Sana’a, Yemen (Al Wahdawy) June , 2015 – Awaiting Death, Abdul Aleem, 30 counts down the years left of his life. That is what reality has become the man who had no idea that he had an appointment with a deadly disease emanating from the health clinic or “hospital”.
His story begins on the operating table at Al Jumhouri Hospital in Aden – the second largest city in Yemen – after he had a traffic accident in late 2003. Doctors decided to amputate his right foot. In the process, he lost a large amount of blood, which necessitated a transfusion to save his life.
Months later, while in Cairo, to which he arrived in early 2004 in order to undergo an operation to correct his urinary tract after part of his male member had been removed as a result of the accident, it was discovered that he had AIDS.
Needless to say Abdul Aleem, whose story had become of public interest and was carried by many media sources, did not undergo the operation. Instead, he returned home with the added burden of a deadly disease, knowing that he was not responsible for it, but the fault lay with the contaminated blood that had been given to him. This reporter has proof of this through documentation.
Abdul Aleem and 62 other AIDS carriers are officially registered in Yemen. There are dozens of cases that have not been documented. All have fallen victim due to old equipment and rudimentary methods of testing and transfusing blood in Yemeni government and private hospitals. After a year of investigation we can report that this has caused patients to become contaminated with the acquired immune deficiency syndrome (AIDS) virus. We have also proof that 60 to 70 government and private hospitals in Sana’a rely on the antiquated method of Chromatography for blood testing which usually gives faulty results.
Only a handful of the blood laboratories carry out the newer forms of testing such as Elisa and PCR, which provide more accurate results. However the lack of expertise at these labs acts as a red flag, warning thousands of blood donors and receivers in Yemeni society, who could be unknowingly carrying the virus. There are 35,000 who have fallen victim to the disease in the country, this according to statistics from the National Program for the Prevention of AIDS, attached to the Ministry of Health. Of this, 64% are males and 34% are females. The first documented case goes back to 1978.
Doctors at hospitals that rely on these old testing methods urge their patients to get tested at other hospitals, according to Dr. Jamal Al Masni who works at a private hospital in the Al Siniya district in West Sana’a. Relying on the results of a non-scientific questionnaire by this reporter which listed the names of the places testing for AIDS that included 70 government and private hospitals, 33 hospitals said they did not trust their own out-dated testing facilities but asked patients to have tests carried out at other hospitals. Another 27 said they carried out their own tests. (Refer to Questionnaire results).
Official Sources as well reports from specialists and results from patients’ files all indicate that the virus is spreading fast because of a lack of monitoring and supervision as well as applying safety precautions when dealing with transfusion equipment in government and private hospitals. Despite this, Abdul Aleem faced constant denial and a long litigation process regarding the transfusion of contaminated blood; the hospital administration denied the incident according to his lawyer Mohammad Ali. He had to undergo a new blood test at the hospital lab, which showed negative results. However, an external committee consisting of private and government doctors, all agreed that Abdul Aleem was in fact living with the virus after having his blood tested at the modern facilities at the Al Thawra Hospital in Sana’a. This was confirmed by committee member Dr. Nabil Abed Al-Rab, who is also head of the AIDS Prevention Committee in Aden.
The findings of the committee also proved that the victim had been provided with 16 units of blood, each one measuring 500cc, taken from about 20 donors from different areas. When they attempted to find the identity of the donors, they found the hospital records empty, with no names or addresses, with the exception of four!
No Data Base
Since the hospital did not have a database with the names and addresses of the donors, it was difficult to track them down to have them tested and carry out the necessary precautions if proven that any of them were carriers of the virus.
This was part of the findings of the committee and led to accusing the hospital administration of negligence during blood transfusions. The fact that the donor names and addresses were not available was a matter punishable by law. Yemeni law does not identify medical negligence in a unique manner, but rather determines fault in general. Article (245) of the Crime and Punishment Law No. 12/1994 states that “anyone who shall cause through error or fault any bodily harm resulting in a disability and emanating at a time when the perpetrator is carrying out the duties of his job or profession shall be sentenced to a period not to exceed one year and fined.”
The hospital administration argued in its defence in court that the situation was one that constituted emergency medical treatment and there was no time for routine procedures. The lawyer for the defence went on to lay the blame on the shoulders of the laboratory technician Ahmad Hussein saying he failed to make sure that the donated blood was free from contamination. The latter admitted to a fault in the testing equipment, which provided erroneous results. Prior to that, the committee had Abdul Aleem’s wife tested because the hospital had counter attacked saying that he had probably been infected with the virus by his wife before entering the hospital. Test results proved that his wife’s blood was negative and that the virus in Abdul Aleem’s blood was still in the initial stages, which meant it had not been in his system for an extended period of time and did not match the time that had elapsed since his entering the hospital.
Abdul Aleem spent two years running around in the justice halls until the penal courts were able to verify that the virus was transmitted through medical fault caused by the lab technician who carried out the blood transfusion. The sentencing found the hospital administration and the Ministry of Health at fault and fined them 50 million Riyals ($233,000) in compensation to Abdul Aleem. The sentencing also included the imprisonment of the lab technician for one year and the allocation of a hospital room for Abdul Aleem where he was to undergo treatment at the expense of the hospital; it has however shirked from this responsibility. The Ministry of Health appealed this ruling, it took two years but the Court of Appeals upheld it, as did the Higher Court in the capital, which took another two years to ratify the ruling. The ministry then wasted another year executing the sentence according to the lawyer Mohammad Ali who finally received the compensation payment for his client in instalments, the first of which came through in 2010.
Proof through experience
With the help of the AIDS Patients Activist Society and a specialist doctor, I carried out two tests on a patient who has been proven as a carrier s of the virus. In the first test we relied upon the out-dated Chromatography methods that is still being used in a number of government and private labs in the country. The result came back negative.
When the same test was carried out at the private-run Awlaqi Labs that rely on the more modern Elisa testing methods the result came back positive, taking into consideration that the time that elapsed between the two tests was less than a week. This discrepancy in results had happened before with Abdul Aleem. In the seven years that had passed, which he spent in litigation trying to get compensation for what had happened to him, the truth sheds light on what goes on inside the blood labs at the Al Jomhuri Hospital, the biggest of its kind in Aden.
The Committee’s report confirms that the only blood-testing machine at the hospital does not yield accurate results, taking into consideration that the solutions used were expired. According to the report, “the hospital administration purchased expired blood analysis solutions from the Radwan Corporation at a cost of 200 thousand Riyals ($930). Had they been effective, the cost would have been 2 million Riyals ($9300), which was the sum that the hospital had entered as expenses in its records. After testing the solution it was determined that they were not the same and that they were only effective for one month; the substances were stored improperly and therefore did not generate correct results for the tests.”
Because of this, the director of the hospital, Suleiman Al Jaffrey, tendered his resignation after the huge scandal emerged. Six members of staff were accused of tampering with public funds and falsifying official reports including the director of the Medical Office in Aden, Al Khadr Nasser. “An example (of the punishment) was made with the lab technician who was jailed for all that happened,” according to Abdul Aleem’s attorney Mohammad Ali.
The court decision did not please Abdul Aleem who says “all the money in the world cannot compensate me for what has been lost.” He was not unable to undergo the operation to correct his urinary tract nor did he get a room inside the hospital for treatment. When I visited him I found him alone lying on his bed inside his house in the governorate of Al Dali’ in South Yemen.
Abdul Aleem complains about the cruelty of society saying: “after people found out that I had contacted AIDS I found myself alone at home abandoned by my wife, daughters and seven brothers, even though they were deaf and dumb and I was their connection to the hearing world and the provider prior to my accident.”
Dr. Abdul Hameed Al Suheibi, director of the Ministry of Health’s national campaign program for the prevention of AIDS and other sexually transmitted diseases, confirms that negligence exists and that errors do happen resulting in the transference of the AIDS virus during blood transfusions and from the surgical equipment. However, he claims that it is very difficult to prove this. He explains that the AIDS virus might be dormant when the system is absent of antibodies, which means it is difficult to measure and cannot be detected for months.
He does go on to add that “some of the testing methods and equipment that are no longer viable for testing are still in operation in Yemen and many catastrophic and fatal errors occur not only with the AIDS virus but also with other viruses more resistant to sterilization such as Hepatitis.” The ministry is working on “trying to prevent such mistakes as well as modernising the blood testing equipment.”
According to publically released figures, 3763 persons contacted AIDS in Yemen by the year 2012. However, the National Program, which published these figures, admits that the number is most likely much more than what is registered or declared. An official report released in early 2013 estimated that the number of AIDS patients is more than 35,000. However, the centre was not able to publish more recent statistics due to the worsening security situation, according to Dr. Abdul Hameed Al Suheibi. The World Health Organization estimated in a report issued in mid 2013 that for every 1 declared case there are 10 unregistered. International expert at WHO, and the person in charge of the Tuberculosis/AIDS Campaign Program at the Yemen Office, Osama Muslim compares the situation to the tip of an iceberg immersed in water.
Osama explains that 31% of those carrying the AIDS virus contacted the disease through negligence and unsanitary medical conditions and out-dated blood transfusion methods. This, he said, is according to a survey carried out on a random number of patients and hospitals by the organization in 2010. The National Centre for AIDS published its findings in a report issued in 2012 – a copy of which was obtained by this reporter – that 63 cases of AIDS were contacted through blood transfusions, 19 of which through the use of dirty needles and unsterilized surgical equipment. There were 496 registered cases, unknown how the disease was contacted besides the thousands of other unregistered cases.
In the governorate of Ibb, an AIDS carrier admitted to the authorities – which apprehended him in 2009 for having been involved in an illegal relationship with African woman – to having donated blood several times without revealing that he had the virus. He confessed to having donated blood during the years 2006 and 2009 at several hospitals in the governorates of Sana’a, Tai’iz and Ibb and that he knew he was a carrier since 2005, after having been tested at a hospital in a neighbouring country where he was working.
He also admitted that he had done this out of revenge against the society, which “had treated him as an outcast and with contempt.” He confessed to this in a report during an investigation at one of the police stations in Ibb, according to a copy of the report obtained by this reporter. Negligence and lack of administration is rampant at the National Centre for Blood Transfusions and Research. The centre monitors all services dealing with blood transfers in the various government and private medical facilities. However, the patients notice much neglect especially amongst the staff, many of whom are unqualified (based on the certificates held by the workers), as well as machines that don’t operate because the correct solutions are not available.
The centre employs 46 official staff members and 15 retired (who are not part of the social service). According to a human resources official who asked to remain anonymous, only 30% of the employees hold the required qualifications to work in such a venue (university graduates and higher). The remaining percentage is divided between those without a university degree but hold certificates from colleges and medical institutes, in addition to 17 who only have a high school diploma, working in administration.
90% of the staff do not have any previous experience and did not carry out any training in blood transfusions and research. The actual venue is quite small, not really befitting the centre and its purpose of virus research, which is limited to one room only. Another room has been allocated for blood transfusions, a third for blood donations and a fourth for refrigeration with the last one being used to match blood type. That is the entire centre besides the area for administrative use, which is usually overflowing with employees.
One also notices at the centre a number of large vessels and containers filled with contaminated blood belonging to anonymous donors; according to officials and documentation by this reporter. The centre has been unable to determine whether these donors were carriers or not. Dr. Fawzi Raheem, the centre’s director calls it a “real catastrophe.” The centre for blood transfusions and research was opened in 2006 and only has one branch in Aden besides the main office in Sana’a.
Dr. Raheem complains that “the state did not provide enough funding to facilitate the work of the centre,” adding that “most Yemeni hospitals still use old equipment that are no longer reliable or accurate.” And despite the fact that the centre received a donation of $2.2 million from the World Fund Campaign against Tuberculosis and AIDS in the form of new equipment, they have been unable to operate the machines because of the lack of solutions needed. The centre has not been able to cover their exorbitant cost of 10 million Riyals ($46,511) annually.
Dr. Raheem also says “the centre was suspicious of certain possible donors but was not able to confirm whether they had the virus or not as that required central laboratories and modern equipment which they did not have so they excluded them from donation.” There have been reports of corruption associated with the consultant for the Arab Agency for Blood Transfer Services, Dr. Arwa Awn who had held the position of director of the National Centre from its founding until 2010, when the Ministry of Health fired her.
She took them to court where she won her case revealing that the ministry had been involved in importing blood analysis solutions that were expired. Awn says: “the Ministry of Health used part of a grant that was donated by UNICEF to carry out an import deal for Indian and Korean blood analysis solutions to be used in PCR to check for AIDS, without consulting with the centre for specifications. The solutions arrived at Sana’a airport with only six months left on their expiry date. After being stored for “four months they were brought to the centre to be used in blood analysis, even though they were expired and would give faulty results causing health catastrophes.”
The Central Agency for Monitoring and Accounting confirmed this incident in a report issued in 2011. It also revealed that the centre had been using solutions (without naming them) at a cost of $131,572 despite the fact that most of them were almost expired.
In order to find out the type of solutions that were imported I got hold of a copy of the import deal and after studying the documents and getting them translated with expert help from the International Warsh Company it came to light that the imported product was blood analysis solutions of the type anti-HCV bought from anti-HCV banks that are banned from blood banks. The company report also indicated that “such anti-HCV solutions should not be used at blood banks, blood donation centres and other institutions that deal with blood testing or any of its by-products.”
The “Qarar” Corporation, one of the civic society’s organisations in Yemen, had also reached the same conclusions at an earlier time. It had sent a letter to the director of one of the anti-HCV banks in the republic in May 2012 asking the them to stop the national centre for blood transfusions from carrying out any research and banning the use of the blood solutions. The letter, which was printed in the main newspaper in the country on the 5th of the same month, also reported that these solutions would cause an increase in the cases of Hepatitis C amongst Yemeni citizens.
Awn, who holds a doctorate degree in haematology and blood transfusions says: “Mistakes occur not only when transferring AIDS contaminated blood from a carrier to a healthy patient but also when transferring blood types that do not match among patients; deaths have happened but they go unregistered.
Going public with such happenings would encourage victims’ families to tell their own stories.” She also believes that “the solutions and equipment currently in use do not do the required job and those in charge do not seem to understand the dangers that can emanate from being lax with procedure when it comes to blood transfusions; a matter that is regarded as part of the national security by some countries.
She passionately goes on to add: “I am a doctor and I worry about any blood transfusions in these circumstances. When a patient tells me he wants to have a transfusion it causes me much worry because I do not know where to send him since there are many possibilities of contamination.”
Dr. Abdul Qawi Al Shumeiri, secretary-general of the Doctors’ Union in Yemen, says he believes that mistakes occur which lead to patients contacting AIDS because of the absence of units monitoring the spread of infectious diseases in hospital as well as poor hygiene and sterilization when it comes to the equipment being used, in addition to the use of out-dated equipment and solutions that do not meet specifications. Dr. Al Shumeiri criticizes the Ministry of Health saying its role in monitoring the events is “negative and weak” and points out the medical staff leave a lot to be desired as is the case with the machinery. “The danger here does not only lie with the spread of the AIDS virus but also with other very dangerous viruses such as Hepatitis which has spread widely amongst the Yemeni population.”
Lack of Resources
This reporter took his findings to the Minister of Health, Ahmad Al Ansi, who referred it to the director-general of the medical sector at the ministry, Ali Al Alfi. He believes that the incompetence in the ministry’s work is caused by limited funds which “do not permit it to carry out all its responsibilities in the health sector in the country.” When asked about the lack of availability of the special solutions required to operate the blood analysis machines at the national centre for blood research Al Alfi’s response was that “the cost of those solutions was not included in the ministry’s budget and it is therefore difficult to add an expense to cover those costs.” He did point out that the ministry had included them in the budget for the year 2014, which was estimated at 62 billion Riyals ($288 million) that is 4% of the state budget. Meanwhile the estimated budget for the Ministry of Defence was 500 billion Riyals and the National Centre was allocated 378,169 Riyals in 2014.
Al Alfi refuses to discuss the issue of the ministry’s involvement in the importing of expired blood analysis solutions saying this was a matter that concerned previous regimes as the minister was appointed to the ministry in the first quarter of 2012. On the ministry’s shirking of its responsibilities in the monitoring of safety regulations with regard to blood transfusion equipment in hospitals, Al Alfi says “the ministry is carrying out its duties within its limited resources and it does plan to enforce more stringent guidelines and monitoring.”
He did point out that the ministry had suspended the licenses of several medical facilities – without naming them – during 2013 “because they did not adhere to the guidelines and did not meet specifications.” He did go on to say that “the limited resources of the ministry were the main reason behind its inability to maintain the medical health sector.”
Meanwhile, Abdul Aleem’s health deteriorated badly. He passed away before the completion of this investigative report, in January 2015. His body was buried along with his pain and suffering. During my last visit to his house in October 2014 he confessed: “I only wait for death to save me from my psychological, physical and social torture.” And, “if I didn’t fear the wrath of God I would have taken my own life and ended my suffering.”
This investigation was completed with the support of Arab Reporters for Investigative Journalism (ARIJ) – www.arij.net