the feet of the directors of the hospitals, who are appointed by the ministry.

The problems underscore Kyrgyzstan’s inability to manage a potential HIV epidemic. In 2010, UNAIDS reported the country had one of the seven fastest growth rates of HIV infection in the world, primarily due to surging injected drug use.

Ismailova, the Ministry of Health specialist, said conditions had improved considerably since the infections were first discovered. “Thanks to the investigations, dirty catheters are not being reused, syringes are being changed. Things are much better than they were.”

Pessimism is the dominant mood among those with direct experience of the government’s response to the crisis. “What bothers me,” said Iriskulbekov, the lawyer, “is that these things happened, and the conditions have remained the same.”

Nate Schenkkan is a Bishkek-based journalist.

Kyrgyzstan: HIV Infections Highlight Systemic Hospital Breakdown

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