Asia Focus

Kazakhstani President Nursultan Nazarbayev is taking swift action to defuse popular outrage over a scandal, in which at least 78 children have been infected with the HIV virus through the negligence of healthcare workers.

On October 25, Nazarbayev traveled to Shymkent, the capital of the South Kazakhstan Region, and the scene of the mass infections, to be briefed on the crisis by local officials. The first reports of children becoming infected surfaced this spring, but the trend rapidly accelerated in recent weeks. As of mid-October, at least seven of the infected children had died from HIV-related illnesses, the Health Ministry reported. Eight mothers of HIV-positive children are also infected.

The scandal has shed light on corruption within Kazakhstan’s healthcare system. It also embarrasses Nazarbayev’s administration, which has gone to great lengths this year to tout Kazakhstan as a rapidly modernizing nation that could soon join the ranks of the world’s 50 largest economies.

The children contracted HIV via tainted blood transfusions. Among the sources of the tragedy, Health Minister Anatoly Dernovoi identified three factors: inadequate equipment, unqualified healthcare staff and misappropriation of funds, the Kazinform news agency reported October 25. Other officials have cited the embezzlement of state assets by healthcare workers as playing a major role in the infections.

Nazarbayev’s visit to Shymkent was designed to demonstrate his direct involvement in improving care conditions in the region. The president received an update on the HIV situation from the health minister and the regional prosecutor. He also vowed that all those responsible for the infections would be brought to justice, and indicated that additional funds would be allocated to correct existing problems. “The economic situation in the region is not bad,” the Kazakhstan Today news agency quoted Nazarbayev as saying. “The only thing that needs to be done is to put right the health situation.”

Criminal proceedings are already under way. Eight senior doctors and public health officials face charges of negligence, according to Torekhan Aday, who is leading the ongoing investigation. Aday identified the accused as the former regional health department director, two of her deputies, a former senior doctor at the regional children’s hospital along with his deputy and two department heads, and a former senior doctor at the regional blood center. Since those indictments, the investigation has broadened its scope; at least 12 more criminal investigations have been opened. Possible charges arising out of these probes could include bribery, Aday told Kazakhstan Today.

The scandal claimed the political careers of several top officials, with Nazarbayev installing a new health minister, Dernovoi, as well as a new regional governor for South Kazakhstan, Umirzak Shukeyev, the former mayor of the capital Astana. In struggling to contain the spread of HIV infections, authorities have screened roughly 10,000 children and 18,000 pregnant women for the disease.

“This catastrophe has arisen due to the fault of specific people,” Shukeyev told a task force set up to tackle the crisis on 26 September. “They must be punished. Society expects that from us; the parents of the victims expect that from us.”

Dernovoi was quick to point the finger at his predecessor, Yerbolat Dosayev, who was sacked on September 20. “Obvious medical mistakes have been made which led to the outbreak of HIV infection,” Dernovoi said in remarks broadcast on Channel 31. “In this lack of professionalism we see mistakes made by the previous management. The Health Ministry is going to push through all reforms and all measures directly aimed at improving the health service for the public.”

The specific origin of the infections has not yet been determined. However, mass media outlets have focused on corrupt practices in the health system. Reports have suggested that graft among hospital managers may have caused equipment shortages, leading to disposable syringes being re-used. The criminal investigation has likewise revealed irregularities in the donor system: blood given for free was re-sold; donors giving their blood for money were underpaid; and one woman remains under investigation for allegedly acting as an intermediary in blood sales.

Reports say that homeless people, prostitutes and drug addicts were routinely giving blood for money, sometimes using fictitious addresses and false IDs. Payments are relatively attractive, ranging from $16 for blood and $32 for plasma. If reports that medical staff pocketed some of that money are accurate, this would indicate both doctors and donors had a financial incentive in the transactions, thereby explaining the lax enforcement of safeguards in Shymkent.

In the wake of the infections, new, stringent standards have been introduced, a doctor at the National Blood Center in Almaty told EurasiaNet. “All laboratories are operating strictly according to the rules now,” the deputy head of the center’s medical unit, Aliya Mamyrkhanova, said. “Our documentation is all in order; we are strictly checking donors to avoid the transfer of infection. … We are aware of our responsibility for blood transfusion, in making sure infection is not passed on.”

To many Kazakhstani citizens, reports of corruption in state-run healthcare facilities do not come as a particular surprise. A payment or gift of some sort, often discretionary, is widely seen as needed to receive attentive care, even though medical services in state-run facilities are supposed to be free. Anecdotal evidence speaks of senior doctors setting targets for junior doctors to bring in a certain sum at the end of each shift.

The families of infected children are to receive financial assistance from the state, including a preliminary payment of approximately $800, and subsidies ranging from $110 to $175 per month while the children are being treated. The children are expected to qualify for a disability allowance of approximately $70 per month until the age of 16. Medical assistance has arrived from abroad. Two Russian experts are working on the ground, one offering psychological counseling to families and medical staff, another focusing on treatment for the infected children, UNICEF says. More foreign specialists are expected in late October.

The stigma of HIV/AIDS is a further source of trauma for the families, who face rejection by a public ignorant of HIV. Some families of infected children have gone public to report being shunned by acquaintances. UNICEF has launched a publicity campaign to encourage ethical reporting of the crisis and warn of the danger of stigmatizing the infected children. “One main problem is to avoid discrimination against children who are infected,” UNICEF communications assistant Torgyn Mukayeva told EurasiaNet. UNICEF conducted a seminar in Shymkent on October 13 to promote awareness that infected people can survive with the virus.

The government is moving to tackle problems in blood transfusion centers. Reports say centers all over Kazakhstan are being inspected. It remains to be seen whether this flurry of activity will translate into real reform of the health system, which is in clear need of an overhaul. As Shukeyev, the new governor of South Kazakhstan, told medical staff in late September: “We may be seeing just the tip of the iceberg.”

Note: Joanna Lillis is a freelance writer who specializes in Central Asian affairs.

Publish: by LuisB

Today, on the threshold of 60 momentous years of Independence, the nation is justifiably proud of its myriad achievements. Among these is the remarkable success in eliminating widespread famines and the impressive increases in food production. Nonetheless, there is a long road to be travelled before the vision of a truly food secure India is achieved.

As the world's leading humanitarian agency and the food aid arm of the United Nations, the World Food Programme (WFP) has been privileged to work with the Government of India in its efforts to eliminate hunger and ensure food security to the poor. Although its assistance is small compared to the scale of the Government's own programmes, yet with its international outreach, and the experience gained globally, the WFP has a special niche in complementing and sharpening government efforts to eliminate hunger.

Recent years have seen the economy booming and growth rates have been among the highest in the world. The flip side, however, is that one in every five Indians suffers from overt or covert hunger.

"Hunger," as stated by Amartya Sen and Jean Dreze, is "intolerable in the modern world" in a way it could not have been in the past, because it is "so unnecessary and unwarranted.

" India is a poignant example of how food sufficiency at the aggregate level has not translated into food security at the household level. A staggeringly large number of undernourished - about 214 million people - is chronically food insecure. Many more, varyingly about 40 million, are exposed to natural disasters. About 50 per cent of children (mostly tribal and rural) are undernourished and stunted, 23 per cent have a low birth weight and 68 out of 1000 die before the age of one year. There is a high prevalence of anaemia and other micronutrient deficiencies.

The challenge before the WFP is to help the country attain the critical Millennium Development Goal on eradicating hunger. The Draft Approach Paper to the Planning Commission's Eleventh Five-Year Plan articulates a "vision of growth that will be much more broad-based and inclusive.” These priorities of the Government match the WFP's own goals and will guide future initiatives. As part of the U.N. system, the WFP also works within the U.N. Development Assistance Framework to achieve synergy and, at the same time, avoid costly duplication of efforts.

Committed to the vision of a hunger-free India, the WFP set itself twin goals. The first is to be a catalyst for change in the country's effort to reduce vulnerability and eliminate food insecurity. The second is to leverage policy and resources to demonstrate models that provide immediate and longer-term food security in the most food insecure areas.

The WFP seeks to achieve its strategic objectives through three major initiatives. The first is the support it extends to the Integrated Child Development Services (ICDS). India is home to the largest number of children in the world. But what distinguishes India is not the numbers but what has been called its "silent emergency": astonishingly high child malnutrition rates. As part of its assistance to the ICDS, the WFP has successfully piloted Indiamix - a nutritious fortified food - widely recognised as an innovative nutrition intervention.

Secondly, the WFP complements the Government of India's mid-day meal scheme in some districts with a mid-morning snack that is fortified with vitamins and minerals and enhances learning by children, many of whom go to school on an empty stomach. This has proved to be an effective means to increase enrolment and retention, especially that of young girls.

With increasing degradation of resources, the livelihoods of poor tribal communities are under threat. In collaboration with the International Fund for Agricultural Development, the WFP assists food-for-work activities in tribal development programmes undertaken by Governments in select States. This has led to empowerment of tribal communities and sustainable use of natural resources.
In addition to the core programmes, the WFP has proposed significant capacity-building initiatives that relate to food fortification, grain banks, and strengthening of the Government's food-based programmes. The Ending Child Hunger and Undernutrition Initiative is an alliance between UNICEF and the WFP at the global level as well as in India that holds great promise.

The WFP takes pride in the analytical rigour it has imparted to the conceptualisation of food security. The Food Insecurity Atlases, prepared in collaboration with the M.S. Swaminathan Research Foundation, were a landmark. Extending the earlier work to the regional and district levels, the WFP proposes to prepare, in partnership with the Government, food insecurity atlases for several States.

The future beckons! As India surges ahead to take its rightful place in the comity of nations, we in the WFP look forward to the coming years with renewed faith and optimism and a firm belief that hunger and undernourishment can be banished.

The revised thrust of the WFP endeavours will be to bring the hungry, malnourished, and vulnerable within the ambit of human development, to change the course of their destiny and unleash their potential through opening a new world of opportunities.