Medical experts have rushed to a village in Cambodia's Battambang province to screen hundreds of locals for HIV after an unlicensed doctor allegedly used unsterilised needles and reused syringes on them.
The Cambodian health authorities have clamped down on news after word leaked that well over 100 people had been infected by the virus that causes Aids. A rural medic, Yem Chhrin, has been arrested and charged with "intentionally spreading" HIV, murder and running a medical business without a licence. If found guilty, he could spend a lifetime in jail.
As of Tuesday, 1,547 people had been screened and the authorities were tight-lipped as to how many had tested positive.
Last week, health officials said a total of 106 people may have been infected in Roka. They could not immediately be reached for a new toll but the Pasteur Institute told The Phnom Penh Post newspaper on Saturday that it had confirmed at least 119 cases in a third round of testing.
"There's an increasing number but I cannot reveal the number," Mr Beng Sor, chief of the Community Health Centre in Roka village which has a population of just under 9,000, told The Straits Times. "What I can say is that there are both small children and elderly people, including two Buddhist monks, who have been officially confirmed with HIV infection."
Local "doctors" with varying degrees of training are a feature of rural Cambodia, among South- east Asia's poorest nations with a per capita income of US$2,890 (S$3,800). Trusted because they are from the community, they often do not demand immediate payment or do not even charge for services. The flip side of this is that safety standards are poor.
What Yem Chhrin was doing is commonplace, experts told The Straits Times. This time, however, the effects are chilling.
Ms Yort Khoeun, a 62-year- old widow from Roka, was working at a cassava plantation near the Thai border when a cousin told her last week that she should return to the village for a blood test. She did so, and tested positive for HIV. The childless woman received two vitamin injections from Yem Chhrin in September.
Now, medical experts at the village are dreading dozens more cases like Ms Yort Khoeun.
Many locals fear they could be stigmatised as word spreads that they have the virus. Almost none can afford treatment for HIV/ Aids. So far, health officials have given them only vitamins.
Experts point to a systemic problem of bad safety standards and inadequately trained private medical practitioners. Some are sceptical that one doctor could have caused all the infections.
Mr Heak Sik, head of an HIV/Aids prevention programme in the province's health department, said: "It's too early to conclude there is a single cause of this spreading. But many people who have tested positive claimed they were frequently treated by this unlicensed medical practitioner."
Battambang's deputy provincial police chief Seng Luch, who questioned Yem Chhrin - the only private doctor in the village - said he admitted to often using one needle for many patients, and not changing syringes at times.
Separately, Mr Beng Sor said Yem Chhrin was treating about 20 HIV/Aids patients in Roka before the jump in the number of infections. Some have died.
A doctor with years of experience in rural health in Cambodia told The Straits Times it is likely that some caught the virus elsewhere and were infected for months or years. She said: "It is disappointing that they are blaming this one man when the fact is, across the board, many health professionals, registered and unregistered, have poor practices which could also result in infections such as these. This episode should be used to strengthen infection control, not to scapegoat one unregistered doctor."