RATODERO (Pakistan) • Nearly 900 children in the small Pakistani city of Ratodero were bedridden early this year with raging fevers that resisted treatment. Parents were frantic, with everyone seeming to know a family with a sick child.
In April, the disease was pinned down, and the diagnosis was devastating: The city was the epicentre of an HIV outbreak that overwhelmingly affected children. Health officials initially blamed the outbreak on a single paediatrician, saying he was reusing syringes.
Since then, about 1,100 citizens have tested positive for the virus, or one in every 200 residents. Almost 900 are younger than 12.
Health officials believe the real numbers are probably much higher, as only a fraction of the population has been tested so far.
Journalist Gulbahar Shaikh, who broke the news of the epidemic to residents of his city and the nation in April, watched as his neighbours and relatives rushed to clinics to queue up and test for the virus.
When officials descended on Ratodero to investigate, they discovered that many of the infected children had gone to the same paediatrician, Dr Muzaffar Ghanghro, who served the city's poorest families and appeared to be at the centre of the outbreak.
Dr Ghanghro was the cheapest option in this city, charging 20 US cents (27 Singapore cents) a visit for the many parents who earn less than US$60 a month.
The paediatrician treated all six of Mr Imtiaz Jalbani's children. Four contracted HIV and the two youngest, 14-month-old Rida and three-year-old Sameena, died.
Mr Jalbani, a labourer, said he first grew alarmed when he saw Dr Ghanghro rummage through the trash for a syringe to use on Ali, his six-year-old son, who has also been infected. Mr Jalbani said that when he protested, Dr Ghanghro snapped at him and told him he was using an old syringe because Mr Jalbani was too poor to pay for a new one.
"He said, 'If you don't want my treatment, go to another doctor'," Mr Jalbani said.
Dr Ghanghro was arrested and charged by the police with negligence, manslaughter and causing unintentional harm. But he has not yet been convicted, and, in an interview with The New York Times, he insisted he is innocent and has never reused syringes.
Health officials now say that Dr Ghanghro is unlikely to be the sole cause of the outbreak. Visiting health workers saw many cases of doctors reusing syringes and intravenous needles. Barbers use the same razor on multiple customers, they said, and roadside dentists crack away at patients' teeth on sidewalks with unsterilised tools.
Such unhygienic practices are prevalent across Pakistan and probably the leading cause of the country's surging rates of HIV infection, according to health officials. But Ratodero is so poor that such practices are likely to be much more common, as residents struggle to make ends meet and scrimp wherever they can.
NYTIMES
