Alexey Goncharov, Shymkent
Legal proceedings in the case of HIV infection of children in Shymkent lasted throughout the entire first six months of 2007. It has literally engrossed the local, as well as not merely local mass media’s attention… The information of what was happening in the courtroom was communicated daily.
Eventually a sentence was passed on June, 27 by the judge Ziyadikhan Perniyaz.
He brought a verdict of guilty for all the defendants. At that, 15 persons were committed to prison immediately in the courtroom. They were sentenced to 3 to 8 year imprisonment with seizure of property. All the arrested in the courtroom are medics from ordinary doctors to head of hospital.
Suspended sentence of two year imprisonment was brought in respect of 5 defendants, with the former head of HH, SKP(House of Health, South Kazakhstan province) Aisulu Tasmagambetova, with two of her deputies and her husband Riskulbek Baikharashev, the former head of UKO Health Services Quality Assurance Department among them, as well as courier cashier of the children’s hospital who was held in custody up to that time and released in the courtroom.
Impassive voice of the immeasurably worn-out judge was heard in the dilapidated assembly hall of the Al-Farhab Regional Department of the Ministry of Interior of Shymkent, as such a spacious premise was not at hand with the judicial authorities. The entourage squalor strongly contrasted with the solemnity of the proceedings attended by quite a number of foreign pressmen. After a vassal of Themis finished reading a sentence the courtroom audience was overwhelmed with emotions.
The female medics sentenced to imprisonment were weeping and the faces of their male colleagues were disfigured by torment. The parents of HIV-infected children strongly grudged the sentence. Some women were shouting and threatening while trying to force their way to A. Tasmagambetova and were hardly stopped by the police. The ambulance medics were called straight to the courtroom as one of the mothers fainted. Squabble that hardly ended in a fight continued in the courtyard.
Everybody was displeased with the sentence. One of the lawyers of the defendants Musatay Bektasov said to the journalists:
- I’m sure everybody will appeal against the sentence. It is not substantiated by any evidence and is unduly stern. The source of HIV-infection is not found and the medics are most likely deprived of liberty because the trial won deep public resonance. There is law and there are guiding interpretations of the Supreme Court of the Republic of Kazakhstan, which clearly spell out that the conviction may not be based on assumptions and should be substantiated by evidence.
None of the defendants pleaded guilty. It appears from their testimony that they believe there are a number of HIV infection hotbeds in the area which were never detected in the course of investigation. At the same time none of those has any relation to the health facilities headed by them.
What also remained unclear for mass media was how could it be possible to conduct legal proceedings while investigation of a case of HIV infection of children was not yet finished at that time? Not that it is finished even now. Why an accountant and a cashier of one of the hospitals were tried along with the doctors? All are incriminated neglect of their duties. And the leadership of the oblast (provincial) blood transfusion center which was mentioned by Torekhan Adai, General Prosecutor’s senior aide as far back as in fall 2006 among the major figures of the then future trial, suddenly disappeared and was never even mentioned at the trial. Why such an important trial was conducted by just one judge who periodically was consulting … with himself? Incidentally primordial criminal cases were initiated in respect of “four managers of provincial children’s hospital”, too, but they were not tried in the court either.
Just looking at this doing from the outside it becomes clear that in fact this trial had nothing to do with the infection of children. Doctors were convicted for negligence, embezzlement and bribes.
“I hold acceptance of bribes proven by the testimony of the victims”, the judge said.
It was a shock. It appears that there is no need for marked banknotes, video cameras, catching red-handed. One only needs to say “I gave to such-and-such person that much” and he will be convicted. Certainly, in reality it is not like that, otherwise we would have put in prison half of civil servants in the country. But elections were at hand and it was time to drop the subject of HIV in the south and it was closed by such an odd trial.
Virtually, immediately after reading of sentence the public opinion in the town swung towards the convicted medics. It became known that simply no valuables were found in their apartments at the time of confiscation and their families with children were literally found out-of-dours without means of subsistence.
Medics in Shymkent started to actively protest against the sentence which was in their opinion ungrounded. Physicians sent letters of protest to the President, the Government and the Prosecutor General’s Office.
Also shocked were the parents of children which were receiving medical treatment from the arrested medics, and now they were asking “Who will help their children, as the best physicians are put in prison?..”
The friends and colleagues of the convicted doctors believe the innocent were put in prison.
- There’s no need to go to far… here.. our head physician assistant Klishbekov. She is a very nice person. She spent nights in the hospital. She lived there. Many saw her mental stress, remember she was crying? And now she is convicted to 4 year imprisonment. Oh, no, honestly it’s like losing heart,- says resuscitation expert Kanat Yertayev.
“After this trial anyone may be put in prison”, - fear the medics.
- It is unlikely that I would like to work in resuscitation unit or in health sphere at all. If there are any such brave guys who are willing to come here I am ready to quit my job,- echoes the head of resuscitation unit of children’s hospital N2 Shaken Alpispayev.
The doctors demanded to conduct the second expert examination in the case of HIV-infected children. At the meeting of medics with the patients of the convicts they started collecting signatures the defense of the convicts.
- All this expert examination should be double checked, no matter however complicated it may be. Because the guilt may not be determined on the basis of case history. But in our case the people were plainly tried. They are the best pediatricians. I know resuscitation experts, here, look, the whole village came to defend Tastanov,- said Svetlana Balbekova, associate professor of the Children Diseases Chair of the Medical Academy.
The parents of children saved by the convicts also spoke in their defense. Aliya Seilkhanova’s child was in the resuscitation unit for two weeks. Dreadful diagnosis of brain edema was beyond any chance for survival. Her child was saved and provided treatment by the doctors who were found at the prisoners’ dock. For Aiya their freedom means confidence in that her baby will live.
- Well, I personally did not give any bribe. I spent forty days in the hospital and all my gratitude cost me a bar of chocolate. Was it too much for the doctors who dragged my child out of the world beyond?- asks Aliya.
No one in the meeting hall was left indifferent by the emotional speeches of parents of the cured children and the convicts’ colleagues. Everyone in the hall was weeping, compassionate for the infected children and those who were convicted. 15 more perverted fates added to the previous 118 ones.
From the very beginning independent trade unions rose actively in favor of the convicted medics. After a time they were joined by formal trade unions.
Thus, the sentence passed on medics was discussed at the special enlarged session of the committee of the Shymkent province (oblast) public health trade union organization. The leader of the public health sector trade union Mereke Butina came to Shymkent specially to familiarize herself with the situation on the spot. Before the meeting she met with the staff of the children’s hospitals, lawyers and relatives of convicts. The implication of the latter event did not fundamentally differ from the previous ones. The only difference was that this time public trade unions which until the last moment were blamed for inaction plugged in the struggle for the rights of the convicted medics, as well as the entire medicine that suffered on the whole.
Once again the colleagues of the convicted medics stated that legal proceedings in Shymkent were galloping, whereas the investigation of cases of mass HIV-infection of children in Libya lasted 8 years. At the end of the discussion the trade union appealed to the Office of the Prosecutor General, Supreme Court of the Republic of Kazakhstan, the human rights plenipotentiary representative and the Human Rights Committee under the president of RK. The appeal contained a claim “to conduct the second thorough investigation of circumstances of this case with the involvement of competent experts, to determine on the basis of scientifically reasoned data sources and channels of infection of children, to review the case and award a fair judgment so as not to allow the infringement of rights and freedoms of the unfairly convicted group of doctors, the citizens of Kazakhstan”.
Now the lawyers of the convicted medics are preparing appeals to the Supreme Court. Four convicts are in prisons, six are released for settlement and suspension of execution is applied in respect of five women. The lawyers’ services provided to the convicts are covered by a special fund established by independent trade unions which have already raised over 2 million tenge. In private conversations with those who are connected with the trial and are willing to help the doctors, they say there is little hope that the appeals may help. As a result the southerners keep to the beaten track and slowly, secretly buy up the convicts from prisons to transfer them for a settlement. It is only rumor, though, with no assertion.
It’s a systemic crisis
“If it were not for the HIV, there would’ve been another outbreak”
Investigation has not yet answer the question of how children were infected. However, it looks as if everything is clear for the state, after all, several convicts are in prison. So, the wave of public disturbance can be directed to them. But what if one tries to look into the situation unofficiously? What if one just talks to the doctors… It turned out to be rather a complicated matter, even provided complete anonymity.
- Mud has already been thrown on us anyway, what for should we once again turn back to this topic,- that was the main leitmotif of refusals.
But still there was a man who agreed to talk about it. Natalia - let’s call her so – a doctor with 15 year experience. However, half a year ago she left the “dear-to-the-last-nail” hospital and now she is successful in business in representation office of a large pharmaceutical company.
- Causes of infection? Let the investigation team try to determine them. What I’m telling is that it’s a crisis of a system itself. And if it were not for the HIV, there would’ve been another breakout.
- But what is this crisis about?
- Essentially, even during the soviet rule our medicine was not ideal and the doctors were secretly paid for treatment. However, at that time remuneration was paid after recovery. And now money is demanded in advance. But I understand these people. In the developed countries worldwide doctors are one of the most well-to-do categories of population, while here it is one of the most poor. And there are still nurses and hospital cleaners. They are paid even less. Now let us add to it the system of employment which exists in the province. It costs 10 thousand to get fixed in a job as a hospital cleaner and 20 thousand as a nurse. Otherwise the head physician will hire his relative from the village for the job of a nurse. She somehow graduated from the medical school. Literally she can do nothing. But it is necessary to hire her. There would have been some excuse if she tried to learn something in practice. But she does not even want to do this, for she knows who stands up for her. One can expect anything from such a nurse, and no doctor is able to keep and eye on her. Everyone knows about this system and keeps silence, if once you speak, you’re fired, the pretext will always be found. And one more thing to say. We were really in shortage of subclavian catheters for some time. It can not be used twice, but what should we do if there is a danger that a patient may die? So we ran risks. And the shortage was caused by the fact that public health department failed to calculate something. And I would really refrain from talking about blood donors. Here is and example, though. There is such a concept as emergency indications. Failure to transfuse blood promptly may result in a patient’s death. In such cases direct blood transfusion is applied. We were only able to determine blood group, and did not check anything else. In that way one father “presented” syphilis to his son.
I tried to find additional confirmation of what my interlocutrix said to me. For example, about donors. Here is what I found in the Internet.
“According to the “The Caravan“ : “...А 29-year old male donor was trying for the last time to donate blood in February this year. The test has shown a hepatitis virus and he was dismissed from blood donation. However, the following test for HIV-infection, the results of which were received in July, showed positive reaction of this donor’s blood for HIV-infection as well. In the course of epidemiological investigation it was also established that at least one of the infected children in question previously received blood from this donor. Presumably nine more children could have received donor components from the same source. It is established that a man is an intravenous drug user”. And how, then, about the statement that no infected donors were detected during the examination in the blood transfusion centre?
A year ago, when assuming office of the province akim, Umirzak Shukeyev said optimistically: “If the number of HIV-infected remains at the same level (55 at that time), then it will be possible to consider that the infection is localized”. Now the number of such children is over 140, and the akim in the province is changed and localization of the outbreak is hardly ever spoken about.
But at the meeting of the province HIV control headquarters the statements of parents are heard periodically which only reconfirm the thesis of systemic crisis in medicine. One of the relatives told that in the case reports/medical cards/ of many infected children the pages with prescription of blood transfusion are torn out. The members of the initiative group of parents of the HIV-infected children stated at the headquarters’ meeting that according to their data in recent interval of time about 80 children died in the hospitals of the town. The diagnoses varied from pneumonia to cirrhosis.
Meanwhile, the rate of HIV prevalence not only in Shymkent, and not even in Kazakhstan, but in the entire region, has already aroused alarm of international institutions.
For the first time the problem of HIV prevalence became the central subject of International Parliamentary Conference held in Kyrgyzstan. The Word Bank representatives published their data on the number of infected people in the territory of Central Asian states, which were part of the USSR. In the opinion of the WB one can, today one can say that Central Asia is experiencing the HIV/AIDS epidemic notable for its blistering rates of infection spread. According to the US Center for Disease Control estimate, around 90.000 individuals in the region are HIV-infected», – believe the World Bank experts.
The economists draw attention of the governments to the global experience testifying to that the measures to combat HIV if taken at the earlier stage help to avoid huge costs in future. “The uninhibited spread of infection in Central Asia during the next decade may cause economic growth rate slowdown by nearly 20 percent in Uzbekistan and 10 percent in Kazakhstan and Kyrgyzstan. On a regional scale the epidemic may lead to the annual decline of economic growth at the level of 0.5 to 1 percent which will strike all sectors of economy, from oil and gas and finance to agriculture, from industrial giants to small enterprises”, – forecasts the World Bank.
The experts rightly believe no one single state alone can cope with this disaster. At the same time, it will also be impossible to localize the dreadful infection within the bounds of any territory. The World Bank suggests to establish a single high level (not lower that the government) coordination body and a single HIV/AIDS monitoring and evaluation system. It is assumed that timely, due and objective information will allow to carry out efficient preventive control.
The former president of the fund “Protection of children from AIDS” Sagdat Mansurov heard the word “AIDS” when the his grandson’s laboratory test results turned out positive.
- I just start to realize that this disease is not that dreadful as the virus of human corruption. It’s all because of money”, - he says.
It is officially alleged that any attempt to find at least one infected donor failed. But the journalists of one of the Kazakhstan publication have found some Zuleykho Sultanova.
Further we cite from the Internet: “This woman was stopped by militia in Kyrgizstan. She needed to go to Kazakhstan, but she had a problem with documents. Some enterprising people immediately offered her to solve the problem: if you want to cross the border, you either pay money or donate blood. The money she had was not enough and Zuleykho was compelled to be a donor.
“They poured everything in one jar. I said to them: I had hepatitis earlier, and jaundice. They said to her: it’s our problem”, - tells Sultanova.
After the procedure Zuleykho entered to Kazakhstan unimpeded. She does not know who used her blood. The Shymkent drug users and drunkards confessedly say in search of money for a bottle or dope they wouldn’t go just anywhere, but to the blood transfusion station. “They should pay 1700 tenge for 200 gram, but they just pay 200”,- they say.”
The data on the number of infected in the province always change, but it is believed that 67.7% of them were infected through blood, 14.6% by sexual transmission, 8.6% are anonymous individuals. At the same time the trend is observed towards the increase in numbers of those infected through sexual transmission and the numbers of infected women. The largest age group of 20-29 year olds accounts for 37%. 31.1 % of total number of carriers in South Kazakhstan Province falls on prisoners.
There are more questions that answers
30% of HIV-infected South Kazakhstan children were infected through the donor’s blood. But investigation bodies did not establish any violations in the work of hemotransfusion center administration.
Now, when the investigation is coming to completion there are more questions than answers to them.
And still odd things are coming to light when one tries to analyze one or another case in the course of time. Investigation of a case of HIV infected children has been lasting for over a year. The doctors are already convicted, but the source of infection still has not been determined. Meanwhile, when looking through the Internet information placed a year ago, one can come across perfectly definite statements on the issue.
“As it turned out, the first 50 infants were infected in the resuscitation ward of the children’s hospital of South Kazakhstan province, where they were treated for other diseases. 15 investigators from different force agencies are now handling a dozen of cases at a time.
“The transcripts of interrogation establish that it was very easy to buy the required portion of blood in the hospitals for 700-2000 tenge”, - says the Prosecutor of SKP Marat Akhmetzjanov.
700 tenge equals roughly five dollars. Those who were selling blood to the parents of the sick children for this money are arrested by now. But in the Office of the Public Prosecutor they say the cause for the HIV tragedy lies not in the donors only. The blood was not placed in quarantine and there was a problem with sterility of medical instruments either».
Now, when the investigation is coming to an end, no one would allege anything so much categorically, and there are still much more questions than answers. How the investigation of a case unprecedented for Kazakhstan is being carried out? That’s what we spoke about to its direct participant, chief of Organized Crime Investigation Division of Investigation Department, Investigation Office of the DI (Department of Interior), SKP, major of police Bolat Yelmurzayev, a member of the General Prosecutor’s Office investigation group.
- Bolat Saparkhanovich, how is this so much uncommon investigation being carried out?
- On July14 last year the Office of the Public Prosecutor commenced a criminal case and it carried out verification of facts of infection – first of 13 and later on of 14 HIV-infected children in SKP. After the case was brought to DI SKP the investigation operations group was immediately established. In the course of investigation interrogations of the victims and witnesses were conducted. Various forensic examinations were carried out, including combined medico-legal, handwriting examinations, genetic typing, etc., many types of expert examinations both in the territory of our province and in Almaty, Astana. Later, because of the public resonance and the increase in number of infected children investigation group under the leadership of the Vice-Prosecutor General, senior counselor of justice of RK Torekhan Aday. The group membership included investigation operations staff of DI SKP, SKP DCNS (Department of Committee of National Security?) RKДКНБ РК, financial police. As a result the group membership increased up to 30. The current number of members is fewer. The criminal case was finished, brought to the court, and the charges were brought, 21 officials were convicted and the verdict entered into force.
- Nothing was mentioned at the trial about the causes of infection and the extent of guilt of doctors. Vast majority of them was convicted on the grounds of the article on negligence…
- The convicts were mainly incriminated in negligence, but there were other articles in accordance with which charges were brought as well. Any individual, including medical worker, when he/she gets fixed at job shall sign a paper of official responsibilities and work in accordance with it. A nurse, a doctor, a manager of the unit, head physician assistant – all have their functional duties. Naturally the head physician’s ones are to keep an eye on everything. The assistant’s duties include supervision of treatment and prevention work, for example, regarding maternity, and many other duties. Same applies to the managers of units and doctors. Every health worker should follow his/her functional duties and work conscientiously. During investigation numerous violations, non-fulfillment and negligence of their functional duties were established. For these reasons criminal proceeding were initiated against these medical workers as children were mainly infected as a result of negligence of medical workers to their duties.
- Sounds a bit vaguely. And still, how about determination of the source of infection?
- Of course, logically one can find the source of everything, but in this particular case the investigators or operational staff are not specialists in the sphere of public health or AIDS, therefore we got specialists in various spheres to take part in the investigation. There were quite a few specialists from the republican and province AIDS Centers. The main responsibility to determine the source of infection was entrusted to the medical workers, the specialists. The work was also complicated by the fact that the infection happened a long time ago and it’s impossible to precisely specify to the day and to the month when the infection started. Because according to the literature there is an incubation period and many other things. In this connection it is impossible to determine specifically the date and time, and it is still a question which child particularly was the primary source. Such research is not carried out in Kazakhstan, therefore we approached a number of competent bodies. In this case my opinion is that the source of infection should be found by the specialists, and then on the basis of their findings we should detect the source, investigate further and determine the guilty participants.
- Did you refer to any world experience in the investigation of cases of the kind?
- Of course, we did. In the very beginning of investigation, as this case was the first one in Kazakhstan, especially since it produced such public resonance and is under the control of the President, we referred to any literature that has any relation to AIDS knowledge and HIV-infection. We even searched for information and articles in the Internet, we “shoveled” a lot of medical literature, we read it ourselves. We referred to the experience of Russian colleagues. There were such facts in Russia and in Libya. We paid attention to the tactics they used in the investigation of criminal cases, what investigative actions they conducted. Just as a matter of adopting experience. Otherwise, for the most part we conducted investigative actions jointly with and under the leadership of the Office of the Prosecutor General, therefore I think we are the pathfinders in the republic. Now we are asked how to handle such cases in other provinces.
- What investigative actions were conducted?
- Well, what we paid attention to was what questions to ask. What shall be of particular interest for the investigator during interrogation of the victims. Not just the circumstances in which they got the infection, but other things as well. That’s what we paid attention to.
- Would you, please, draw an example?
- There are quite a lot of questions, for example, about the source of infection – where from, where were the patients treated, for how long were they hospitalized? Altogether there were a lot of questions. But it was not the main base of interrogation. In general the investigative actions were conducted in conformity with our legislation.
- Initially in all the officials’ statements regarding those guilty in the tragedy the leadership of the hemotransfusion center appeared. Why they were not present at the trial?
- By the time the case was finished almost all donors were examined, interrogated by the investigation operations group. The reason why I say “almost” is that with the increase in number of infected children that of donors who need to be examined increases, too. Each person, each child, of course, has its donor. At that time there were 78 children, and now the number is 145. By that time all donors were examined. After the interrogation they were necessarily sent by our officers to the province AIDS center, where the specialists took blood samples and conducted examination. There was no a single case of detection of the HIV infection by that time. In the very beginning a criminal case was commenced in respect of the former head doctor of hemotransfusion center Sedinov. But as there was nothing to impute to him, as all donors were examined and HIV test results were negative, criminal proceedings were not instituted against him.
- Let us recall once again on what articles the doctors were convicted.
- The officials – namely the head of the unit, head doctor’s assistants, head doctor, chief of department and his deputy – were arraigned negligence. In addition there were articles on fraud which was fixed at the moment of selling blood to the parents of HIV-infected children, in other words, they were deceived and sold blood in a fraudulent manner. Although actually under the government program the blood should be provided free. The same is true when the doctors or officials were taking bribes. They were charged on the article of bribery. We also brought to court a case of acceptance of unlawful honorary/gratification/ by those who are not the officials. Mainly on the articles of “fraud”, “negligence”, “acceptance of bribes”. For example, “unlawful honorary/gratification”, article 224. That is when the doctor, while being an official takes money from a parent for providing health services, although these medical services are free. This article is applied when there is a fact of extortion on the part of the medical worker. In other words, the medical worker puts a parent in such conditions, where the parent is made to pay money. All this is proved during the investigative actions: interrogation of witnesses, victims, confrontations, verification of testimony on the spot. We only brought such charge when a few persons were testifying against the doctor, we ran investigative experiments and compared testimonies and facts.
- The culprits are convicted. Why the number of HIV-infected children is growing?
- You know, should the punished individuals acted conscientiously and in due time toward their duties, we wouldn’t have faced such fact of infection. It is still unknown when the first 13 children, whose tests showed HIV, were infected. These 13 children contacted with other children. It is quite possible that at that time infection spread to other children, and perhaps for this reason we see such increase. It is simply an echo of that infection. It is an echo of the facts for which 21 officials were convicted.
This is a bit strange talk that we had. Let’s draw our attention to the fact that the investigation did not establish any violations in the actions of leadership of the hemotransfusion center. Not even the notorious negligence. Although many believe that all troubles are caused by it. However, the statements of drug using donors or assumptions of the pressmen is one thing, and the results of official expert examination conducted in Atlanta is а totally different thing.
According to the provisional data of Central Asia CDC Office, around 30% of HIV-infected children in South Kazakhstan were infected through donated blood. “As of today one can firmly state that around 30% of infected and examined children were infected during blood transfusion”, - said Director of Central Asia CDC Office Michael Favorov at the press conference. “One and the same portion of blood was divided into several portions, however, it is not improbable that in the course of short interval of time, just several days, one and the same individual donated blood and several children became infected”, - he explained. Later, according to M. Favorov, the following mechanism of spread of infection was actuated: “The children infected through blood served as a trigger. Now the infection spread further to others because of stay in the hospital”. “As you know, according to research subclavian catheterization ranks second”, - he explained to the journalists. The CDC Office Director believes there exists the third factor as well – duration of stay in the hospital. “The longer the child was staying, the more contacts he had through the medical instruments. It should be taken into consideration that the doze is very important. If a child receives a small doze injection, subcutaneous, he is not infected. In other words, he may wait until the point where he receives a large quantity of virus, and then he will fall sick”, - explained M. Favorov. He stressed that studies of the channels of HIV-infection of children and their mothers are not yet completed. “The work on the material is still underway. Not all are examined. The material is very complex for the examination. In order to show diversity of viruses it’s necessary to study 250 nucleotides. In order to show that they are identical it’s necessary to study one thousand nucleotides. That is why it is a very complicated investigation both in terms of time and technique”, - he explained. Talking to correspondent of the agency M. Favorov said that “concerning the issue of channels of infection “a child – a mother” one can firmly state that infection in the samples available passed from a child to a mother”. In the opinion of M. Favorov, final results of analyses of the HIV-infected children carried out in the CDC laboratories in Atlanta, can be expected not earlier than after three-four months time.
So, it looks as if investigation by medics is more a success that that of the policemen. Although it is not yet completed, there is firm belief in some things. 30% of infected children is about 50 children infected through donor’s blood. But no negligence was detected by the police in the work of the former leaders of the hemotrasfusion center…
Nomads because of disease
Landlords request to leave rented apartments when they find out that the child is HIV-infected
It is very difficult to draw them out, these people have a feeling that no one can help them, and it also seems to them that nothing worse may happen. They only have hopes. They rest their hopes on the Most High, on the aid by the state and the relief fund for the HIV-infected children. One can meet them exactly near this fund. But to talk to the journalist they ask to go aside with them. For some reason they fear that someone from the fund may see them and, suppose, will not give the money or cease their aid at all. It’s incomprehensible where this fear comes from.
My interlocutors are slightly over thirty. They are from the village. They rent a flat in the town. Following further is a simple-minded, unsophisticated monolog:
- We are now changing the sixth flat. When landlords find out that child is HIV-infected, they request to leave the flat. Therefore we conceal it, but sooner or later they get to know. Today we came to the relief fund for HIV-infected children headed by Kanat Alseitov. The fund promised to give money – 1.5 million tenge. But today we found out that only 1 million tenge will be allocated. They say that the amount is less because there is not enough funds for all and besides us there are other newly HIV-infected and their number is growing. We have once received 1.5 million tenge. But now to get this money we’ve been coming here for two months. Today, at last, we’ve been told that our name is on the list of persons who will receive 1 million tenge. Total of 13 names. We were also promised allotment of flat, but we haven’t still got it. We’ve been offered a plot of land in the micro-district “Dostyk”. But we have no money to build a house. And then, they offer a two-room flat in the cottage for 4 owners, but there is no gas there. In addition, our family is big and there won’t be room for all of us.
We are told in the fund that we ought to be grateful to them, because it is only thanks to the work and effort of the fund that we receive aid. Otherwise we would have already died.
Our child in recent time more frequently fells sick. Twice a month we go to the in-patient hospital. One can not stay for a long time in the hospital because of the shortage of beds. The doctors say the number of patients grows and the number of beds is not enough.
We are provided treatment for free. The conditions in the hospital are good. But we buy vitamins and some medications ourselves. The parents were also told that pension will be paid at the amount of nine thousand tenge. But we have to collect a lot of references. We have not received any pension so far.
That’s the way a certain aid is being provided to the families of HIV-infected children, although it is beyond any comparison with compensations paid to their Libyan fellow-sufferers.
However, it does not agree with the statements of the Minister of Public Health Anatoly Dernovoy that “the quality of life of those children who will receive treatment will be high and their future should not arouse anxiety neither in parents, nor in a child himself”. The Minister also said: “Today socialization with the HIV-infected child does not pose any threat to those around them. If a child receives treatment, the level of virus concentration is such that it does not cause any clinical manifestations in the organism”. But those around them still fear and it is not the Minister to blame, simply nothing can be done about it.
The victims’ families demand accommodation in the province center. It’s not only troublesome, but dangerous for children’s health to bring them twice a month to Shymkent. Initially they were offered accommodations in the micro-district “Dostyk”, which was build specifically for the low-income people in the west outskirts of Shymkent
- The day before yesterday I went to look at it, I saw ruins, not houses there, - said the father of one child to the journalists,- The plaster peels off. No light, no toilet, no fence. There is nothing there. Just rubbish. How are our children supposed to live there? It is difficult even to get to the hospital. It’s better to bury us alive than to allot such dwelling.
The authorities are sort of doing what they can. The decision was taken on allocation of financial compensation for travels from the villages to Shymkent at the amount of 22.200 tenge to cover fare, accommodation and meals. For the Shymkent families compensation amounts to 14.200 tenge. The province ex-akim Umirzak Shukeyev at the meeting of the committee on localization of infection offered quite an original idea: “Assign children to entrepreneurs. They always need help to find a car to go anywhere, especially from the village to the province to visit the doctor or to seek legal advice”. Even a memorandum of sponsorship of HIV-infected children was signed with the South Kazakhstan brunch of republican union of entrepreneurs “Atamaken”. According to this document, entrepreneurs undertook to provide regular aid to such families. However, no one could tell its real size.
In the end everyone goes to the fund for HIV-infected children to get aid. We dropped in, too. Decent room with no luxury and repairs, with two chairs and lock box of a soviet manufacture.
The chairman Kanat Alseitov is about forty. He himself is from among those who were in trouble one day. He became a manager of the fund at end September. Our talk turned out to be long. Therefore I will cite just the most interesting points.
- What is the real current situation with the children and their parents?
- Unfortunately many parents fail to fully realize the problem related to the HIV/AIDS disease. They fail to understand it in a way that it is not merely a disease, but a problem of social nature. Thanks to akimat of the province. They do their best to provide as much aid as possible. Here, for example, on the basis of sanatorium-preventorium “Mother and child” a hospital was built which is specifically designed for our HIV/AIDS infected children. The doctors comprehend the problem, they have a will to work, but now it’s necessary that the parents duly understand the problem, too, and participate in this work. I myself study, I always study, read books, and I came to a conclusion that once a person falls sick with such disease, he goes through six stages: failure of physical tonus, onset of anger, then apathy, haggling, depression and the last stage is comprehension. I can tell you from my experience. A year passed, and I’ve just now came to understand it. There was everything, including anger at doctors and all that. But now I came to understand that life continues and one has to live on. One has to find oneself in this life so that children grow up and become full-fledged citizens of the community. There are also problems of discrimination of such families in the society.
- Would you, please, explain what is particularly that the parents do not understand?
- Well, now we have new families with HIV-infected children, about15 families. These are the families which received the HIV diagnosed status two months ago. They are now in shock condition. They are now at the stage of anger, depression. We’ve already spoken at the meeting of the committee in the province akimat, we said that first of all they need psychological and social support. I try to deliver the message to the leadership that if a family and the child gets the HIV-infection status, as early as the next day the team of psychologists, social workers and akimat officers should go to visit the family. All aspects including social, should be discussed, so that the people feel support. Unfortunately this is not the case at present. Yes, different teams and groups under the province akimat have been created, but this work will not be duly carried without financial support. But now I’m pleased to know that the funds for this undertaking have been allocated starting from the next year. In other words, there will be finance for the groups which will include psychologists, sociologists, akimat representatives and other specialists. They will have to visit the family at least once a week for the first two or three months and once a month afterwards. So that the family can feel that it is not alone and it is being supported.
- When the fund was in process of establishment literally everybody transferred money to it. It was a question of hundred million tenge, and how much money do you have now?
- At present the remainder amount is about 19.5 million tenge and there are now more 12-15 new families waiting for aid. So, each dispensing in our first tranche was 1.5 million tenge and later we dispensed in 1 million. And now an issue will be raised to dispense in 500 tenge, because practically the money we have is not enough. But we still have to reserve some money for the office development. So, these are financial difficulties we have. Negotiations were conducted already with the province akimat on providing assistance to the fund. We work on the involvement of donors as well. We will participate in programs providing grants. But there are still few specialists, there are practically no specialists. At present we approach businessmen for assistance, because 130 children is a big burden as we deal not only with children, but with the family itself. There are a lot of NGOs and institutions, I use to tell all of them “I’m your partner because I’m not going to compete with any of you”. It is not a secret, after all, that there is some unsound competition among the organizations of this kind. If occasion arises, I’m ready to give up this job if there is someone who wishes to do it, or otherwise come and help. Just the other day I spoke to one organization which is somehow connected with the deputies, they want to help, to provide psychologists. Well, of course, if psychologists will be available, I would like the doctors talk to them first and only afterwards let them go to families. Because there are serious, distressing situations and “difficult” families. Frankly speaking, at times it’s difficult even for me to understand them. There are all categories of society among 130 families. At present there are even the families of state officials and the deputies. To be sincere, we’re even “glad”, because now, perhaps, it will get things moving forward. Because these are such families, after all, they will be interested themselves.
As far back as year ago, under Shukeyev, I kept saying to them that the trouble may knock at anybody’s door. We have to be prepared in order to meet it with dignity and show the door to it. In reality it’s a hard thing for me to do. It’s a hard work load, I do it just for reason of circumstances. I have my own brokerage firm, I’m a custom-house broker. Now I think we will have to work hard for a year or two so as to get the society understand and accept us. So that there is no discrimination.
- And what do you think about the sentence of the court in respect of the doctors?
- I think the trial was objective and in my opinion the doctors were rightly punished. When I talked to the judge I was asking just for one thing, it is important for me that the court confirms the fact that my son was infected in the health facility, by medical workers. Thanks to the court I now have the verdict that HIV infection was introduced in the health facility, by medical staff. I demanded it so that to show this document to my son when he grows up and tell him that your mother is not a prostitute and your father is not a drug user, but it happened so and so. Now he is two and half years old, he does not understand it, but when he will grow up he will have questions to ask. In addition, there are also facts of bribetaking. There are facts of humiliation of parents by the doctors. That is to say, they drove parents into a corner and would not cure their children until parents bring the money. Isn’t it a mockery? For me personally there is one more problem, and it’s a moral one, and no one has presented his/her official apologies. No one except the President of the country. Now we are preparing to file an action for moral and financial damage. Actions will be files against the Department of Public Health of the province.
- Don’t you think that the hemotransfusion center remained aloof from the legal proceeding?
- According to the facts of investigation procedure all donors were examined and interrogated. They turned to be “clean”. You know that you, the journalists, were coming in and out from the courtroom in the middle of the proceedings, while there, at the sittings of the court, there were such things as people sticking out their tongues on us and making faces at us, but you didn’t see all that, though. It was very unpleasant. Well, it’s understandable, when people find themselves in such a situation they commit inadequate actions. For example, someone Auelbekov. Imagine, the sentence is being read out, he is convicted to 8 year imprisonment, while he is sitting and calmly puzzling out the crossword. Is it a kind of some stage of schizophrenia or has he already “set” everything and keeps sitting quiet? The parents of HIV-infected children were sitting in the courtroom and were scared. There was also pressure on the part of the defense lawyers of the convicts. We had a lawyer who served us for 60 thousand tenge per month. We had no possibility to hire a better lawyer. I myself hired the lawyer, a young guy. After three months he committed a suicide. The guy hung himself and the reason is unknown. A week before it happened he gave me a call and said he was not going to plead this case any more.
And one more thing: when my child was in a hospital I always bought baby’s food for him, and syringes and many other things as well, although it turned out that all the stuff was supposed to be provided for free. At present thanks to akimat we do not bring anything at all to the “Mother and child” hospital. All stuff is available there. Generally all hospitals should be like this one. There should be a prohibition on fetching food to hospitals. It turns out that money is surely allocated for everything.
- Is the source of infection found?
- One cannot find the source of HIV infection, it’s impossible. I talked to the member of the academy Pokrovsky and I called the Minister of Public Health in Russia, and I was told: “How can’t your Kazakhs realize that it’s impossible to find the primary source?” Blood is the source, and how it was introduced is another matter. The trial was conducted, and the sentence was not in favor of deliberated infection, article 116, although the lawyers were inclined to do so. There is no deliberated infection in this case, it’s simply negligence, article 316. There are facts that blood was sold without any sealed documents applied at all. The doctors did it. And it is proved. I talked to the parents of HIV-infected children, 50-60 children were infected through hemotransfusion, and the rest because of the negligence of duties.
Things are different with them
The Libyan “doctors’ case” was being investigated for 8 years. According to mass media reports, the victims’ families obtain compensation of 1million Euros annually.
The HIV infection outbreak in children in Shymkent is certainly not the first one in the history of this dreadful disease. In its time the similar situation in Russian Elista was widely covered in the world’s mass media. And not long ago the same happened in Libya. In order to gain an understanding of whether or not the actions of the Kazakhstan authorities were appropriate it is worth to look into how the situation was tackled in these two cases.
The HIV infection outbreak in Elista dates as back as to1988, when the HIV and AIDS notions per se were so much a strange and terrible exotic thing, though, for soviet people and no antiretroviral therapy used nowadays was simply not existent.
As of today 110 of the then 260 infected children have survived. These are the data of the Russian Federal Center for providing aid to AIDS-infected pregnant women and children (Saint-Petersburg).
According to the Center’s the data, 260 thousand Russian citizens, of which 60 thousand women, are HIV-infected. In Saint-Petersburg only, which population is 5 million, from 1987 on, about one thousand children were born to the HIV infected mothers.
It is in Saint-Petersburg that since 1990 the only special-purpose medical assistance center to help HIV-infected pregnant women and children in Russia is functioning (there is no such center in Kazakhstan so far). About one thousand adults and five hundred children have undergone medication therapy during 14 years. Twice a year little patients with their parents from all regions of the country come to the Center to help their organism in its combat with the mortally dangerous virus. A special unit for the “abdicated” HIV-infected children is established here, too. At present there are 30 kids aged 1 to 5 years there.
But let us get as far back as 20 years ago. At this point we are particularly interested in the causes of outbreaks of the dreadful disease and their consequences, including in the legal sense. In1988-1991 various versions for the causes of immune deficiency outbreaks were advanced, where it was explained by the consequences of environmental disaster, or marriages between relatives and introduction of unknown preparation/agent… And it was not easy at all, including psychologically, to establish the fact that it was an HIV infection in children. The doctors could just not believe it...
However, in the upshot Russian medics fixed a well-defined scheme that has led to the outbreak. “The first detected person was an HIV-infected female donor; it was detected that her child had AIDS infection and she got infected from him when she was breast-feeding him (through the fissure of the mother’s nipple and small sores in the child’s mouth, i.e. “from blood to blood”). At the next stage, after all contact children have been examined, over 70 HIV-positive children were detected, while all children who died in the hospitals in Elista showed apparent clinical AIDS symptoms. It became clear further that one deceased child was born to the HIV-infected mother. Her husband turned out to be sick with AIDS, too (a few years earlier he worked in Congo where he had intimate relationships with local women). So, in that way succession of events was drawn up: the husband, on his return from Congo, infected his wife and she gave birth to an HIV-infected child. The child infected other children who were undergoing treatment in the same hospital – through unsterile instruments (catheters, syringes).
Thus, over one hundred children were HIV-infected in Elista, some of which were transferred to Volgograd, Stavropol, Rostov-on-Don where the second wave of infection started. Many children were in grave condition as they were infected during treatment in the resuscitation unit”.
As one can see, the medics in Shymkent had detected nothing of the kind, although there were foreign consultants and a tremendous experience that has been accumulated in medicine during two decades.
In 1992 the Republican Clinical Hospital in Ust-Izjor near Saint-Petersburg where these children were referred to for treatment was established.
The HIV outbreak in Elista, Rostov and Volgograd in 1987 resulted in about 250 HIV-infected children in Russia. At that period of time it was over one half of total number of infected not only in the RSFSR, but in the USSR. However, this fact was not followed by any political and legal actions. The USSR’s legislation on AIDS of the 1990 showed no reaction to the real existing relationships in connection with infection of children with mortal disease in health institutions, i.e. establishing it a criminal offense. One had to wait for another four years until December 13, 1994, when amendments were introduced into the Criminal Code of RSFSR. Criminal legislation was supplemented with Article 222 establishing criminal responsibility for the violation of sanitary-epidemiological requirements which resulted in HIV-infection.
Now the medics building on the experience from treatment of those ill-fated children may make some long-term prognoses.
That is particularly what the Minister of Public Health of Kazakhstan Anatoly Dernovoy spoke about during his visit to Shymkent: “Children who suffered HIV-infection twenty years ago in Elista have now found normal families, they have borne healthy children, at that it happened in conditions of the level of providing medical care that existed at that time and in the absence of highly effective medications that are available nowadays”.
Indeed, for a long time the children who were infected at that time were only provided social support. 10-12 children died annually. Now such children are cured. Two girls who in the old days were infected have recently borne perfectly healthy kids.
The Elista outbreak was demonstrative of a well-defined definition of the infection scheme, whereas the outbreak in Libya was covered in the world’s mass media primarily in terms of its legal consequences which could have been very serious.
Let us remind that the Supreme Court of this country with its very peculiar, in fact dictatorship-type structure of power masked with democracy, took a verdict of guilty of intentional infection of children with HIV to five Bulgarian nurses and a Palestine doctor. The sentence was death penalty. The sentence was passed in July 2007.
The Libyan “doctors’ case” was initiated in 1999 when five Bulgarian nurses (Kristina Vulcheva, Nasya Nenova, Valentina Siropulo, Valya Chervenyashka, Snezjana Dimitrova) and the Palestinian doctor Ashraf Al-Khadjiadje were arrested. They all worked in one of the hospitals in Benghazi where сases of mass HIV-infection of children were detected, later they were found guilty of intentional infection of 438 Libyan children through the transfusion of infected blood. 56 of these children died. In the course of the whole proceedings the medics kept stating that it was a question of tragic fortuity.
Having shoveled piles of sites with the information on Libyan case, I still failed to find at least a single story on how the investigation was conducted and an on what grounds the medics were found guilty of intentional infection of children.
The only thing I managed to clarify was that as a result of the long judicial proceedings in May 2004 the court sentenced the convicts to be shot. But under the pressure of international public opinion in December 2005 the Supreme Court of Libya admitted the presence of blunders in the course of investigation, allowed the appeal lodged by the lawyers and send the case for retrial. The retrial procedure started on May 11, 2006, but it was concluded in December with the same result: the court again brought the verdict of guilty and sentenced the medics to death.
It roused indignation of the world community which tried to put pressure on Libya to vacate a sentence. However, the Libyan Leader Muammar Kaddafi rejected the call for the revision of the sentence having stressed “the independence of Libyan judicial system”.
During the entire proceedings specialists from Bulgaria and other European states were insisting that the results of medical examinations speak of the innocence of the medics. According to the statements of experts in the field of acquired immune deficiency syndrome (AIDS), the HIV epidemic in Libya started long before the convicts arrived in the country. It was recognized, with difficulty though, in 2007 by the Libyan authorities as well. However, they stated that although it was not a malicious intent, but the negligence that caused the infection, Libya and the European Union should agree upon how the needs of the families of the infected children shall be met and to raise funds for the children’s treatment. Bulgaria, its EU allies and Washington established the international fund to collect money, purchase medications and collect other donations for the infected children and their families.
Finally the sentence of death penalty was changed for life-term imprisonment. On July 24 the medics were sent home to serve the sentence there. However, the President of Bulgaria signed a decree of presidential clemency. In the course of the proceedings the Palestinian doctor was admitted to a citizenship of Bulgaria and thus was saved, too.
Meanwhile the relatives of the infected Libyan children started receiving huge pecuniary compensations. The families of the victims just received checks which could be cashed in the banks. Who pays compensations to the Libyan children-victims is still a puzzle. And the exact amounts are unknown, too. The amounts most often mentioned in the mass media are about one million Euros per family.
Thus, the Libyan outbreak was very sharply defined in the legal field. Whether or not it was righteous, but the medics were tried just for infecting children, but for nothing else, unlike in the Shymkent trial, where the causes of infection were not even mentioned. The amounts of compensations to the families are very impressive as well, the southerners have never ever dreamt of such money.
Now here are the three dreadful HIV outbreaks in three countries with such different outcomes. In the USSR and later in Russia the causes of outbreaks were clearly defined. In Libya the trial was conducted as a result of which the medics were let free and the victims’ families obtained compensations which will provide them with the means of subsistence for the rest of their lives. However, neither was done so far in Kazakhstan.
Alexey Goncharov. With materials used from INTERNET sites.