An odd cause

Alexey Goncharov, Shymkent

Legal proceedings in the case of HIV infection of children in Shymkent lasted throughout the entire first six months of 2007. It has literally engrossed the local, as well as not merely local mass media’s attention… The information of what was happening in the courtroom was communicated daily.
Eventually a sentence was passed on June, 27 by the judge Ziyadikhan Perniyaz.
He brought a verdict of guilty for all the defendants. At that, 15 persons were committed to prison immediately in the courtroom. They were sentenced to 3 to 8 year imprisonment with seizure of property. All the arrested in the courtroom are medics from ordinary doctors to head of hospital.
Suspended sentence of two year imprisonment was brought in respect of 5 defendants, with the former head of HH, SKP(House of Health, South Kazakhstan province) Aisulu Tasmagambetova, with two of her deputies and her husband Riskulbek Baikharashev, the former head of UKO Health Services Quality Assurance Department among them, as well as courier cashier of the children’s hospital who was held in custody up to that time and released in the courtroom.
Impassive voice of the immeasurably worn-out judge was heard in the dilapidated assembly hall of the Al-Farhab Regional Department of the Ministry of Interior of Shymkent, as such a spacious premise was not at hand with the judicial authorities. The entourage squalor strongly contrasted with the solemnity of the proceedings attended by quite a number of foreign pressmen. After a vassal of Themis finished reading a sentence the courtroom audience was overwhelmed with emotions.
The female medics sentenced to imprisonment were weeping and the faces of their male colleagues were disfigured by torment. The parents of HIV-infected children strongly grudged the sentence. Some women were shouting and threatening while trying to force their way to A. Tasmagambetova and were hardly stopped by the police. The ambulance medics were called straight to the courtroom as one of the mothers fainted. Squabble that hardly ended in a fight continued in the courtyard.
Everybody was displeased with the sentence. One of the lawyers of the defendants Musatay Bektasov said to the journalists:
— I’m sure everybody will appeal against the sentence. It is not substantiated by any evidence and is unduly stern. The source of HIV-infection is not found and the medics are most likely deprived of liberty because the trial won deep public resonance. There is law and there are guiding interpretations of the Supreme Court of the Republic of Kazakhstan, which clearly spell out that the conviction may not be based on assumptions and should be substantiated by evidence.
None of the defendants pleaded guilty. It appears from their testimony that they believe there are a number of HIV infection hotbeds in the area which were never detected in the course of investigation. At the same time none of those has any relation to the health facilities headed by them.
What also remained unclear for mass media was how could it be possible to conduct legal proceedings while investigation of a case of HIV infection of children was not yet finished at that time? Not that it is finished even now. Why an accountant and a cashier of one of the hospitals were tried along with the doctors? All are incriminated neglect of their duties. And the leadership of the oblast (provincial) blood transfusion center which was mentioned by Torekhan Adai, General Prosecutor’s senior aide as far back as in fall 2006 among the major figures of the then future trial, suddenly disappeared and was never even mentioned at the trial. Why such an important trial was conducted by just one judge who periodically was consulting … with himself? Incidentally primordial criminal cases were initiated in respect of “four managers of provincial children’s hospital”, too, but they were not tried in the court either.
Just looking at this doing from the outside it becomes clear that in fact this trial had nothing to do with the infection of children. Doctors were convicted for negligence, embezzlement and bribes.
“I hold acceptance of bribes proven by the testimony of the victims”, the judge said.
It was a shock. It appears that there is no need for marked banknotes, video cameras, catching red-handed. One only needs to say “I gave to such-and-such person that much” and he will be convicted. Certainly, in reality it is not like that, otherwise we would have put in prison half of civil servants in the country. But elections were at hand and it was time to drop the subject of HIV in the south and it was closed by such an odd trial.
Virtually, immediately after reading of sentence the public opinion in the town swung towards the convicted medics. It became known that simply no valuables were found in their apartments at the time of confiscation and their families with children were literally found out-of-dours without means of subsistence.
Medics in Shymkent started to actively protest against the sentence which was in their opinion ungrounded. Physicians sent letters of protest to the President, the Government and the Prosecutor General’s Office.
Also shocked were the parents of children which were receiving medical treatment from the arrested medics, and now they were asking “Who will help their children, as the best physicians are put in prison?..”
The friends and colleagues of the convicted doctors believe the innocent were put in prison.
— There’s no need to go to far… here.. our head physician assistant Klishbekov. She is a very nice person. She spent nights in the hospital. She lived there. Many saw her mental stress, remember she was crying? And now she is convicted to 4 year imprisonment. Oh, no, honestly it’s like losing heart,- says  resuscitation expert Kanat Yertayev. 
“After this trial anyone may be put in prison”, — fear the medics.
— It is unlikely that I would like to work in resuscitation unit or in health sphere at all. If there are any such brave guys who are willing to come here I am ready to quit my job,- echoes the head of resuscitation unit of children’s hospital N2 Shaken Alpispayev.
The doctors demanded to conduct the second expert examination in the case of HIV-infected children.  At the meeting of medics with the patients of the convicts they started collecting signatures the defense of the convicts.
— All this expert examination should be double checked, no matter however complicated it may be. Because the guilt may not be determined on the basis of case history. But in our case the people were plainly tried. They are the best pediatricians.  I know resuscitation experts, here, look, the whole village came to defend Tastanov,- said Svetlana Balbekova, associate professor of the Children Diseases Chair of the Medical Academy.
The parents of children saved by the convicts also spoke in their defense. Aliya Seilkhanova’s child was in the resuscitation unit for two weeks. Dreadful diagnosis of brain edema was beyond any chance for survival. Her child was saved and provided treatment by the doctors who were found at the prisoners’ dock.  For Aiya their freedom means confidence in that her baby will live.
— Well, I personally did not give any bribe. I spent forty days in the hospital and all my gratitude cost me a bar of chocolate. Was it too much for the doctors who dragged my child out of the world beyond?- asks Aliya.
No one in the meeting hall was left indifferent by the emotional speeches of parents of the cured children and the convicts’ colleagues. Everyone in the hall was weeping, compassionate for the infected children and those who were convicted.  15 more perverted fates added to the previous 118 ones.
From the very beginning independent trade unions rose actively in favor of the convicted medics. After a time they were joined by formal trade unions.
Thus, the sentence passed on medics was discussed at the special enlarged session of the committee of the Shymkent province (oblast) public health trade union organization. The leader of the public health sector trade union Mereke Butina came to Shymkent specially to familiarize herself with the situation on the spot. Before the meeting she met with the staff of the children’s hospitals, lawyers and relatives of convicts. The implication of the latter event did not fundamentally differ from the previous ones. The only difference was that this time public trade unions which until the last moment were blamed for inaction plugged in the struggle for the rights of the convicted medics, as well as the entire medicine that suffered on the whole.
Once again the colleagues of the convicted medics stated that legal proceedings in Shymkent were galloping, whereas the investigation of cases of mass HIV-infection of children in Libya lasted 8 years. At the end of the discussion the trade union appealed to the Office of the Prosecutor General, Supreme Court of the Republic of Kazakhstan, the human rights plenipotentiary representative and the Human Rights Committee under the president of RK. The appeal contained a claim “to conduct the second thorough investigation of circumstances of this case with the involvement of competent experts, to determine on the basis of scientifically reasoned data sources and channels of infection of children, to review the case and award a fair judgment so as not to  allow the infringement of rights and freedoms of the unfairly convicted group of doctors, the citizens of Kazakhstan”.
Now the lawyers of the convicted medics are preparing appeals to the Supreme Court. Four convicts are in prisons, six are released for settlement and suspension of execution is applied in respect of five women.  The lawyers’ services provided to the convicts are covered by a special fund established by independent trade unions which have already raised over 2 million tenge. In private conversations with those who are connected with the trial and are willing to help the doctors, they say there is little hope that the appeals may help. As a result the southerners keep to the beaten track and slowly, secretly buy up the convicts from prisons to transfer them for a settlement. It is only rumor, though, with no assertion.

It’s a systemic crisis
“If it were not for the HIV, there would’ve been another outbreak”

Investigation has not yet answer the question of how children were infected. However, it looks as if everything is clear for the state, after all, several convicts are in prison. So, the wave of public disturbance can be directed to them. But what if one tries to look into the situation unofficiously? What if one just talks to the doctors… It turned out to be rather a complicated matter, even provided complete anonymity.
— Mud has already been thrown on us anyway, what for should we once again turn back to this topic,- that was the main leitmotif of refusals.
But still there was a man who agreed to talk about it. Natalia — let’s call her so – a doctor with 15 year experience. However, half a year ago she left the “dear-to-the-last-nail” hospital and now she is successful in business in representation office of a large pharmaceutical company.
— Causes of infection? Let the investigation team try to determine them. What I’m telling is that it’s a crisis of a system itself. And if it were not for the HIV, there would’ve been another breakout.
— But what is this crisis about?
— Essentially, even during the soviet rule our medicine was not ideal and the doctors were secretly paid for treatment. However, at that time remuneration was paid after recovery. And now money is demanded in advance. But I understand these people. In the developed countries worldwide doctors are one of the most well-to-do categories of population, while here it is one of the most poor. And there are still nurses and hospital cleaners. They are paid even less. Now let us add to it the system of employment which exists in the province. It costs 10 thousand to get fixed in a job as a hospital cleaner and 20 thousand as a nurse. Otherwise the head physician will hire his relative from the village for the job of a nurse. She somehow graduated from the medical school. Literally she can do nothing. But it is necessary to hire her. There would have been some excuse if she tried to learn something in practice. But she does not even want to do this, for she knows who stands up for her. One can expect anything from such a nurse, and no doctor is able to keep and eye on her. Everyone knows about this system and keeps silence, if once you speak, you’re fired, the pretext will always be found. And one more thing to say. We were really in shortage of subclavian catheters for some time. It can not be used twice, but what should we do if there is a danger that a patient may die? So we ran risks. And the shortage was caused by the fact that public health department failed to calculate something. And I would really refrain from talking about blood donors. Here is and example, though. There is such a concept as emergency indications. Failure to transfuse blood promptly may result in a patient’s death. In such cases direct blood transfusion is applied. We were only able to determine blood group, and did not check anything else. In that way one father “presented” syphilis to his son.
I tried to find additional confirmation of what my interlocutrix said to me. For example, about donors. Here is what I found in the Internet.
“According to the “The Caravan“ : “…А 29-year old male donor was trying for the last time to donate blood in February this year. The test has shown a hepatitis virus and he was dismissed from blood donation. However, the following test for HIV-infection, the results of which were received in July, showed positive reaction of this donor’s blood for HIV-infection as well. In the course of epidemiological investigation it was also established that at least one of the infected children in question previously received blood from this donor. Presumably nine more children could have received donor components from the same source. It is established that a man is an intravenous drug user”.  And how, then, about the statement that no infected donors were detected during the examination in the blood transfusion centre?
A year ago, when assuming office of the province akim, Umirzak Shukeyev said optimistically: “If the number of HIV-infected remains at the same level (55 at that time), then it will be possible to consider that the infection is localized”.  Now the number of such children is over 140, and the akim in the province is changed and localization of the outbreak is hardly ever spoken about.
But at the meeting of the province HIV control headquarters the statements of parents are heard periodically which only reconfirm the thesis of systemic crisis in medicine. One of the relatives told that in the case reports/medical cards/ of many infected children the pages with prescription of blood transfusion are torn out. The members of the initiative group of parents of the HIV-infected children stated at the headquarters’ meeting that according to their data in recent interval of time about 80 children died in the hospitals of the town. The diagnoses varied from pneumonia to cirrhosis.
Meanwhile, the rate of HIV prevalence not only in Shymkent, and not even in Kazakhstan, but in the entire region, has already aroused alarm of international institutions.
For the first time the problem of HIV prevalence became the central subject of International Parliamentary Conference held in Kyrgyzstan. The Word Bank representatives published their data on the number of infected people in the territory of Central Asian states, which were part of the USSR. In the opinion of the WB one can, today one can say that Central Asia is experiencing the HIV/AIDS epidemic notable for its blistering rates of infection spread. According to the US Center for Disease Control estimate, around 90.000 individuals in the region are HIV-infected», – believe the World Bank experts.
The economists draw attention of the governments to the global experience testifying to that the measures to combat HIV if taken at the earlier stage help to avoid huge costs in future. “The uninhibited spread of infection in Central Asia during the next decade may cause economic growth rate slowdown by nearly 20 percent in Uzbekistan and 10 percent in Kazakhstan and Kyrgyzstan. On a regional scale the epidemic may lead to the annual decline of economic growth at the level of 0.5 to 1 percent which will strike all sectors of economy, from oil and gas and finance to agriculture, from industrial giants to small enterprises”, – forecasts the World Bank.
The experts rightly believe no one single state alone can cope with this disaster. At the same time, it will also be impossible to localize the dreadful infection within the bounds of any territory. The World Bank suggests to establish a single high level (not lower that the government) coordination body and a single HIV/AIDS monitoring and evaluation system. It is assumed that timely, due and objective information will allow to carry out efficient preventive control.
The former president of the fund “Protection of children from AIDS” Sagdat Mansurov  heard the word “AIDS” when the his grandson’s laboratory test results turned out positive.
— I just start to realize that this disease is not that dreadful as the virus of human corruption. It’s all because of money”, — he says.
It is officially alleged that any attempt to find at least one infected donor failed. But the journalists of one of the Kazakhstan publication have found some Zuleykho Sultanova.
Further we cite from the Internet: “This woman was stopped by militia in Kyrgizstan. She needed to go to Kazakhstan, but she had a problem with documents. Some enterprising people immediately offered her to solve the problem: if you want to cross the border, you either pay money or donate blood. The money she had was not enough and Zuleykho was compelled to be a donor.
“They poured everything in one jar. I said to them: I had hepatitis earlier, and jaundice. They said to her: it’s our problem”, — tells Sultanova.
After the procedure Zuleykho entered to Kazakhstan unimpeded. She does not know who used her blood. The Shymkent drug users and drunkards confessedly say in search of money for a bottle or dope they wouldn’t go just anywhere, but to the blood transfusion station. “They should pay 1700 tenge for 200 gram, but they just pay 200”,- they say.”
The data on the number of infected in the province always change, but it is believed that 67.7% of them were infected through blood, 14.6% by sexual transmission, 8.6% are anonymous individuals. At the same time the trend is observed towards the increase in numbers of those infected through sexual transmission and the numbers of infected women. The largest age group of 20-29 year olds accounts for 37%. 31.1 % of total number of carriers in South Kazakhstan Province falls on prisoners.