When in the late 1990s an intrahospital epidemic in Benghazi, Libya resulted in infection of about 400 children with AIDS, I thought that I'd wish to popularize what we know about this disease and to devote these texts to the Benghazi victims. Since I started this blog, I have written many times to defend the Bulgarian medics accused in spreading the virus (see my posts with label "HIV trial in Libya", the latest of them here), but never to educate. I even thought that I need not write educational texts about AIDS because there are already many of them written by other, more competent authors. Now, however, I am going to write at least one such post.
These days, Indian journalist Rupa Chinai wrote on the WIP site a series of three articles about the AIDS situation in India. Intelectual honesty requires that I link directly to my opponent's writings, but I am unwilling, because I find their contradiction to the best available AIDS knowledge too dangerous if used by somebody as medical advice. Rupa has talent and compassion and presents real problems, such as the massive supply of bogus AIDS diagnostic tests giving false results and the inability of Indian health care system to control (and even monitor) properly the spread and progression of AIDS. However, she is also highly critical to science (which she calls "Western" science) and particularly to current scientific consensus about AIDS and the so-called by her "AIDS lobby" - a loose association of researchers, pharmaceutical companies and Western government agencies as well as international ones such as UNAIDS. Taken together, these convictions lead her to AIDS (HIV) denialism. Actually Rupa claims only to be unbiased observer of the debate between mainstream scientists and "the dissidents" (as denialists prefer to call themselves), but her preferences to the latter seem clear to me; and even if she was truly standing in the middle, this would be enough to me to regard her as belonging to the other camp, exactly as I regard Sarah Palin's wish to teach both creationism and Darwinism as indicative of her being a creationist, though she doesn't insist Darwinism to be thrown away from school.
Thinking what arguments to put forward in favour of the HIV causation of AIDS, I first wanted to point out that anti-retroviral drugs significantly increase the life span of infected patients. However, after reading Rupa's third (last) article, I was happy that I hadn't talked about the drugs, because it featured a group of HIV positive women who had lost their husbands to AIDS but remained in a reasonably good condition for many years by adhering to a healthy lifestyle, adequate (to their opinion) nutrition and "traditional" medicine. While I am glad that these women do so well, I think that they would do even better (and longer) on anti-retroviral drugs, and hope that nobody follows their example. Contrary to what these women, their so-called doctors and Rupa think, it is easy for the "AIDS lobby" to explain their cases: the "bright" period between encountering HIV and developing an AIDS-defining illness varies much between individuals and is 10 years on average. For the women in the report, this period has been so far 12-14 years, which doesn't differ dramatically from 10 years. So they seem just to have longer than average "bright" periods. I bet that other HIV-infected Indians have followed the same strategy but have had shorter than average bright periods, as the elementary calculus of mean values requires. These people, similarly to many Africans, have paid with their lives for the decision to be natural, traditional and non-Western and now aren't around to tell Rupa their stories.
I also wanted to refer Rupa to the Layperson's Guide to the Scientific Literature, published by Prometheus in three parts (1, 2, 3). However, it would hardly be of any use to her in this particular case, because AIDS denialists (similarly to other knights of anti-science and pseudo-science) are characterized by persistent absence of any works published in the peer-reviewed scientific literature; instead, they talk directly to the science-doubting lay public. I am sure that members of the public regard the poor scientific record of "dissidents" as proving not their incompetence but suppression of these good guys by the conspiring big bad "AIDS lobby". Turning one's own incompetence and professional impotence into virtue - what a feat! Why don't these people make careers as PR experts?
So let me return back to basics in my search for arguments. 19th century German microbiologist Robert Koch established four postulates for proving causal relationship between a particular microbe and a disease. Namely, the microbe must (1) be found in all organisms suffering from the disease, (2) be isolated from a diseased organism and grown in a pure culture, (3) cause disease when introduced from this culture to a healthy organism (typically an experimental animal) and (4) be isolated from the inoculated, diseased new host.
In the early years of AIDS research, scientists had problems with the 3rd and 4th postulate because HIV is highly host-specific and common experimental animals are resistant to it. In the late 1980s, three lab workers were infected with a pure, defined HIV strain by accident. They became HIV+ and developed AIDS. As Jon Cohen writes in top scientific journal Science in 1994, this incident alone means fulfilling Koch's postulates for HIV causation of AIDS. However, as noted in the same article, it failed to convince HIV denialists. Is anybody surprised? And can we expect any anti-scientist to change his theories when confronted by contradicting empirical data? After all, if anti-science people would allow their opinions to be influenced by facts, they wouldn't be anti-science, they would be pro-science.
Also in the 1990s, Koch's postulates were also proven using as experimental animal the chimpanzee, which is the natural host of HIV-1 (see Tim Teeter's article HIV Causes AIDS: Proof Derived from Koch's Postulates). Another animal model are immunodeficient mice "humanized" by grafting human immune cells. These mice are susceptible to HIV infection and special measures are needed to prevent them from dying within 1.5 months (Watanabe et al., 2007).
In his post Age of Unreason Prometheus wrote, "Much of “alternative” medicine encourages people to abandon scientific principles that have brought us in the West to a level of health and longevity that are unrivalled in human history. If we want to see what happens (when science is abandoned), we only have to look to those parts of the world where – for economic or philosophical reasons – scientific medicine is unavailable." Like Prometheus (and unlike Rupa), I think that "Western" science cannot be blamed for the poor life quality and short life span of people who are either prevented from accessing its fruits or, alas, reject them by deliberate choice.
Showing posts with label disease. Show all posts
Showing posts with label disease. Show all posts
Monday, December 15, 2008
Friday, November 07, 2008
On the stem cell controversy
Let me begin with a quote from Maria Rossbauer's report Unproven stem-cell therapy ban published in Nature journal on Aug. 20:
"The Bulgarian deputy minister for health has resigned over the country's decision to ban the use of a controversial stem-cell therapy to treat neurological disorders. The therapy, which since 2005 has been carried out on around 250 patients at St Ivan Rilski Hospital in Sofia, contravenes European Union regulations and is of unproven value, the Bulgarian health ministry ruled on 8 August."
Subscribers to Nature can read the whole text here.
I wasn't going to blog about the stem cell controversy, after it had a relatively happy ending, but on Oct. 3 our Faculty Board decided to "condemn the unethical and unscientific statements of members of our community (Prof. Bobev, Prof. Svinarov, Prof. Kremenski) in the campaign against the (Department of) Neurosurgery on the occasion of stem cells". Bulgarian readers can find the protocol of the Faculty Board session here. The three condemned professors apparently blew the whistle and this led to banning the therapy.
I am not a doctor, let alone a neurosurgeon, but let me share my thoughts on the subject.
First, bone marrow contains hematopoietic and mesenchymal stem cells. Both belong to the connective tissue, which isn't close to the nervous tissue, so I think it isn't very likely for these stem cells to "convert" and differentiate into neurons. Therefore, to my opinion, this low probability hardly justifies injecting bone marrow stem cells into the brain or the spinal cord, which is invasive and (I guess) not 100% safe procedure. At least not until the treatment has been shown to work in an animal model.
Second, after this experimental treatment has still been given a try, I think that after a reasonable number of treated patients (much fewer than 250) the results must have been submitted to a peer-reviewed journal for publication, no matter whether they have been negative or positive. The team claims positive results - improvement in as many as 50% of patients. However, without a publication it is unclear whether this improvement has been detected in a "blind" manner (i.e. by people unaware of the treatment) or by the treating doctors or even by the patients themselves. In the latter cases of course we cannot distinguish real improvement from placebo effect.
Third, what I disapprove most in the story is that the patients have paid for the therapy. I think that people undergoing experimental medical procedures must never pay (in some cases they may ever receive payments).
Still, I wouldn't like to condemn anybody because I want to believe in the good intentions of all people involved. However, I don't understand why the Faculty members haven't given such a benefit of the doubt to their opponents. So I wish to express solidarity with the three condemned professors.
Thanks to the colleague who informed me about the above cited documents (you know who you are).
"The Bulgarian deputy minister for health has resigned over the country's decision to ban the use of a controversial stem-cell therapy to treat neurological disorders. The therapy, which since 2005 has been carried out on around 250 patients at St Ivan Rilski Hospital in Sofia, contravenes European Union regulations and is of unproven value, the Bulgarian health ministry ruled on 8 August."
Subscribers to Nature can read the whole text here.
I wasn't going to blog about the stem cell controversy, after it had a relatively happy ending, but on Oct. 3 our Faculty Board decided to "condemn the unethical and unscientific statements of members of our community (Prof. Bobev, Prof. Svinarov, Prof. Kremenski) in the campaign against the (Department of) Neurosurgery on the occasion of stem cells". Bulgarian readers can find the protocol of the Faculty Board session here. The three condemned professors apparently blew the whistle and this led to banning the therapy.
I am not a doctor, let alone a neurosurgeon, but let me share my thoughts on the subject.
First, bone marrow contains hematopoietic and mesenchymal stem cells. Both belong to the connective tissue, which isn't close to the nervous tissue, so I think it isn't very likely for these stem cells to "convert" and differentiate into neurons. Therefore, to my opinion, this low probability hardly justifies injecting bone marrow stem cells into the brain or the spinal cord, which is invasive and (I guess) not 100% safe procedure. At least not until the treatment has been shown to work in an animal model.
Second, after this experimental treatment has still been given a try, I think that after a reasonable number of treated patients (much fewer than 250) the results must have been submitted to a peer-reviewed journal for publication, no matter whether they have been negative or positive. The team claims positive results - improvement in as many as 50% of patients. However, without a publication it is unclear whether this improvement has been detected in a "blind" manner (i.e. by people unaware of the treatment) or by the treating doctors or even by the patients themselves. In the latter cases of course we cannot distinguish real improvement from placebo effect.
Third, what I disapprove most in the story is that the patients have paid for the therapy. I think that people undergoing experimental medical procedures must never pay (in some cases they may ever receive payments).
Still, I wouldn't like to condemn anybody because I want to believe in the good intentions of all people involved. However, I don't understand why the Faculty members haven't given such a benefit of the doubt to their opponents. So I wish to express solidarity with the three condemned professors.
Thanks to the colleague who informed me about the above cited documents (you know who you are).
Thursday, April 26, 2007
The HIV trial in Libya, part 5: Discussing unintentional infection
This is continued from part 4 (http://mayas-corner.blogspot.com/2007/03/hiv-trial-in-libya-part-4-how-infection.html). The end of the sequel will be devoted to the Libyans' attitudes towards the HIV case.
Although it is impossible to perform a real opinion poll in Libya, it is clear that most Libyans believe the accused in the HIV trial are guilty. This is reported by all foreign journalists and by the Libyans themselves. However, I think this seemingly homogenous public opinion is in fact divided into at least three distinct groups. Let me first address those Libyans who believe only in unintentional infection. (I don't understand why they are so confident that the police, even if wrong about the intentional infection, have found the right people; after all, inquisitional type justice systems like the one in Libya are known to routinely indict the wrong people even in very simple criminal cases. But let's not dig into this issue.)
The Libyan prosecutors, showing what Butler called stubborn idiocy, keep considering intentional spreading of HIV as the only hypothesis able to explain the epidemic in Benghazi. However, some ordinary Libyans, while believing that the police caught the right people, have come to the conclusion that the crime has most likely been of negligence. Two years ago, Highlander wrote, "I don’t want to believe that the Bulgarians could have deliberately given AIDS to Libyan kids" (http://lonehighlander.blogspot.com/2005/04/case-441999-story-of-bulgarian-medics.html). I'll try now to present the opinion of these Libyans.
"Let them acquit he lady who has never worked at the El-Fateh hospital, but I want the others punished. And, while I don't believe they acted intentionally, I don't mind them being sentenced as if they did, because the punishments for negligence are a joke, compared to what happened to the children. Even if you are right that they were picked randomly among scores of nurses and doctors doing absolutely the same things, they were caught and I want them sentenced. The Romanians may be happy to have a legion of infected babies and nobody punished - I am not. You described yourself how careless and good-for-nothing health workers spread HIV to every corner of Africa! I am sure this happened because nobody was ever held responsible. If several people are punished, hopefully the others will be more careful next time. Like Mark Twain, I think it is better to have one or a few innocent persons suffering than five hundred."
This viewpoint deserves respect, especially if free of the revengeful "I want somebody punished" attitude which too easily degrades into "I want anybody punished". The preventive, deterring role of the punishment, while somewhat unfair to the defendant in question, is a cornerstone of any justice system. However, will the guilty verdicts have preventive role? Will they send the right message to medics working in Libya?
No, they won't. First, if you don't prosecute people for violating safety rules, you cannot expect the sentence to force others to observe these rules. Second, prosecuting only foreigners will not encourage Libyan health workers to improve their work standards. Moreover, it will not have this effect even on foreign medics, because they know that if the Q-man needs them as scapegoats, he will get them, no matter how precisely they are working. Third, most important, all of the accused except Dr. Hajuj are nurses. As I commented once on Highlander's blog, "if there is something wrong in a hospital, it is the doctors' responsibility, not the nurses'. Doctors are better educated, paid and empowered than the nurses and have to supervise them." (https://www2.blogger.com/comment.g?blogID=5760993&postID=114306313998064632).
Let's imagine that back in 1997-98, a nurse had told her patients' parents, "Your child will need intravenous injections, so please leave him here and find and bring at least 5 sealed needles, because the ones we have are non-sterile and unsafe." Would the parents be grateful? Some would, but most would react by going around the hospital asking questions and complaining and the nurse would quickly go into trouble. Or imagine that during a break some nurses and doctors are making coffee, a nurse comes and removes the coffee from the heating plate in order to boil needles and syringes. "I want to be sure that these are sterile and won't contaminate our patients." Would her superiors praise her and her colleagues be inspired to follow her example? No, their reaction would be, "Who do you think you are?". And most normal people have very strong herd mentality and sense of hierarchy. They'll prefer to risk infecting others and themselves with a deadly disease rather than confronting the who-do-you-think-you-are attitude. Then, who could hope that the risk to be arrested and sentenced will scare them enough to overcome this mentality?
Let me also quote from the remarkable essay Silence kills by J. Grenny (http://www.duncanworldwide.com/cc/SilenceKills.html): "The recent deaths of Jessica Santillan... and Jeanella Aranda..., resulting from carelessly mismatched blood types during organ transplants, illustrate the tragic results of silence... People who should have been aware of the blood-type mismatches simply said nothing rather than challenge doctors to follow the standard double-checking procedures... Why nurses and fellow doctors did not hold each other accountable for existing policies that already required cross-checks to ensure the accuracy of blood types? The answer, unfortunately, is that most health care workers operate in a culture in which silence is the preferred response when physicians violate protocols... The tragedy, of course, extends far beyond Jessica Santillan and Jeanella Aranda. A culture in which health care workers fail to hold each other accountable contributes to some two million hospital-induced infections each year and results in tens of thousands of unnecessary patient deaths. For instance, a federal Centers for Disease Control and Prevention (CDC) study found that health care professionals wash their hands about half the number of times that policies require – a key factor in the spread of hospital-borne infections. The study probed whether redesigning the care environment through... more sinks available would help doctors and nurses to wash their hands when they should. The answer? It didn’t. What mattered most was whether or not the senior doctor washed his or her hands. Period. When the lead person set a bad example, not only did nurses, residents, and others not speak up, they fell in line – and failed to wash their hands as well."
Let's repeat: the key person was "the senior doctor". What happened to the senior doctors at the El-Fateh hospital who let the hygiene deteriorate to medieval standards? They were acquitted and cleared and can roam freely in their luxury cars, while five nurses and an ordinary doctor are hanging on death row. What message will this send to senior doctors of other Libyan hospitals?
To conclude: I think that even if Dr. Hajuj and four of the Bulgarian nurses have unintentionally contributed to the AIDS epidemic, their role has been quite a minor one, while those truly responsible got away with it. Punishing the "Tripoli six" will not give justice to the infected children. Neither will it help to prevent similar tragedies in the future or bring any good to the Libyan health care. We know from history that too many communities, when facing the onslaught of a deadly infectious disease, have reacted by losing their humaneness and doing irrational acts that could only worsen the situation. It is up to the Libyans whether to do the same or to show the reason and compassion that we hoped would characterize our age.
Although it is impossible to perform a real opinion poll in Libya, it is clear that most Libyans believe the accused in the HIV trial are guilty. This is reported by all foreign journalists and by the Libyans themselves. However, I think this seemingly homogenous public opinion is in fact divided into at least three distinct groups. Let me first address those Libyans who believe only in unintentional infection. (I don't understand why they are so confident that the police, even if wrong about the intentional infection, have found the right people; after all, inquisitional type justice systems like the one in Libya are known to routinely indict the wrong people even in very simple criminal cases. But let's not dig into this issue.)
The Libyan prosecutors, showing what Butler called stubborn idiocy, keep considering intentional spreading of HIV as the only hypothesis able to explain the epidemic in Benghazi. However, some ordinary Libyans, while believing that the police caught the right people, have come to the conclusion that the crime has most likely been of negligence. Two years ago, Highlander wrote, "I don’t want to believe that the Bulgarians could have deliberately given AIDS to Libyan kids" (http://lonehighlander.blogspot.com/2005/04/case-441999-story-of-bulgarian-medics.html). I'll try now to present the opinion of these Libyans.
"Let them acquit he lady who has never worked at the El-Fateh hospital, but I want the others punished. And, while I don't believe they acted intentionally, I don't mind them being sentenced as if they did, because the punishments for negligence are a joke, compared to what happened to the children. Even if you are right that they were picked randomly among scores of nurses and doctors doing absolutely the same things, they were caught and I want them sentenced. The Romanians may be happy to have a legion of infected babies and nobody punished - I am not. You described yourself how careless and good-for-nothing health workers spread HIV to every corner of Africa! I am sure this happened because nobody was ever held responsible. If several people are punished, hopefully the others will be more careful next time. Like Mark Twain, I think it is better to have one or a few innocent persons suffering than five hundred."
This viewpoint deserves respect, especially if free of the revengeful "I want somebody punished" attitude which too easily degrades into "I want anybody punished". The preventive, deterring role of the punishment, while somewhat unfair to the defendant in question, is a cornerstone of any justice system. However, will the guilty verdicts have preventive role? Will they send the right message to medics working in Libya?
No, they won't. First, if you don't prosecute people for violating safety rules, you cannot expect the sentence to force others to observe these rules. Second, prosecuting only foreigners will not encourage Libyan health workers to improve their work standards. Moreover, it will not have this effect even on foreign medics, because they know that if the Q-man needs them as scapegoats, he will get them, no matter how precisely they are working. Third, most important, all of the accused except Dr. Hajuj are nurses. As I commented once on Highlander's blog, "if there is something wrong in a hospital, it is the doctors' responsibility, not the nurses'. Doctors are better educated, paid and empowered than the nurses and have to supervise them." (https://www2.blogger.com/comment.g?blogID=5760993&postID=114306313998064632).
Let's imagine that back in 1997-98, a nurse had told her patients' parents, "Your child will need intravenous injections, so please leave him here and find and bring at least 5 sealed needles, because the ones we have are non-sterile and unsafe." Would the parents be grateful? Some would, but most would react by going around the hospital asking questions and complaining and the nurse would quickly go into trouble. Or imagine that during a break some nurses and doctors are making coffee, a nurse comes and removes the coffee from the heating plate in order to boil needles and syringes. "I want to be sure that these are sterile and won't contaminate our patients." Would her superiors praise her and her colleagues be inspired to follow her example? No, their reaction would be, "Who do you think you are?". And most normal people have very strong herd mentality and sense of hierarchy. They'll prefer to risk infecting others and themselves with a deadly disease rather than confronting the who-do-you-think-you-are attitude. Then, who could hope that the risk to be arrested and sentenced will scare them enough to overcome this mentality?
Let me also quote from the remarkable essay Silence kills by J. Grenny (http://www.duncanworldwide.com/cc/SilenceKills.html): "The recent deaths of Jessica Santillan... and Jeanella Aranda..., resulting from carelessly mismatched blood types during organ transplants, illustrate the tragic results of silence... People who should have been aware of the blood-type mismatches simply said nothing rather than challenge doctors to follow the standard double-checking procedures... Why nurses and fellow doctors did not hold each other accountable for existing policies that already required cross-checks to ensure the accuracy of blood types? The answer, unfortunately, is that most health care workers operate in a culture in which silence is the preferred response when physicians violate protocols... The tragedy, of course, extends far beyond Jessica Santillan and Jeanella Aranda. A culture in which health care workers fail to hold each other accountable contributes to some two million hospital-induced infections each year and results in tens of thousands of unnecessary patient deaths. For instance, a federal Centers for Disease Control and Prevention (CDC) study found that health care professionals wash their hands about half the number of times that policies require – a key factor in the spread of hospital-borne infections. The study probed whether redesigning the care environment through... more sinks available would help doctors and nurses to wash their hands when they should. The answer? It didn’t. What mattered most was whether or not the senior doctor washed his or her hands. Period. When the lead person set a bad example, not only did nurses, residents, and others not speak up, they fell in line – and failed to wash their hands as well."
Let's repeat: the key person was "the senior doctor". What happened to the senior doctors at the El-Fateh hospital who let the hygiene deteriorate to medieval standards? They were acquitted and cleared and can roam freely in their luxury cars, while five nurses and an ordinary doctor are hanging on death row. What message will this send to senior doctors of other Libyan hospitals?
To conclude: I think that even if Dr. Hajuj and four of the Bulgarian nurses have unintentionally contributed to the AIDS epidemic, their role has been quite a minor one, while those truly responsible got away with it. Punishing the "Tripoli six" will not give justice to the infected children. Neither will it help to prevent similar tragedies in the future or bring any good to the Libyan health care. We know from history that too many communities, when facing the onslaught of a deadly infectious disease, have reacted by losing their humaneness and doing irrational acts that could only worsen the situation. It is up to the Libyans whether to do the same or to show the reason and compassion that we hoped would characterize our age.
Monday, March 19, 2007
The HIV trial in Libya, part 4: How the infection must have occurred
This is continued from part 3 - the previous post (http://mayas-corner.blogspot.com/2007/03/hiv-trial-in-libya-part-3-tale-of-two.html). Here, I'll try to keep my writing as short as possible and to use instead citations from people who know better. Two important terms, used below, are iatrogenic - caused by medical procedures, and nosocomial - acquired in a hospital; both terms refer to health damage, usually an infection.
Let's begin from the beginning: decades earlier and thousands of miles away from the Libyan "crime scene", a virus found a new host. The following citation is from http://main.uab.edu/show.asp?durki=8535.
"Origin of HIV-1 Discovered
...Scientists at the University of Alabama at Birmingham (UAB) have discovered the origin of Human Immunodeficiency Virus Type 1 (HIV-1)...The researchers identified a subspecies of chimpanzee (Pan troglodytes troglodytes) native to West-Central Africa as the natural reservoir for HIV-1...The final piece of the puzzle was put in place when the researchers realized that the natural habitat for Pan troglodytes troglodytes overlaps precisely with the region in West-Central Africa where all three groups of HIV-1(M, N, and O) were first recognized. Based on these findings, Hahn and her colleagues concluded that Pan troglodytes troglodytes is the origin of HIV-1 and has been the source of at least three independent cross-species transmission events...While the origin of the AIDS epidemic has been clarified, an explanation for why the epidemic arose in the mid-20th century, and not before, remains a matter of speculation."Chimpanzees are frequently hunted for food, especially in West-Central Africa, and we believe that HIV-1 was introduced into the human population through exposure to blood during hunting and field dressing of these animals," says Hahn. She further believes that while incidental transmissions of chimpanzee viruses to humans may have occurred throughout history, it was the socio-economic changes in post-World War II Africa that provided the particular circumstances leading to the spread of HIV-1 and the development of the AIDS epidemic. "Increasing urbanization, breakdown of traditional lifestyles, population movements, civil unrest, and sexual promiscuity are all known to increase the rates of sexually transmitted diseases and thus likely triggered the AIDS pandemic," adds Hahn."
Dr. Hahn omitted one very important factor for spreading HIV: the health care system, which was practically not present in Africa until the 20th century. You think I am stretching my thesis too much? First, please read the following translation from the book "Sanu, bature" by Bulgarian zoologist Peter Beron. He describes his experience in Nigeria in 1976:
"Before returning to Bulgaria, we had to be immunized against cholera. There was a special immunization center in the town. However, before we went there, Dr. Malyavko (a Russian physician - M.M.) gave me three sealed disposable syringes and told me to insist that the local doctor uses them. I was hesitating - the doctor could be offended by such lack of trust. I went to the center with Kinka and Vladko (the author's wife and son, respectively - M.M.). In the street, there was an endless line. The doctor was sitting in front of the door and immunizing everybody with one and the same needle. These were prospective hajjis. They were preparing to travel to Mecca and the local Asclepius evidently thought that Allah wouldn't let any hepatitis creep into such pious Muslims. At that time, nobody knew about AIDS. Seeing us, the Asclepius called us and offered to immunize us immediately. I told him I had had polyo before and for that reason had to use a separate syringe. Vladko had been in contact with a person with hepatitis etc. The doctor showed full understanding. He unsealed the first syringe, injected Vladko, then injected Kinka with the second syringe and me with the third one. Then he, with my needle, continued injecting the long line of the candidate hajjis."
The case of the infected more than 400 Libyan children would be tragic even if it were exceptional, but unfortunately it isn't. We shall never know the exact number of AIDS victims throughout Africa and elsewhere whom medicine, instead of helping, failed, betrayed and doomed. The following citation (as well as others which I'll indicate by their PubMed identification numbers) is obtained from PubMed, a database of biomedical literature. PubMed abstracts and some full text articles can be accessed at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed.
Gisselquist D. et al. (2003). Let it be sexual: how health care transmission of AIDS in Africa was ignored. PMID: 12665437
"The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission... Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence."
Another work: Brewer D.D. et al. (2003). Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm. PMID: 12665436. The citation is from http://www.cirp.org/library/disease/HIV/brewer1/, where the full text of the article is given.
"A number of these observations raise the question of an alternative route of transmission, for which medical care and the use of injections are prime candidates17,19-22. Prostitutes, for example, are often recruited for studies from STI clinics, where treatment is frequently given by injection, where non-sterile equipment is used with high frequency, and wherein the underlying prevalence of HIV is high7. Many studies that have assessed the impact of sexual activity on HIV transmission -notably those in Mwanza and Rakai, whose discordant results are still a subject of debate23-failed to consider the potential confounding effects of medical care in the propagation of HIV24.
Rapid HIV transmission in Africa has often occurred in countries with good access to medical care, like Botswana, Zimbabwe, and South Africa. For example, high rates in rural South Africa have paralleled aggressive efforts to deliver health care to rural populations. It is difficult to understand how improved access to health care, with its offers of public health messages, free condoms, and preventive services, would be associated with increased HIV transmission. Similarly, HIV prevalence is often higher in cities and among persons of high socioeconomic attainment than in rural areas or among less fortunate persons. Favourable access to health care is one of the differences that distinguishes between these groups."
In my recent post, I argued that sexually transmitted diseases shouldn't be regarded as God's punishment because they infect the innocent as well as the "guilty". In fact, it is worse - they infect first and foremost the innocent. Just read the following citation:
Gisselquist D. et al. (2004). HIV transmission during paediatric health care in sub-Saharan Africa--risks and evidence. PMID: 15034989
"Health care systems in sub-Saharan Africa are challenged not only to improve care for the increasing number of HIV-infected children, but also to prevent transmission of HIV to other children and health care workers through contaminated medical procedures and needlestick accidents. HIV-infected children aged to 1 year typically have high viral loads, making them dangerous reservoirs for iatrogenic transmission... This leads to high HIV prevalence among inpatient and outpatient children... Investigations of large iatrogenic outbreaks in Russia, Romania, and Libya demonstrate efficient HIV transmission through paediatric health care... In addition, several studies have reported much higher HIV prevalence in children 5-14 years old than could be expected from mother-to-child transmission alone."
So we are coming to the Libyan scene. The following citation, I think, illustrates well how the Libyan health care system initially reacted to the crisis - it focused efforts not on controlling the infection but on attempting to cover it up:
Kovac C, Khandjiev R. (2001). Doctors face murder charges in Libya. PMID: 11157524
"Nine Libyans, including the director of the Al-Fateh Hospital and the undersecretary of Benghazi's Department of Health, are charged with exposing 19 of the mothers of the infected children to HIV. They "hid the fact that the children were already infected" and failed to take prophylactic measures to protect the mothers... Ironically, according to a UNAIDS report, Libya has not supplied any information on AIDS cases in that country for 1998-2000."
In the same year, doctors in Switzerland analyzed the blood of infected children:
Yerly S. et al. (2001). Nosocomial outbreak of multiple bloodborne viral infections. PMID: 11443566
"After a major outbreak of human immunodeficiency virus (HIV) infection in approximately 400 children in 1998 in Libya, we tested HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) markers in 148 children and collected epidemiological data in a subgroup of 37 children and 46 parents. HIV infection was detected in all children but one, with HCV or HBV coinfection in 47% and 33%, respectively... The children visited the same hospital 1-6 times; at each visit, invasive procedures with potential blood transmission of virus were performed."
The finding of other blood-borne viruses in such a high proportion of the HIV-infected children supports the poor hygiene hypothesis, not the intentional infection hypothesis which lies so close to the hearts of Libyan prosecutors. Mention also that some children visited the hospital several (up to 6) times, so it is possible that they after being infected became secondary sources of infection for other young patients.
The next report is by Italian scientists:
Visco-Comandini U. et al. (2002). Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya. PMID: 12167281
"A cluster of HIV-1 infection has been identified in Libya in 1999, involving 402 children admitted to "El-Fath" Children's Hospital in Benghazi (BCH) during 1998 and 19 of their mothers... Out of this group, 104 children and 19 adult women have been followed at the National Institute for Infectious Diseases L. Spallanzani in Rome during 1 year. At BCH, all children had received intravenous infusions but not blood or blood products. A single child receiving a blood transfusion in 1997 and the 17 infected mothers were never hospitalized in Benghazi. In addition, two nurses were diagnosed as HIV-1 infected... The phylogenetic analyses showed that a monophyletic recombinant HIV-1 form CRF02-AG was infecting all of the HIV-1-seropositive patients admitted at BCH... A different strain was found in the child infected by blood transfusion."
Please mention that a child was infected in 1997 by blood transfusion with a different strain of HIV. This fact alone seems to disprove the claims of many Libyans that before the accused medics introduced the virus in 1998, there had been no HIV in Libya. Rather, the virus had arrived but the Libyan health care officials weren't ready to confront the threat and preferred to bury their heads into the sands of wishful thinking - our people aren't promiscuous, so it won't happen here...
The other noteworthy detail in this report is that the HIV strain is described as "recombinant". This English term can mean "product of natural recombination process" (as above) or "product of recombinant DNA technology (gene engineering)". Bulgarian journalists reporting from the Libyan courtroom said that the term was translated to Arabic and interpreted by Libyans in its second meaning only, i.e. that it was not a natural HIV strain but one modified by gene engineering. Hence, the infection must have been intentional. I don't know whether this misinterpretation was due to deliberate framing of the accused or to incompetence of the Libyan "experts". Let's not be paranoic and prefer the second explanation. In fact, the incompetence of some of the experts seems to be a public secret in Libya. Defense lawyer Byzanti at one point, after hearing reports of such experts accusing his clients, exclaimed, "But what scientists are they?". (The judge didn't like the remark.) If we talk seriously, even if the infection was intentional, it wouldn't make sense to use modified virus. If you intend to use a common cold virus as a bioweapon, you of course first have to modify it quite a lot, because the original virus is almost harmless. But why modify a virus which is lethal as it is? Just to leave a smoking gun at the crime scene? Why don't people use their heads, why are they ready to believe every nonsense they hear?
The next citation is from one of the most prestigeous scientific journals, Nature.
De Oliveira T. et al. (2006). Molecular epidemiology: HIV-1 and HCV sequences from Libyan outbreak. PMID: 17171825
"In 1998, outbreaks of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) infection were reported in children attending Al-Fateh Hospital in Benghazi, Libya. Here we use molecular phylogenetic techniques to analyse new virus sequences from these outbreaks. We find that the HIV-1 and HCV strains were already circulating and prevalent in this hospital and its environs before the arrival in March 1998 of the foreign medical staff (five Bulgarian nurses and a Palestinian doctor) who stand accused of transmitting the HIV strain to the children."
No comment needed, I think.
The last PubMed citation I'll give is an appeal by Sidaction (I don't know this organization but its name is evidently derived from SIDA - AIDS in French):
Fleutelot E. (2006). 'Libyan Trial': a verdict running counter to scientific evidence. PMID: 17192180
"Sidaction denounces this trial as a parody of justice, which cannot hide the total incapacity of the Libyan Government to promote an appropriate politics of prevention and take care of people who are ill secondary to HIV infection-adults and children-in an appropriate way. It is useful to recall that the majority of Libyan people living with AIDS who are in need of an antiretroviral treatment can still not afford it."
***
It is easy to violate safety rules when working with blood and other human material under inadequate funding and supervision. I admit I have done it myself.
In recent decades reusable syringes, needles and other items were largely replaced by disposable ones. This was meant to assure safety, because sterilization of reusable equipment can always fail for some technical reason. However, as a result medical workers lost their expertise in sterilization and the good habit to perform it. So, when they are short of disposable equipment, they are quite likely to reuse it without even attempting sterilization or at least disinfection. Simple boiling would kill HIV without damaging most types of disposable equipment; but there must be somebody to do the boiling.
What exactly happened in Benghazi? Of course I cannot know exactly, but this is how I imagine it. The hospital has too many patients and too few syringes and needles. So, a nurse or a sanitary worker at the end of the day collects the used ones, soaks them in water and then washes them. Just washing, no sterilization. The boss hasn't ordered sterilization or disinfection. Trapped in the "good-people-don't-get-STDs" mentality, he cannot even think that the hospital's patients, these little angels, may have AIDS. But one child has it, contracted somehow outside the hospital. He is injected and then, when his syringe and needle are soaked, the virus contaminates all the other soaked needles. So other children, possibly dozens of them at once, are infected. The remaining virus in the hospital eventually dies out, it cannot reproduce outside the human body, but then one of the infected children comes for a new shot...
I would wish to end my post here, but I remember something I read on Highlander's blog:
"Whilst I’m sure many of them (medics-guest workers in Libya) honoured their contracts I can tell you from personal experience that some of them could not care less, and even the fact that US sanctions resulted in the deterioration of Libyan hospitals and that probably some Libyan health workers were also unscrupulous does not give the right to foreign workers to treat the Libyan patients like 'shit'. I’ve seen it as some of them ruled unconditionally in the hospitals and clinics, and you don’t want to be on their bad side as they may not treat you or worse may give you the wrong treatment. So again I wanted to say that not all of them were angels and saviours" (http://lonehighlander.blogspot.com/2005/04/case-441999-story-of-bulgarian-medics.html).
Of course, among the health workers from any country some are not very good professionals, some are capable but not very polite, and even those who are both may have their bad days; besides, miscommunication because of language barrier can create impression of rudeness. This is not the point. The point, I think, is the implicit question behind the cited text: Was it a mere coincidence that the infection happened in a hospital with so many foreign workers? My answer: Maybe it wasn't. I must immediately state that this is not an admission that the defendants are guilty - there were dozens of other guest workers in the El Fateh hospital, while two of the accused had never worked there.
First, one of the most important factors pushing us to do good work is pressure from our clients. If we are health workers, this means that we shall work better if our relations, friends, neighbours or their children can become our patients any minute. If we are treating some completely unrelated people, we are more likely to take it easy. Remember, one of the other major iatrogenic AIDS outbreaks was among Romanian orphan children. The doctors and nurses immunizing them relaxed the safety rules because they knew their own children and their friends' children wouldn't be among the patients.
Second, a guest worker is unlikely to become a whistleblower. He'll prefer just to do what he is paid for and not risk trouble. Remember the Egyptian doctor who warned a Bulgarian nurse (in Part 2). However, he didn't warn the Libyan patients and the local community. The Bulgarian workers in fact couldn't do this even if they wanted, because they didn't speak Arabic. It was the journalists of the La magazine who first gave publicity of the outbreak, and they did get into trouble. They knew they were risking, but still wrote the article because they cared. They regarded it as their duty as citizens. So, before we all become true citizens of the world, it makes no harm to remember that only a citizen is likely to care.
Let's begin from the beginning: decades earlier and thousands of miles away from the Libyan "crime scene", a virus found a new host. The following citation is from http://main.uab.edu/show.asp?durki=8535.
"Origin of HIV-1 Discovered
...Scientists at the University of Alabama at Birmingham (UAB) have discovered the origin of Human Immunodeficiency Virus Type 1 (HIV-1)...The researchers identified a subspecies of chimpanzee (Pan troglodytes troglodytes) native to West-Central Africa as the natural reservoir for HIV-1...The final piece of the puzzle was put in place when the researchers realized that the natural habitat for Pan troglodytes troglodytes overlaps precisely with the region in West-Central Africa where all three groups of HIV-1(M, N, and O) were first recognized. Based on these findings, Hahn and her colleagues concluded that Pan troglodytes troglodytes is the origin of HIV-1 and has been the source of at least three independent cross-species transmission events...While the origin of the AIDS epidemic has been clarified, an explanation for why the epidemic arose in the mid-20th century, and not before, remains a matter of speculation."Chimpanzees are frequently hunted for food, especially in West-Central Africa, and we believe that HIV-1 was introduced into the human population through exposure to blood during hunting and field dressing of these animals," says Hahn. She further believes that while incidental transmissions of chimpanzee viruses to humans may have occurred throughout history, it was the socio-economic changes in post-World War II Africa that provided the particular circumstances leading to the spread of HIV-1 and the development of the AIDS epidemic. "Increasing urbanization, breakdown of traditional lifestyles, population movements, civil unrest, and sexual promiscuity are all known to increase the rates of sexually transmitted diseases and thus likely triggered the AIDS pandemic," adds Hahn."
Dr. Hahn omitted one very important factor for spreading HIV: the health care system, which was practically not present in Africa until the 20th century. You think I am stretching my thesis too much? First, please read the following translation from the book "Sanu, bature" by Bulgarian zoologist Peter Beron. He describes his experience in Nigeria in 1976:
"Before returning to Bulgaria, we had to be immunized against cholera. There was a special immunization center in the town. However, before we went there, Dr. Malyavko (a Russian physician - M.M.) gave me three sealed disposable syringes and told me to insist that the local doctor uses them. I was hesitating - the doctor could be offended by such lack of trust. I went to the center with Kinka and Vladko (the author's wife and son, respectively - M.M.). In the street, there was an endless line. The doctor was sitting in front of the door and immunizing everybody with one and the same needle. These were prospective hajjis. They were preparing to travel to Mecca and the local Asclepius evidently thought that Allah wouldn't let any hepatitis creep into such pious Muslims. At that time, nobody knew about AIDS. Seeing us, the Asclepius called us and offered to immunize us immediately. I told him I had had polyo before and for that reason had to use a separate syringe. Vladko had been in contact with a person with hepatitis etc. The doctor showed full understanding. He unsealed the first syringe, injected Vladko, then injected Kinka with the second syringe and me with the third one. Then he, with my needle, continued injecting the long line of the candidate hajjis."
The case of the infected more than 400 Libyan children would be tragic even if it were exceptional, but unfortunately it isn't. We shall never know the exact number of AIDS victims throughout Africa and elsewhere whom medicine, instead of helping, failed, betrayed and doomed. The following citation (as well as others which I'll indicate by their PubMed identification numbers) is obtained from PubMed, a database of biomedical literature. PubMed abstracts and some full text articles can be accessed at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed.
Gisselquist D. et al. (2003). Let it be sexual: how health care transmission of AIDS in Africa was ignored. PMID: 12665437
"The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission... Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence."
Another work: Brewer D.D. et al. (2003). Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm. PMID: 12665436. The citation is from http://www.cirp.org/library/disease/HIV/brewer1/, where the full text of the article is given.
"A number of these observations raise the question of an alternative route of transmission, for which medical care and the use of injections are prime candidates17,19-22. Prostitutes, for example, are often recruited for studies from STI clinics, where treatment is frequently given by injection, where non-sterile equipment is used with high frequency, and wherein the underlying prevalence of HIV is high7. Many studies that have assessed the impact of sexual activity on HIV transmission -notably those in Mwanza and Rakai, whose discordant results are still a subject of debate23-failed to consider the potential confounding effects of medical care in the propagation of HIV24.
Rapid HIV transmission in Africa has often occurred in countries with good access to medical care, like Botswana, Zimbabwe, and South Africa. For example, high rates in rural South Africa have paralleled aggressive efforts to deliver health care to rural populations. It is difficult to understand how improved access to health care, with its offers of public health messages, free condoms, and preventive services, would be associated with increased HIV transmission. Similarly, HIV prevalence is often higher in cities and among persons of high socioeconomic attainment than in rural areas or among less fortunate persons. Favourable access to health care is one of the differences that distinguishes between these groups."
In my recent post, I argued that sexually transmitted diseases shouldn't be regarded as God's punishment because they infect the innocent as well as the "guilty". In fact, it is worse - they infect first and foremost the innocent. Just read the following citation:
Gisselquist D. et al. (2004). HIV transmission during paediatric health care in sub-Saharan Africa--risks and evidence. PMID: 15034989
"Health care systems in sub-Saharan Africa are challenged not only to improve care for the increasing number of HIV-infected children, but also to prevent transmission of HIV to other children and health care workers through contaminated medical procedures and needlestick accidents. HIV-infected children aged to 1 year typically have high viral loads, making them dangerous reservoirs for iatrogenic transmission... This leads to high HIV prevalence among inpatient and outpatient children... Investigations of large iatrogenic outbreaks in Russia, Romania, and Libya demonstrate efficient HIV transmission through paediatric health care... In addition, several studies have reported much higher HIV prevalence in children 5-14 years old than could be expected from mother-to-child transmission alone."
So we are coming to the Libyan scene. The following citation, I think, illustrates well how the Libyan health care system initially reacted to the crisis - it focused efforts not on controlling the infection but on attempting to cover it up:
Kovac C, Khandjiev R. (2001). Doctors face murder charges in Libya. PMID: 11157524
"Nine Libyans, including the director of the Al-Fateh Hospital and the undersecretary of Benghazi's Department of Health, are charged with exposing 19 of the mothers of the infected children to HIV. They "hid the fact that the children were already infected" and failed to take prophylactic measures to protect the mothers... Ironically, according to a UNAIDS report, Libya has not supplied any information on AIDS cases in that country for 1998-2000."
In the same year, doctors in Switzerland analyzed the blood of infected children:
Yerly S. et al. (2001). Nosocomial outbreak of multiple bloodborne viral infections. PMID: 11443566
"After a major outbreak of human immunodeficiency virus (HIV) infection in approximately 400 children in 1998 in Libya, we tested HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) markers in 148 children and collected epidemiological data in a subgroup of 37 children and 46 parents. HIV infection was detected in all children but one, with HCV or HBV coinfection in 47% and 33%, respectively... The children visited the same hospital 1-6 times; at each visit, invasive procedures with potential blood transmission of virus were performed."
The finding of other blood-borne viruses in such a high proportion of the HIV-infected children supports the poor hygiene hypothesis, not the intentional infection hypothesis which lies so close to the hearts of Libyan prosecutors. Mention also that some children visited the hospital several (up to 6) times, so it is possible that they after being infected became secondary sources of infection for other young patients.
The next report is by Italian scientists:
Visco-Comandini U. et al. (2002). Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya. PMID: 12167281
"A cluster of HIV-1 infection has been identified in Libya in 1999, involving 402 children admitted to "El-Fath" Children's Hospital in Benghazi (BCH) during 1998 and 19 of their mothers... Out of this group, 104 children and 19 adult women have been followed at the National Institute for Infectious Diseases L. Spallanzani in Rome during 1 year. At BCH, all children had received intravenous infusions but not blood or blood products. A single child receiving a blood transfusion in 1997 and the 17 infected mothers were never hospitalized in Benghazi. In addition, two nurses were diagnosed as HIV-1 infected... The phylogenetic analyses showed that a monophyletic recombinant HIV-1 form CRF02-AG was infecting all of the HIV-1-seropositive patients admitted at BCH... A different strain was found in the child infected by blood transfusion."
Please mention that a child was infected in 1997 by blood transfusion with a different strain of HIV. This fact alone seems to disprove the claims of many Libyans that before the accused medics introduced the virus in 1998, there had been no HIV in Libya. Rather, the virus had arrived but the Libyan health care officials weren't ready to confront the threat and preferred to bury their heads into the sands of wishful thinking - our people aren't promiscuous, so it won't happen here...
The other noteworthy detail in this report is that the HIV strain is described as "recombinant". This English term can mean "product of natural recombination process" (as above) or "product of recombinant DNA technology (gene engineering)". Bulgarian journalists reporting from the Libyan courtroom said that the term was translated to Arabic and interpreted by Libyans in its second meaning only, i.e. that it was not a natural HIV strain but one modified by gene engineering. Hence, the infection must have been intentional. I don't know whether this misinterpretation was due to deliberate framing of the accused or to incompetence of the Libyan "experts". Let's not be paranoic and prefer the second explanation. In fact, the incompetence of some of the experts seems to be a public secret in Libya. Defense lawyer Byzanti at one point, after hearing reports of such experts accusing his clients, exclaimed, "But what scientists are they?". (The judge didn't like the remark.) If we talk seriously, even if the infection was intentional, it wouldn't make sense to use modified virus. If you intend to use a common cold virus as a bioweapon, you of course first have to modify it quite a lot, because the original virus is almost harmless. But why modify a virus which is lethal as it is? Just to leave a smoking gun at the crime scene? Why don't people use their heads, why are they ready to believe every nonsense they hear?
The next citation is from one of the most prestigeous scientific journals, Nature.
De Oliveira T. et al. (2006). Molecular epidemiology: HIV-1 and HCV sequences from Libyan outbreak. PMID: 17171825
"In 1998, outbreaks of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) infection were reported in children attending Al-Fateh Hospital in Benghazi, Libya. Here we use molecular phylogenetic techniques to analyse new virus sequences from these outbreaks. We find that the HIV-1 and HCV strains were already circulating and prevalent in this hospital and its environs before the arrival in March 1998 of the foreign medical staff (five Bulgarian nurses and a Palestinian doctor) who stand accused of transmitting the HIV strain to the children."
No comment needed, I think.
The last PubMed citation I'll give is an appeal by Sidaction (I don't know this organization but its name is evidently derived from SIDA - AIDS in French):
Fleutelot E. (2006). 'Libyan Trial': a verdict running counter to scientific evidence. PMID: 17192180
"Sidaction denounces this trial as a parody of justice, which cannot hide the total incapacity of the Libyan Government to promote an appropriate politics of prevention and take care of people who are ill secondary to HIV infection-adults and children-in an appropriate way. It is useful to recall that the majority of Libyan people living with AIDS who are in need of an antiretroviral treatment can still not afford it."
***
It is easy to violate safety rules when working with blood and other human material under inadequate funding and supervision. I admit I have done it myself.
In recent decades reusable syringes, needles and other items were largely replaced by disposable ones. This was meant to assure safety, because sterilization of reusable equipment can always fail for some technical reason. However, as a result medical workers lost their expertise in sterilization and the good habit to perform it. So, when they are short of disposable equipment, they are quite likely to reuse it without even attempting sterilization or at least disinfection. Simple boiling would kill HIV without damaging most types of disposable equipment; but there must be somebody to do the boiling.
What exactly happened in Benghazi? Of course I cannot know exactly, but this is how I imagine it. The hospital has too many patients and too few syringes and needles. So, a nurse or a sanitary worker at the end of the day collects the used ones, soaks them in water and then washes them. Just washing, no sterilization. The boss hasn't ordered sterilization or disinfection. Trapped in the "good-people-don't-get-STDs" mentality, he cannot even think that the hospital's patients, these little angels, may have AIDS. But one child has it, contracted somehow outside the hospital. He is injected and then, when his syringe and needle are soaked, the virus contaminates all the other soaked needles. So other children, possibly dozens of them at once, are infected. The remaining virus in the hospital eventually dies out, it cannot reproduce outside the human body, but then one of the infected children comes for a new shot...
I would wish to end my post here, but I remember something I read on Highlander's blog:
"Whilst I’m sure many of them (medics-guest workers in Libya) honoured their contracts I can tell you from personal experience that some of them could not care less, and even the fact that US sanctions resulted in the deterioration of Libyan hospitals and that probably some Libyan health workers were also unscrupulous does not give the right to foreign workers to treat the Libyan patients like 'shit'. I’ve seen it as some of them ruled unconditionally in the hospitals and clinics, and you don’t want to be on their bad side as they may not treat you or worse may give you the wrong treatment. So again I wanted to say that not all of them were angels and saviours" (http://lonehighlander.blogspot.com/2005/04/case-441999-story-of-bulgarian-medics.html).
Of course, among the health workers from any country some are not very good professionals, some are capable but not very polite, and even those who are both may have their bad days; besides, miscommunication because of language barrier can create impression of rudeness. This is not the point. The point, I think, is the implicit question behind the cited text: Was it a mere coincidence that the infection happened in a hospital with so many foreign workers? My answer: Maybe it wasn't. I must immediately state that this is not an admission that the defendants are guilty - there were dozens of other guest workers in the El Fateh hospital, while two of the accused had never worked there.
First, one of the most important factors pushing us to do good work is pressure from our clients. If we are health workers, this means that we shall work better if our relations, friends, neighbours or their children can become our patients any minute. If we are treating some completely unrelated people, we are more likely to take it easy. Remember, one of the other major iatrogenic AIDS outbreaks was among Romanian orphan children. The doctors and nurses immunizing them relaxed the safety rules because they knew their own children and their friends' children wouldn't be among the patients.
Second, a guest worker is unlikely to become a whistleblower. He'll prefer just to do what he is paid for and not risk trouble. Remember the Egyptian doctor who warned a Bulgarian nurse (in Part 2). However, he didn't warn the Libyan patients and the local community. The Bulgarian workers in fact couldn't do this even if they wanted, because they didn't speak Arabic. It was the journalists of the La magazine who first gave publicity of the outbreak, and they did get into trouble. They knew they were risking, but still wrote the article because they cared. They regarded it as their duty as citizens. So, before we all become true citizens of the world, it makes no harm to remember that only a citizen is likely to care.
Thursday, March 08, 2007
God and sexually transmitted diseases
This post is inspired by a discussion on Highlander's blog. On https://www2.blogger.com/comment.g?blogID=5760993&postID=2126398597000378614, she wrote, "...Even following treatment for AIDS, it will still be found in the semen and is capable of replication and infection of body cells again... Which led me to wonder whether the scriptures have been right ? Is that why all 3 monotheistic religion have always advocated chastity and the prohibition of fornication and adultery? Could it be their method of warning us about this killer disease in a way that is graspable by our limited psyche /knowledge 2000 years ago, and so have to disguise it as based on morality? How to inculcate morality in us? One husband per wife ? family virtues etc…"
I commented, "...Chastity norms meant to secure a stable family as a base of the society, rather than to protect people from STDs. If God didn't want us to die of AIDS (and of other STDs - syphilis has for centuries been as lethal as AIDS is today), why didn't He give humans natural immunity against pathogens causing STDs?"
Highlander replies, "You cannot explain to people of a certain mindset about STD so you tell them to be chaste because that is a virtue etc..But then you create STDs so that the ahem no offense meant 'unchaste' gets it . whether is is Syphillis , AIDS or simple chlamydia infection which can cause such havoc though right ? That's how God tests our strenght because it is difficult to overcome desire and humankind will be human after all :P."
I'll cite also two other bloggers who posted relevant comments.
The Lost Libyano: "Who said god didnt want people to die from AIDS. Quite the contrary he sent it to kill people, millions of people, just like he sent syphilis, and just like he sent the black plague, which wiped out 2/3 of Europes population, and he will send much more. "
Um Haleema: "I wonder what message he was trying to send to the babies born with aids and innocent 'pure' people that get aids through blood transfusions."
After this introduction of citations, I'll continue with new text.
The original Highlander's post didn't quite clarify what she thought about the origin of STD-causing pathogens. Has God set rules to protect us from germs created by someone else, e.g. the devil? Or are these germs created by God himself to punish us if we neglect His rules? Then, in the comment, Highlander was explicit that it was God who created the pathogenic bacteria and viruses.
Diseases definitely are an important theological problem. Most believers think that they are trials God sends to us. When this cannot apply, most notably when a young child has a fatal disease, they think that for some reason unknown to us God needed to take the child back right now. Although this is not my view, I generally like it because it doesn't label the sufferer as a sinner.
However, about sexually transmitted diseases (and occasionally about other infectious diseases, such as the plague) some believers think they are God's punishments. Notably the puritans. I wonder how many puritans, Highlander included, can be such wonderful, good and tolerant people while admiring such a nasty God.
While do I find this God nasty? First, because he has invented germs to punish people having unauthorized sex but nothing specific to punish true villains. There are no germs for murderers. What am I supposed to think of a God who finds making love worse than killing?
Second, because STD-causing pathogens don't punish just the "sinners". They are not precision bombs. They are weapons of mass destruction. They infect the innocent as well as the "guilty". If a rapist has a STD, he will transmit it to his victim. If an adulterous husband contracts HIV, he'll later infect his wife, even if she has never had sex with another man. And if they conceive, the baby will very likely be infected, too. Among other sexually transmitted diseases, Highlander mentioned the chlamydia infection. But if we call the pathogen by its full name, Chlamydia trachomatis, we'll imagine another picture: children who hopelessly scratch their eyes burning from pain and gradually lose their vision (see e.g. http://www.trachoma.org/trachoma.php).
Third, God hasn't saved all these goodies for humans. He has created STD-causing pathogens also for other species, where chastity (and other moral categories) simply makes no sense. In fact, HIV-1 and 2 are evidently viruses of non-human primates which recently discovered us as a new host species. So, if we are to regard AIDS as God's punishment (which I don't recommend), it is rather a punishment for invading and destroying the last remaining habitats of our little brothers.
I wonder how people can live under such a God and still enjoy life. I would be rather depressed. It seems much worse than living under Qaddafi. Of course, where the majority of people have a God like this one, they also tend to have a ruler like Qaddafi. But if you live under a dictator, you can attempt emigration, dream of a revolution or simply remember that sooner or later he will die. None of this applies to God. You cannot escape Him even by suicide.
Still, there is a way out. You could, like the girl in the Labyrinth movie say, "You have no power over me", and find a gentler God. Mine would be one who loves equally all His creatures. When they clash, He doesn't intervene and lets them have a fair fight. However, this would be just a biologist's God. Other people are likely to prefer a tyrant God to one who holds HIV and treponema as close to His heart as humans. Besides, all religions I know explicitly postulate a special status for the human species.
I commented, "...Chastity norms meant to secure a stable family as a base of the society, rather than to protect people from STDs. If God didn't want us to die of AIDS (and of other STDs - syphilis has for centuries been as lethal as AIDS is today), why didn't He give humans natural immunity against pathogens causing STDs?"
Highlander replies, "You cannot explain to people of a certain mindset about STD so you tell them to be chaste because that is a virtue etc..But then you create STDs so that the ahem no offense meant 'unchaste' gets it . whether is is Syphillis , AIDS or simple chlamydia infection which can cause such havoc though right ? That's how God tests our strenght because it is difficult to overcome desire and humankind will be human after all :P."
I'll cite also two other bloggers who posted relevant comments.
The Lost Libyano: "Who said god didnt want people to die from AIDS. Quite the contrary he sent it to kill people, millions of people, just like he sent syphilis, and just like he sent the black plague, which wiped out 2/3 of Europes population, and he will send much more. "
Um Haleema: "I wonder what message he was trying to send to the babies born with aids and innocent 'pure' people that get aids through blood transfusions."
After this introduction of citations, I'll continue with new text.
The original Highlander's post didn't quite clarify what she thought about the origin of STD-causing pathogens. Has God set rules to protect us from germs created by someone else, e.g. the devil? Or are these germs created by God himself to punish us if we neglect His rules? Then, in the comment, Highlander was explicit that it was God who created the pathogenic bacteria and viruses.
Diseases definitely are an important theological problem. Most believers think that they are trials God sends to us. When this cannot apply, most notably when a young child has a fatal disease, they think that for some reason unknown to us God needed to take the child back right now. Although this is not my view, I generally like it because it doesn't label the sufferer as a sinner.
However, about sexually transmitted diseases (and occasionally about other infectious diseases, such as the plague) some believers think they are God's punishments. Notably the puritans. I wonder how many puritans, Highlander included, can be such wonderful, good and tolerant people while admiring such a nasty God.
While do I find this God nasty? First, because he has invented germs to punish people having unauthorized sex but nothing specific to punish true villains. There are no germs for murderers. What am I supposed to think of a God who finds making love worse than killing?
Second, because STD-causing pathogens don't punish just the "sinners". They are not precision bombs. They are weapons of mass destruction. They infect the innocent as well as the "guilty". If a rapist has a STD, he will transmit it to his victim. If an adulterous husband contracts HIV, he'll later infect his wife, even if she has never had sex with another man. And if they conceive, the baby will very likely be infected, too. Among other sexually transmitted diseases, Highlander mentioned the chlamydia infection. But if we call the pathogen by its full name, Chlamydia trachomatis, we'll imagine another picture: children who hopelessly scratch their eyes burning from pain and gradually lose their vision (see e.g. http://www.trachoma.org/trachoma.php).
Third, God hasn't saved all these goodies for humans. He has created STD-causing pathogens also for other species, where chastity (and other moral categories) simply makes no sense. In fact, HIV-1 and 2 are evidently viruses of non-human primates which recently discovered us as a new host species. So, if we are to regard AIDS as God's punishment (which I don't recommend), it is rather a punishment for invading and destroying the last remaining habitats of our little brothers.
I wonder how people can live under such a God and still enjoy life. I would be rather depressed. It seems much worse than living under Qaddafi. Of course, where the majority of people have a God like this one, they also tend to have a ruler like Qaddafi. But if you live under a dictator, you can attempt emigration, dream of a revolution or simply remember that sooner or later he will die. None of this applies to God. You cannot escape Him even by suicide.
Still, there is a way out. You could, like the girl in the Labyrinth movie say, "You have no power over me", and find a gentler God. Mine would be one who loves equally all His creatures. When they clash, He doesn't intervene and lets them have a fair fight. However, this would be just a biologist's God. Other people are likely to prefer a tyrant God to one who holds HIV and treponema as close to His heart as humans. Besides, all religions I know explicitly postulate a special status for the human species.
Saturday, September 23, 2006
The HIV trial in Libya, part 2: The victims
(This is coutinued from Part 1, which is at http://mayas-corner.blogspot.com/2006/09/hiv-trial-in-libya-part-1-infection.html.)
From now on, the story may be wrong in some details because it will rely only on occasional official and unofficial Bulgarian and Libyan sources, which are not very trustworthy (esp. the official ones). Corrections are welcome. However, I believe the picture as a whole is fairly accurate.
An author of detective stories once said that the victim of a crime usually has some characheristics that have led to him/her becoming a victim. In this story, we have two groups of victims: the infected little patients of Benghazi and the accused medics. Let's consider them, the children first.
Why Benghazi
In a recent comment, I called the Iranian opposition "better and stronger" than the Libyan one, implying that the latter, apart from being weak (no wonder - Qaddafi is not the ruler to tolerate alive opposition), doesn't appeal very much to me. It is because, while Iranian opposition is generally pro-Western, opposition-minded Libyans (those who live in Libya and still make their voices heard) are Islamists. In other words, they rebel against the Q-man not because he is an incompetent ruler, liar, oppressor, terrorist and mass murderer, but because they think he isn't Islamist enough. And the center of this opposition is the city of Benghazi. Here, I expect the reader to remember that exactly this city was the center of Libyan February cartoon riots, when at least 11 people laid down their lives (at the same time, residents of Tripoli were reluctant to take part even in an official peaceful demonstration - testimony of Khadija-Teri). Hanu thought that the Benghazi protests were orchestrated by government. I would rather suppose they were provoked by government agents but the ordinary participants were quite sincere. So, the residents of Benghazi must have (on average) more courage than any other group of Libyans but, unfortunately, the same cannot be said about their intellect. The Q-man knows this, understands their way of thinking very well and although they hate him, he can most of the time manipulate them as he wishes.
In 1986, a group of Benghazi residents killed a high-ranking Libyan official. Nine were sentenced and hanged (http://www.libyanet.com/feb1987.htm; warning: graphic photos). I've read (though can't give a link) that the plot was not just secret work of a few people but had wide popular support. Some Bulgarian journalists wrote that, after crushing the rebels, Qaddafi decided to punish the entire city by sharply reducing its funds. Such measures are used in many countries by the central governments against regions expressing dissent (in dictatorships) or just voting for the other party (in semi-democracies). Of course most severely affected are the industries most dependent on subsidies, such as health care.
In the following years, as admitted by a former Libyan health care minister, hospitals throughout Libya were poorly supplied with even the most basic consumatives and medications. This was conveniently blamed on the sanctions and may indeed have been partly due to them. However, in Benghazi the situation was worse than in other places. A Bulgarian nurse who worked for some time at the El Fateh Children's hospital later said, "The senior nurse every morning distributed syringes - 5 for each nurse. No more, no matter how many patients would come."
Another Bulgarian nurse, when beginning work at the same hospital in early 1998, said, "Upon arrival, I was immediately warned by an Egyptian doctor to be very careful, because there was an ongoing AIDS epidemic in the hospital." But nobody warned the patients and the community of Benghazi. Parents continued to bring their little ones to the hospital, thinking they were doing the best for them.
Later in 1998, another Bulgarian nurse - Nasya Nenova, was assigned to work at the same hospital, at a department newly formed especially for the children with AIDS. She wrote to her family: "I am of course very afraid that I may get infected, I work with two pairs of rubber gloves... Some of the children are already in very grave condition. One died last night. At least I hadn't to watch him die, a Philippino nurse was on duty then."
In the following years, dozens more children would die.
Why Bulgarians
As anger accumulated in Benghazi, the regime had to find a way out of the crisis. Of course the truth - that the epidemics was due to the punitive starvation funding of the city, plus shocking incompetence of the hospital's most responsible people - would do little to calm down the spirits. But if the virus was distributed intentionally, then the Q-man and his officials would deserve no blame. So scapegoats were needed. And because the goal was to pacify the Libyans, foreigners would make the best scapegoats.
The regime had plenty of them. Highlander once wrote, "in Libya we have thousands of foreign guest workers in the health sector for whom I am grateful as they make up the deficit." As I wrote before, I'm not sure she should be grateful. Even when they are good and caring professionals, they take positions that would otherwise be occupied by Libyans. To keep the status quo, "they enjoy an enormously better salary than the locals" (same Highlander's post). So they, together with the numerous guest workers in other industries, allow the regime to minimize the number of educated and skilled workers-citizens who are the brain and backbone of any society and in dictatorships often form dangerous opposition. Ottoman Turks made their best to keep the Libyans uneducated and unqualified, and I think Qaddafi today is following their example. Of course the guest workers themselves don't realize this (I haven't seen such a discussion in Bulgarian media, and what isn't in the media doesn't exist for the public). Nor do they realize that one of the reason they are hired is to serve as scapegoats if something goes wrong.
The first scapegoat was Ashraf al Hajuj, a doctor of Palestinian origin. I know little about him; he had lived in Libya since early childhood (probably born there) but, according to the good Arab tradition, was regarded as a Palestinian and not a naturalized Libyan. He was engaged to a Libyan girl who supported him during the following 5 years, but then left him, exhausted to be a fiance of an inmate on death row. After the arrest, al Hajuj was tortured until he was ready to confess anything that was wanted from him.
It is easy to figure out why he was taken. Much later, he said, "The interrogators were telling me that there was nobody to entreat for me because I (as a Palestinian) had no state. I am sure that, hadn't Bulgaria taken me under its protection together with the nurses, I would be now rotting in some mass grave." (I think that if Palestinians had common sense, the name and fate of al Hajuj would be known in every Palestinian house as an illustration of how much their Arab "allies" care for them. If I had such friends, I'd try to strike an immediate deal with my enemy! But of course if Palestinians had common sense, the world would be another and much better place. Mention also that he said "mass grave", not just "grave".)
However, al Hajuj alone was not enough. Non-Arab infidels would make far better villains in the eyes of Benghazeeans, so numerous guest workers were arrested - not only from Bulgaria but also from the Philippines, Poland and other countries. At this stage, there were only two Bulgarian detainees - nurses Snezhana Dimitrova and Sevda Yablanska.
I believe that Libyan authorities made these wide and apparently random arrests to probe which country was least able and willing to protect its nationals. (This protection, I think, contradicts to the very idea of justice, but unfortunately seems needed in today's imperfect world where so many countries are eager to put foreigners to cangaroo courts.) The guest worker communities of Poles and Philippinos, but NOT Bulgarians, swiftly organized and threatened that they would all abandon their contracts and leave Libya immediately if their fellow countrymen were not released. Also, the diplomatic missions of these countries made some unknown to me but apparently effective moves. The Bulgarian embassy also took measures, if you read the official Bulgarian site. However, the unofficial story is different. When a nurse informed the Embassy that two her colleagues were arrested, she obtained the answer, "Let the whores save themselves". So the Bulgarian tradition to fill the diplomatic missions with arrogant, incompetent and lazy people who care neither for the Bulgarian state nor for its nationals brought disastrous results.
There were also other reasons making Bulgaria a good target. It was a small poor coutry outside the mighty Western alliances: we were only applying for NATO, and the EU membership was behind mountains. At the same time, the Bulgarian government in 1992 had condemned Libya as a atate sponsor of terror. Significantly, this government "forgot" to inform its people about this, so Bulgarians going to Libya didn't know that Qaddafi had a reason to regard them as citizens of a hostile state. Next door in Serbia, the next Yugoslavian war was about to burst out (it would be the last one, but nobody knew it at the time). And finally, Libya had a debt to Bulgaria and Qaddafi hoped, with good reason, to get rid of that debt and even to extort additional money.
So the first group of arrested foreign nationals were released, but then 17 Bulgarians were detained. Nurse Nelia Zhdereva said, "They had come for me also, but I didn't open the door. I just stayed quiet, pretending not to be at the quarter." After this, she returned to Bulgaria within days and nobody tried to apprehend her. Those who have read Gulag Archipelago will remember quite similar cases in Stalin's Soviet Union when the security forces, unable to find immediately their intended targets, arrested other people instead. This is to be expected when a certain number of detainees is planned, but their personalities are not very important because they have actually done no crime and the police know this better than anyone else.
Most of the arrested Bulgarians were soon released (some after being tortured), but six were kept. Of the original two detainees, Snezhana Dimitrova was rearrested. Three other nurses working at the El Fateh hospital were also arrested: Valentina Siropulo, Valya Chervenyashka and the above mentioned Nasya Nenova. Another arrested nurse, Kristiana Valcheva, had never been in the hospital in question. She was working at another hospital hundreds of kilometers away from Benghazi, so she couldn't be accused of infecting kids. Her alleged crime was that she collaborated with Hajuj and obtained the virus from the CIA/Mossad agents "John the Englishman" and "Adel the Egyptian" and handed it to the other nurses to inject the children. Kristiana's husband, Dr. Zdravko Georgiev, was working away from both Benghazi and his wife's workplace. Hearing that his wife had disappeared, he tried to find out what had happened and how to help her. He was arrested also, finishing the list of the accused.
The six Bulgarians were tortured in order to confess. Some of them showed remarkable courage. Valya Chervenyashka later said, "I never considered it possible to help them, to confess the nonsense they wanted from me. I was just awaiting my death." However, she was middle-aged and with kidney and heart problems (her heart stopped twice during the interrogations), so her torturers were aware she could die if they pushed her too hard - and this was not what they wanted.
Kristiana Valcheva and Nasya Nenova were younger and healthier and were pushed harder. Kristiana confessed, but this was not found enough. The investigation brought also evidence - blood banks with HIV found in her quarter. Just don't ask why the banks were found during the 4th search of the quarter, how the virus remained detectable in dried droplets after weeks at room temperature and what methods were used to detect it.
Nasya Nenova, when threatened to be injected with HIV, said, "Well, inject me, so please don't beat me more!" (This is the same nurse who had worked with double rubber gloves to avoid HIV infection.) The worst torturer was Juma Misheri. At one point, he left the city for a couple of days; when Nasya heard he had returned, she attempted suicide. Finally, she was so broken that she confessed three times and now is in a worse situation that even Kristiana.
Juma Misheri was later accused of having used torture but of course was acquitted. He is hailed as a popular hero because he has made the "witches" confess. Oh sancta simplicitas! Don't the people of Benghazi ever ask how many of THEM have been tortured by him?
UPDATE: Today (Sept. 26) I received an e-mail from Dr. Declan Butler, a senior reporter at the top science journal Nature. He is currently trying to use the opportunities of the blogosphere to help the accused medics in Libya. Here is a citation from his Sept. 20 post "Can the blogosphere help free the Tripoli six? — innocent medics risking execution in Libya" (http://declanbutler.info/blog/?p=59):
"“Imagine that five American nurses and a British doctor have been detained and tortured in a Libyan prison since 1999, and that a Libyan prosecutor called at the end of August for their execution… on trumped-up charges of deliberately contaminating more than 400 children with HIV in 1998. Meanwhile, the international community and its leaders sit by, spectators of a farce of a trial, leaving a handful of dedicated volunteer humanitarian lawyers and scientists to try to secure their release.
Implausible? That scenario, with the medics enduring prison conditions reminiscent of the film Midnight Express, is currently playing out in a Tripoli court, except that the nationalities of the medics are different. The nurses are from Bulgaria and the doctor is Palestinian.”
These are the opening paragraphs of an unusually strongly-worded editorial — ‘Libya’s travesty‘ – published in tomorrow’s issue of Nature. It is accompanied by a news story over two pages — ‘Lawyers call for science to clear AIDS nurses in Libya‘ — explaining the case. (Both articles are on free access; to access free articles on Nature you just need to register once, and it is free.)"
At http://www.connotea.org/user/Declan/tag/tripoli%20six?num=100, Dr. Butler has listed the blog posts since on the Libya HIV affair.
From now on, the story may be wrong in some details because it will rely only on occasional official and unofficial Bulgarian and Libyan sources, which are not very trustworthy (esp. the official ones). Corrections are welcome. However, I believe the picture as a whole is fairly accurate.
An author of detective stories once said that the victim of a crime usually has some characheristics that have led to him/her becoming a victim. In this story, we have two groups of victims: the infected little patients of Benghazi and the accused medics. Let's consider them, the children first.
Why Benghazi
In a recent comment, I called the Iranian opposition "better and stronger" than the Libyan one, implying that the latter, apart from being weak (no wonder - Qaddafi is not the ruler to tolerate alive opposition), doesn't appeal very much to me. It is because, while Iranian opposition is generally pro-Western, opposition-minded Libyans (those who live in Libya and still make their voices heard) are Islamists. In other words, they rebel against the Q-man not because he is an incompetent ruler, liar, oppressor, terrorist and mass murderer, but because they think he isn't Islamist enough. And the center of this opposition is the city of Benghazi. Here, I expect the reader to remember that exactly this city was the center of Libyan February cartoon riots, when at least 11 people laid down their lives (at the same time, residents of Tripoli were reluctant to take part even in an official peaceful demonstration - testimony of Khadija-Teri). Hanu thought that the Benghazi protests were orchestrated by government. I would rather suppose they were provoked by government agents but the ordinary participants were quite sincere. So, the residents of Benghazi must have (on average) more courage than any other group of Libyans but, unfortunately, the same cannot be said about their intellect. The Q-man knows this, understands their way of thinking very well and although they hate him, he can most of the time manipulate them as he wishes.
In 1986, a group of Benghazi residents killed a high-ranking Libyan official. Nine were sentenced and hanged (http://www.libyanet.com/feb1987.htm; warning: graphic photos). I've read (though can't give a link) that the plot was not just secret work of a few people but had wide popular support. Some Bulgarian journalists wrote that, after crushing the rebels, Qaddafi decided to punish the entire city by sharply reducing its funds. Such measures are used in many countries by the central governments against regions expressing dissent (in dictatorships) or just voting for the other party (in semi-democracies). Of course most severely affected are the industries most dependent on subsidies, such as health care.
In the following years, as admitted by a former Libyan health care minister, hospitals throughout Libya were poorly supplied with even the most basic consumatives and medications. This was conveniently blamed on the sanctions and may indeed have been partly due to them. However, in Benghazi the situation was worse than in other places. A Bulgarian nurse who worked for some time at the El Fateh Children's hospital later said, "The senior nurse every morning distributed syringes - 5 for each nurse. No more, no matter how many patients would come."
Another Bulgarian nurse, when beginning work at the same hospital in early 1998, said, "Upon arrival, I was immediately warned by an Egyptian doctor to be very careful, because there was an ongoing AIDS epidemic in the hospital." But nobody warned the patients and the community of Benghazi. Parents continued to bring their little ones to the hospital, thinking they were doing the best for them.
Later in 1998, another Bulgarian nurse - Nasya Nenova, was assigned to work at the same hospital, at a department newly formed especially for the children with AIDS. She wrote to her family: "I am of course very afraid that I may get infected, I work with two pairs of rubber gloves... Some of the children are already in very grave condition. One died last night. At least I hadn't to watch him die, a Philippino nurse was on duty then."
In the following years, dozens more children would die.
Why Bulgarians
As anger accumulated in Benghazi, the regime had to find a way out of the crisis. Of course the truth - that the epidemics was due to the punitive starvation funding of the city, plus shocking incompetence of the hospital's most responsible people - would do little to calm down the spirits. But if the virus was distributed intentionally, then the Q-man and his officials would deserve no blame. So scapegoats were needed. And because the goal was to pacify the Libyans, foreigners would make the best scapegoats.
The regime had plenty of them. Highlander once wrote, "in Libya we have thousands of foreign guest workers in the health sector for whom I am grateful as they make up the deficit." As I wrote before, I'm not sure she should be grateful. Even when they are good and caring professionals, they take positions that would otherwise be occupied by Libyans. To keep the status quo, "they enjoy an enormously better salary than the locals" (same Highlander's post). So they, together with the numerous guest workers in other industries, allow the regime to minimize the number of educated and skilled workers-citizens who are the brain and backbone of any society and in dictatorships often form dangerous opposition. Ottoman Turks made their best to keep the Libyans uneducated and unqualified, and I think Qaddafi today is following their example. Of course the guest workers themselves don't realize this (I haven't seen such a discussion in Bulgarian media, and what isn't in the media doesn't exist for the public). Nor do they realize that one of the reason they are hired is to serve as scapegoats if something goes wrong.
The first scapegoat was Ashraf al Hajuj, a doctor of Palestinian origin. I know little about him; he had lived in Libya since early childhood (probably born there) but, according to the good Arab tradition, was regarded as a Palestinian and not a naturalized Libyan. He was engaged to a Libyan girl who supported him during the following 5 years, but then left him, exhausted to be a fiance of an inmate on death row. After the arrest, al Hajuj was tortured until he was ready to confess anything that was wanted from him.
It is easy to figure out why he was taken. Much later, he said, "The interrogators were telling me that there was nobody to entreat for me because I (as a Palestinian) had no state. I am sure that, hadn't Bulgaria taken me under its protection together with the nurses, I would be now rotting in some mass grave." (I think that if Palestinians had common sense, the name and fate of al Hajuj would be known in every Palestinian house as an illustration of how much their Arab "allies" care for them. If I had such friends, I'd try to strike an immediate deal with my enemy! But of course if Palestinians had common sense, the world would be another and much better place. Mention also that he said "mass grave", not just "grave".)
However, al Hajuj alone was not enough. Non-Arab infidels would make far better villains in the eyes of Benghazeeans, so numerous guest workers were arrested - not only from Bulgaria but also from the Philippines, Poland and other countries. At this stage, there were only two Bulgarian detainees - nurses Snezhana Dimitrova and Sevda Yablanska.
I believe that Libyan authorities made these wide and apparently random arrests to probe which country was least able and willing to protect its nationals. (This protection, I think, contradicts to the very idea of justice, but unfortunately seems needed in today's imperfect world where so many countries are eager to put foreigners to cangaroo courts.) The guest worker communities of Poles and Philippinos, but NOT Bulgarians, swiftly organized and threatened that they would all abandon their contracts and leave Libya immediately if their fellow countrymen were not released. Also, the diplomatic missions of these countries made some unknown to me but apparently effective moves. The Bulgarian embassy also took measures, if you read the official Bulgarian site. However, the unofficial story is different. When a nurse informed the Embassy that two her colleagues were arrested, she obtained the answer, "Let the whores save themselves". So the Bulgarian tradition to fill the diplomatic missions with arrogant, incompetent and lazy people who care neither for the Bulgarian state nor for its nationals brought disastrous results.
There were also other reasons making Bulgaria a good target. It was a small poor coutry outside the mighty Western alliances: we were only applying for NATO, and the EU membership was behind mountains. At the same time, the Bulgarian government in 1992 had condemned Libya as a atate sponsor of terror. Significantly, this government "forgot" to inform its people about this, so Bulgarians going to Libya didn't know that Qaddafi had a reason to regard them as citizens of a hostile state. Next door in Serbia, the next Yugoslavian war was about to burst out (it would be the last one, but nobody knew it at the time). And finally, Libya had a debt to Bulgaria and Qaddafi hoped, with good reason, to get rid of that debt and even to extort additional money.
So the first group of arrested foreign nationals were released, but then 17 Bulgarians were detained. Nurse Nelia Zhdereva said, "They had come for me also, but I didn't open the door. I just stayed quiet, pretending not to be at the quarter." After this, she returned to Bulgaria within days and nobody tried to apprehend her. Those who have read Gulag Archipelago will remember quite similar cases in Stalin's Soviet Union when the security forces, unable to find immediately their intended targets, arrested other people instead. This is to be expected when a certain number of detainees is planned, but their personalities are not very important because they have actually done no crime and the police know this better than anyone else.
Most of the arrested Bulgarians were soon released (some after being tortured), but six were kept. Of the original two detainees, Snezhana Dimitrova was rearrested. Three other nurses working at the El Fateh hospital were also arrested: Valentina Siropulo, Valya Chervenyashka and the above mentioned Nasya Nenova. Another arrested nurse, Kristiana Valcheva, had never been in the hospital in question. She was working at another hospital hundreds of kilometers away from Benghazi, so she couldn't be accused of infecting kids. Her alleged crime was that she collaborated with Hajuj and obtained the virus from the CIA/Mossad agents "John the Englishman" and "Adel the Egyptian" and handed it to the other nurses to inject the children. Kristiana's husband, Dr. Zdravko Georgiev, was working away from both Benghazi and his wife's workplace. Hearing that his wife had disappeared, he tried to find out what had happened and how to help her. He was arrested also, finishing the list of the accused.
The six Bulgarians were tortured in order to confess. Some of them showed remarkable courage. Valya Chervenyashka later said, "I never considered it possible to help them, to confess the nonsense they wanted from me. I was just awaiting my death." However, she was middle-aged and with kidney and heart problems (her heart stopped twice during the interrogations), so her torturers were aware she could die if they pushed her too hard - and this was not what they wanted.
Kristiana Valcheva and Nasya Nenova were younger and healthier and were pushed harder. Kristiana confessed, but this was not found enough. The investigation brought also evidence - blood banks with HIV found in her quarter. Just don't ask why the banks were found during the 4th search of the quarter, how the virus remained detectable in dried droplets after weeks at room temperature and what methods were used to detect it.
Nasya Nenova, when threatened to be injected with HIV, said, "Well, inject me, so please don't beat me more!" (This is the same nurse who had worked with double rubber gloves to avoid HIV infection.) The worst torturer was Juma Misheri. At one point, he left the city for a couple of days; when Nasya heard he had returned, she attempted suicide. Finally, she was so broken that she confessed three times and now is in a worse situation that even Kristiana.
Juma Misheri was later accused of having used torture but of course was acquitted. He is hailed as a popular hero because he has made the "witches" confess. Oh sancta simplicitas! Don't the people of Benghazi ever ask how many of THEM have been tortured by him?
UPDATE: Today (Sept. 26) I received an e-mail from Dr. Declan Butler, a senior reporter at the top science journal Nature. He is currently trying to use the opportunities of the blogosphere to help the accused medics in Libya. Here is a citation from his Sept. 20 post "Can the blogosphere help free the Tripoli six? — innocent medics risking execution in Libya" (http://declanbutler.info/blog/?p=59):
"“Imagine that five American nurses and a British doctor have been detained and tortured in a Libyan prison since 1999, and that a Libyan prosecutor called at the end of August for their execution… on trumped-up charges of deliberately contaminating more than 400 children with HIV in 1998. Meanwhile, the international community and its leaders sit by, spectators of a farce of a trial, leaving a handful of dedicated volunteer humanitarian lawyers and scientists to try to secure their release.
Implausible? That scenario, with the medics enduring prison conditions reminiscent of the film Midnight Express, is currently playing out in a Tripoli court, except that the nationalities of the medics are different. The nurses are from Bulgaria and the doctor is Palestinian.”
These are the opening paragraphs of an unusually strongly-worded editorial — ‘Libya’s travesty‘ – published in tomorrow’s issue of Nature. It is accompanied by a news story over two pages — ‘Lawyers call for science to clear AIDS nurses in Libya‘ — explaining the case. (Both articles are on free access; to access free articles on Nature you just need to register once, and it is free.)"
At http://www.connotea.org/user/Declan/tag/tripoli%20six?num=100, Dr. Butler has listed the blog posts since on the Libya HIV affair.
Friday, September 08, 2006
The HIV trial in Libya, part 1: The infection and the charges
I have intended to write about the HIV trial in Libya ever since I begun this blog. I have mentioned this trial in two earlier posts, here and in a here. These days Libyan-American blogger Suliman expressed wish to put a comment about this trial on my blog, so I am providing an appropriate post. I warn from the beginning that I won't try to be "objective" and when writing of what evil and crazy people did, will use the adjectives that seem appropriate to me.
To my surprise, the trial has its own page in Wikipedia at http://en.wikipedia.org/wiki/AIDS_scandal_in_Libya. A chronology of the events by the Bulgarian news agency BTA can be found at http://www.bta.bg/site/libya/en/02chronology.htm. However, it reflects exclusively what official Bulgarian institutions say.
Because the text will be too long, I'll divide it into more than one post.
The infection
The core of the story are the numerous cases of HIV-infected children among those treated in the El-Fateh Children's Hospital in Benghazi, Libya. It is difficult to say when the infections began, given the various and often long incubation periods of the disease, the tendency of the Libyan authorities to lie even when the dates of infections are known in order to dismiss the possibility that some occured before the defendants began work in the hospital, and the wish of the same authorities to put under the common denominator all childhood HIV infections in Libya. According to two Western scientists who later became defense witnesses, the epidemic began in 1997. The official number of the infected children is 426.
The alleged motivation of this monstrous alleged crime? I'll cite a BBC report: "At one point, the Libyan leader, Colonel Muammar Gaddafi, had accused the health workers of acting on orders from the CIA and the Israeli secret service, Mossad. Libya later rowed back on this allegation." (http://news.bbc.co.uk/2/hi/africa/3689355.stm). I know from the media (unfortunately, I cannot find a link) that currently the Libyan prosecution says the accused were performing an illegal trial of anti-HIV vaccine developed by a Western company. They allegedly injected the children first with the vaccine and then with the actual virus to see whether the vaccine works (and it evidently didn't).
Should I discuss the original charge, after it is so absurd that even its authors couldn't maintain it after the case received international publicity? It seems to me that to duscuss it, means to offend the intellectual capacity of my readers. However, I cannot skip it because, according to opinion polls and my personal observation, many Muslims either believe it or for some reason find it necessary to claim that they believe it. I won't state that Bulgarians are not so blood-thirsty and it is virtually impossible to find not one or two but six Bulgarian psychopaths to realize such a plan. This would be akin to the statements of many Arabs and Muslims that Arabs and Muslims are good people and would never crash kidnapped planes into buildings. Nobody buys such arguments, and with good reason.
However, each crime (unless done by absolutely insane people) has its motivation and purpose. Why would CIA and/or Mossad attack Libyan children? Both secret services have had enough experience with totalitarian regimes to know that a regime like Qaddafi's one cannot be harmed by terror against civilians. It is democratic governments that are vulnerable to terror. So why waste the virus? I can imagine CIA encouraging some top Libyan officials to overthrow Mr. Qaddafi, but not to supply virus for Libyan children. As for Mossad, they lack even the motivation. As far as I know, the Q-man doesn't do much harm to Israel. Well, he brainwashes his people with anti-Semitism, but who doesn't do this? If Mossad wanted to fight their Arab enemies by infecting children, wouldn't you rather expect Palestinian children to be infected?
Besides, both secret services would have enormous problems with the law and the public opinion once the operation comes to light. Remember what problems Sharon had with the Sabra and Shatila massacre, although it was done by Israel's Lebanese allies and not by Israelis themselves. As for the USA, they are still in shock because years ago the penises of suspected criminals and terrorists were photographed in Abu Ghraib.
Also, when one is considering a current event, it is often helpful (though no proof) to compare it to similar earlier events. I know of two accusations of deliberately causing epidemics in order to hurt a regime or a community: against the medieval Jews (e.g. http://scarab.msu.montana.edu/historybug/YersiniaEssays/Doherty.htm) and against Jewish doctors at the end of Stalin's rule (e.g. http://en.wikipedia.org/wiki/Doctors). It is now evident that both were phony: in the first case, the Jews couldn't have the necessary knowledge of plague epidemiology needed to use it as a bio-weapon, nor could they have any means to protect themselves; in the second case, there was simply no epidemic at all. On the other hand, known iatrogenic (i.e. caused by medical procedures) AIDS epidemics have been found to be due to "incompetence, greed, bribery, denial, and conflict of interest" - but not to malicious intent (see e.g. http://content.nejm.org/cgi/content/full/340/12/973 and for cases of children's infections, http://query.nytimes.com/gst/fullpage.html?sec=health&res=990CE7DE1730F932A0575BC0A963958260 and http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14534057&dopt=Abstract).
Let's now consider the current charge that the children were infected in order to perform an illegal vaccine trial. At least, this is not a thing unheard of in history: Edward Jenner did exactly this, vaccinating with cowpox and then innoculating with smallpox first his baby son and then another 8-year-old boy. However, his vaccine worked and so he is remembered as a hero, not as a villain. Of course today it is absolutely unthinkable to innoculate a pathogen in order to test a vaccine's efficiency. You have to recruit a large group of volunteers, inject half of them with the vaccine (of which you believe that it is at least safe) and the others with a placebo, then let them live their lives and check how many will catch the infection naturally. If you do the things like Jenner did, you not only risk to find yourself behind bars, but you cannot publish the results in any scientific journals and hence cannot make money from your vaccine. So why make an illegal trial, after you have to make a legal one anyway to obtain publishable results? Why do the work twice?
"But the illegal trial will show you whether the vaccine works or not, and if it doesn't work, you needn't perform a legal trial and will save money and time," somebody might say.
No, the illegal trial will show nothing. You need to recruit some idiots to do it and smuggle first the vaccine, then the actual virus. If the injected children remain healthy, this means either that the vaccine works or that the virus has lost its virulence because of the non-standard conditions of the trial (e.g. overheated during the smuggling or improperly manipulated by the idiots). If the children become infected, this means either that the vaccine doesn't work or that it has lost its activity, as was just described for the virus. At the end of the day, you know nothing. No one pharmaceutical company operating this way would survive in business for more than three days. So, I think that the vaccine trial hypothesis also doesn't hold water.
Anyway, at some time the epidemics was halted. Not immediately after the arrests, but some time after them the young patients of the El Fateh hospital stopped being infected. To my opinion, this shows that while the professional torturers were weaving fairy tales about CIA and Mossad, another team of professionals was sent to the hospital to find out what was wrong and fix it. However, these men and women remain unknown to us because any acknowledgement of their work would blow up the official conspiracy theory. So they haven't received and are unlikely ever to receive the gratitudes of the Benghazi parents whose kids would otherwise also be infected and the whole Libyan society. But, as Walter Scott once wrote, people who fulfil their duty are rarely rewarded by the world, their reward is a sense of internal satisfaction which the world could neither give nor take away.
To my surprise, the trial has its own page in Wikipedia at http://en.wikipedia.org/wiki/AIDS_scandal_in_Libya. A chronology of the events by the Bulgarian news agency BTA can be found at http://www.bta.bg/site/libya/en/02chronology.htm. However, it reflects exclusively what official Bulgarian institutions say.
Because the text will be too long, I'll divide it into more than one post.
The infection
The core of the story are the numerous cases of HIV-infected children among those treated in the El-Fateh Children's Hospital in Benghazi, Libya. It is difficult to say when the infections began, given the various and often long incubation periods of the disease, the tendency of the Libyan authorities to lie even when the dates of infections are known in order to dismiss the possibility that some occured before the defendants began work in the hospital, and the wish of the same authorities to put under the common denominator all childhood HIV infections in Libya. According to two Western scientists who later became defense witnesses, the epidemic began in 1997. The official number of the infected children is 426.
At any rate, in 1998 it became evident that there was a real AIDS epidemic among children in Benghazi and that at least for some of them the only possible infection source was the El-Fateh Children's Hospital. At first, the reaction of the authorities was to try to cover up the problem. A Libyan, when later asked by the Bulgarian journalist Nina Spasova why such an important event wasn't widely discussed in public space, answered by asking, "In 1986, was there much public talk about Chernobyl in Bulgaria?".
However, the three-digit number of infected children made silence impossible. The story was made public by the Libyan magazine La in an article including interviews with victims' parents and linking the infection to the particular hospital. Years ago, I read an English translation of this article at the Libya Our Home site. Unfortunately, I cannot find it now. The article was published without (and as it turned out, against) the authorities' approval. For that reason, the journal was closed. I don't know what happened to the journalists; I hope they just lost their jobs and didn't suffer further consequences.
However, the three-digit number of infected children made silence impossible. The story was made public by the Libyan magazine La in an article including interviews with victims' parents and linking the infection to the particular hospital. Years ago, I read an English translation of this article at the Libya Our Home site. Unfortunately, I cannot find it now. The article was published without (and as it turned out, against) the authorities' approval. For that reason, the journal was closed. I don't know what happened to the journalists; I hope they just lost their jobs and didn't suffer further consequences.
To prove how unobjective I am, I'll state right now what my opinion is: the infection was due to poor hygiene and violation of safety rules in the hospital. This was clear to all people with common sense right from the beginning. Later the above mentioned scientists, Luc Montagnier (co-discoverer of HIV) and Vittorio Colizzi, wrote a report coming to the same conclusion. However, the official Libyan opinion was different.
The charges
Libyan authorities finally reacted to the scandal by arresting dozens of foreign medics-guest workers from various countries. Most foreigners were soon released but another wave of arrests followed, smaller and targetting exclusively Bulgarians. So in early 1999 the list of the defendants "crystallized", including 6 Bulgarians (5 nurses and a doctor), a Palestinian doctor and 9 Libyan doctors holding high positions at the El-Fateh hospital. The foreigners were accused of INTENTIONALLY infecting the children, while the Libyans were accused only of carelessly letting the satanic foreign plot unveil under their very noses. At least some of these Libyan defendants later, speaking before the court, supported the official version of intentional infection and so tried to save their asses by sacrificing their colleagues. They were acquitted, so the only court they may have problems with is that of their conscience. (By the way, not all Western media kept silence about these defendants, as seemed to Highlander; e.g. San Francisco Chronicle mentions them athttp://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/06/06/INGUQ6VPD91.DTL.)The charges
The alleged motivation of this monstrous alleged crime? I'll cite a BBC report: "At one point, the Libyan leader, Colonel Muammar Gaddafi, had accused the health workers of acting on orders from the CIA and the Israeli secret service, Mossad. Libya later rowed back on this allegation." (http://news.bbc.co.uk/2/hi/africa/3689355.stm). I know from the media (unfortunately, I cannot find a link) that currently the Libyan prosecution says the accused were performing an illegal trial of anti-HIV vaccine developed by a Western company. They allegedly injected the children first with the vaccine and then with the actual virus to see whether the vaccine works (and it evidently didn't).
Should I discuss the original charge, after it is so absurd that even its authors couldn't maintain it after the case received international publicity? It seems to me that to duscuss it, means to offend the intellectual capacity of my readers. However, I cannot skip it because, according to opinion polls and my personal observation, many Muslims either believe it or for some reason find it necessary to claim that they believe it. I won't state that Bulgarians are not so blood-thirsty and it is virtually impossible to find not one or two but six Bulgarian psychopaths to realize such a plan. This would be akin to the statements of many Arabs and Muslims that Arabs and Muslims are good people and would never crash kidnapped planes into buildings. Nobody buys such arguments, and with good reason.
However, each crime (unless done by absolutely insane people) has its motivation and purpose. Why would CIA and/or Mossad attack Libyan children? Both secret services have had enough experience with totalitarian regimes to know that a regime like Qaddafi's one cannot be harmed by terror against civilians. It is democratic governments that are vulnerable to terror. So why waste the virus? I can imagine CIA encouraging some top Libyan officials to overthrow Mr. Qaddafi, but not to supply virus for Libyan children. As for Mossad, they lack even the motivation. As far as I know, the Q-man doesn't do much harm to Israel. Well, he brainwashes his people with anti-Semitism, but who doesn't do this? If Mossad wanted to fight their Arab enemies by infecting children, wouldn't you rather expect Palestinian children to be infected?
Besides, both secret services would have enormous problems with the law and the public opinion once the operation comes to light. Remember what problems Sharon had with the Sabra and Shatila massacre, although it was done by Israel's Lebanese allies and not by Israelis themselves. As for the USA, they are still in shock because years ago the penises of suspected criminals and terrorists were photographed in Abu Ghraib.
Also, when one is considering a current event, it is often helpful (though no proof) to compare it to similar earlier events. I know of two accusations of deliberately causing epidemics in order to hurt a regime or a community: against the medieval Jews (e.g. http://scarab.msu.montana.edu/historybug/YersiniaEssays/Doherty.htm) and against Jewish doctors at the end of Stalin's rule (e.g. http://en.wikipedia.org/wiki/Doctors). It is now evident that both were phony: in the first case, the Jews couldn't have the necessary knowledge of plague epidemiology needed to use it as a bio-weapon, nor could they have any means to protect themselves; in the second case, there was simply no epidemic at all. On the other hand, known iatrogenic (i.e. caused by medical procedures) AIDS epidemics have been found to be due to "incompetence, greed, bribery, denial, and conflict of interest" - but not to malicious intent (see e.g. http://content.nejm.org/cgi/content/full/340/12/973 and for cases of children's infections, http://query.nytimes.com/gst/fullpage.html?sec=health&res=990CE7DE1730F932A0575BC0A963958260 and http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14534057&dopt=Abstract).
Let's now consider the current charge that the children were infected in order to perform an illegal vaccine trial. At least, this is not a thing unheard of in history: Edward Jenner did exactly this, vaccinating with cowpox and then innoculating with smallpox first his baby son and then another 8-year-old boy. However, his vaccine worked and so he is remembered as a hero, not as a villain. Of course today it is absolutely unthinkable to innoculate a pathogen in order to test a vaccine's efficiency. You have to recruit a large group of volunteers, inject half of them with the vaccine (of which you believe that it is at least safe) and the others with a placebo, then let them live their lives and check how many will catch the infection naturally. If you do the things like Jenner did, you not only risk to find yourself behind bars, but you cannot publish the results in any scientific journals and hence cannot make money from your vaccine. So why make an illegal trial, after you have to make a legal one anyway to obtain publishable results? Why do the work twice?
"But the illegal trial will show you whether the vaccine works or not, and if it doesn't work, you needn't perform a legal trial and will save money and time," somebody might say.
No, the illegal trial will show nothing. You need to recruit some idiots to do it and smuggle first the vaccine, then the actual virus. If the injected children remain healthy, this means either that the vaccine works or that the virus has lost its virulence because of the non-standard conditions of the trial (e.g. overheated during the smuggling or improperly manipulated by the idiots). If the children become infected, this means either that the vaccine doesn't work or that it has lost its activity, as was just described for the virus. At the end of the day, you know nothing. No one pharmaceutical company operating this way would survive in business for more than three days. So, I think that the vaccine trial hypothesis also doesn't hold water.
Anyway, at some time the epidemics was halted. Not immediately after the arrests, but some time after them the young patients of the El Fateh hospital stopped being infected. To my opinion, this shows that while the professional torturers were weaving fairy tales about CIA and Mossad, another team of professionals was sent to the hospital to find out what was wrong and fix it. However, these men and women remain unknown to us because any acknowledgement of their work would blow up the official conspiracy theory. So they haven't received and are unlikely ever to receive the gratitudes of the Benghazi parents whose kids would otherwise also be infected and the whole Libyan society. But, as Walter Scott once wrote, people who fulfil their duty are rarely rewarded by the world, their reward is a sense of internal satisfaction which the world could neither give nor take away.
Wednesday, June 21, 2006
What passes as good news in Bulgaria
Our second-in-importance TV channel, BTV, regularly features in its central news emission The Good News ("Dobrata novina"). It is interesting to see what passes as good news after 16 years of half-hearted imitation of capitalism. Last week, The Good News showed a single mother of 3-year-old twin girls. The mother was caring for them alone, with 160 leva (EUR 80) monthly welfare and loans. Nothing was said about the father. Bulgarian laws and practice are very kind to men who divorce or make children out of wedlock; these fathers usually are forced to pay only symbolic sums for their children and get away when they prefer not to pay even these cents. The worst thing in the story was the hydrocephaly of one of the girls. It was relatively mild, otherwise the child, who looked normal on TV, wouldn't have survived at all. However, she had some abnormalities in development and couldn't speak. Although speech delay is not uncommon among 3-year-olds (my own son will soon be 3 and still isn't talking), the kindergarten used it as an excuse not to accept the child, forcing the mother to stay at home to provide care. This was all introduction. The story proper: The mother was told that, in order to develop near-normally, her daughter needed a brain-draining implant costing 3000 leva (EUR 1500). You understand that if they had requested a million, it would have been the same for the mother. She put charity-collection boxes in all local shops and people dropped their change, but the needed sum was not likely to be collected this way during the current century. Then, residents of the district had another idea. They emptied their basements from old paper and glass packages and brought all this for sale. The price of recycled materials if very low, but the quantity must have been huge, because the 3000 leva were collected and now the child will have the badly needed implant.
Well, dear reader, do you see anything really good in this news? Should we be so happy that an innocent little girl is given some chance which must have been available from the beginning? What if the residents hadn't come to the recycle-and-sell idea, or had cleaned their basements more regularly during the years? How much precious time was lost until some genius got the idea, and then in the inevitable technological delay while moving old papers and bottles around?
According to Bulgarian law, government pays the health insurance of all children. However, it is not uncommon for a health-insured patient to hear that he needs some treatment that costs EUR 1000 or more and, although essential, is not covered by health insurance or the money is exhausted for the moment. This is incomprehensible for the normal mind, but it is a fact. The most famous case in recent time are the cancer patients, periodically deprived of drugs that must be taken regularly to prevent tumour relapse and progression. Atanas Shterev, surgeon and member of Parliament, got attention with his public remark that "we mustn't waste so much funds on cancer drugs, because patients with cancer are doomed anyway". Drugs taken by transplanted patients to prevent rejection of the organ also go missing periodically. In general, any patient needing a relatively expensive treatment for a relatively rare condition is likely to find himself in this situation.
I think this is because our health care is based on herd mentality. Its philosophy is to keep the population as a whole in fair health to ensure people's fitness as workers and taxpayers, rather than to guarantee the life and well-being of the individual. I suppose this is because Bulgaria has rudimentary civil society, no religious values, small per capita income and a recent totalitarian Communist past.
Well, dear reader, do you see anything really good in this news? Should we be so happy that an innocent little girl is given some chance which must have been available from the beginning? What if the residents hadn't come to the recycle-and-sell idea, or had cleaned their basements more regularly during the years? How much precious time was lost until some genius got the idea, and then in the inevitable technological delay while moving old papers and bottles around?
According to Bulgarian law, government pays the health insurance of all children. However, it is not uncommon for a health-insured patient to hear that he needs some treatment that costs EUR 1000 or more and, although essential, is not covered by health insurance or the money is exhausted for the moment. This is incomprehensible for the normal mind, but it is a fact. The most famous case in recent time are the cancer patients, periodically deprived of drugs that must be taken regularly to prevent tumour relapse and progression. Atanas Shterev, surgeon and member of Parliament, got attention with his public remark that "we mustn't waste so much funds on cancer drugs, because patients with cancer are doomed anyway". Drugs taken by transplanted patients to prevent rejection of the organ also go missing periodically. In general, any patient needing a relatively expensive treatment for a relatively rare condition is likely to find himself in this situation.
I think this is because our health care is based on herd mentality. Its philosophy is to keep the population as a whole in fair health to ensure people's fitness as workers and taxpayers, rather than to guarantee the life and well-being of the individual. I suppose this is because Bulgaria has rudimentary civil society, no religious values, small per capita income and a recent totalitarian Communist past.
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