Dec 1 - - Lets pray for her today.. - -

This is the story of an HIV infected baby who passed away on March 18th 2006. The baby belongs to Pachalloor region. She was found to have been infected with HIV a year ago.

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The saddest story ever heard about HIV!

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One year ago, on 26 March 2006, Sree Avittom Tirunal (SAT) Hospital is one of the premier government institutes of Kerala, had hit the local, national and international news headlines, due to the death of an infant – the well known case of baby Reshmi.

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Baby Reshmi had been treated at SAT hospital for jaundice, soon after her birth on 25^th July, 2004. Although discharged from the hospital soon after, the child continued to suffer recurring health problems and was finally re-admitted to SAT hospital shortly before her first birthday after she developed a case of cough. She was diagnosed with whooping cough. A few months later, when the cough persisted, the SAT hospital authorities conducted a HIV test on the child and declared her HIV positive!

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The intriguing facts in the case were:

a) Hospital authorities tested Reshmi for HIV without knowing the HIV status of baby Reshmi’s parents, who could have been the only source of HIV infection in the infant.

* A HIV test of the parents later confirmed they were HIV negative!

b) The only other source of the infection could have been hospital borne – through the blood transfusions which the child had been administered when she was being treated for jaundice.

* Several inquiry committees ruled out blood transfusion as the possible source of HIV infection as the blood units used for transfusion had undergone all screening tests and a portion of the same blood had been used for transfusion to two other patients who showed no signs of HIV!

c) The hospital authorities went on to administer antiretroviral therapy (ART) to Reshmi, despite of the fact that she had a high CD4 count.

* ART is known to be highly toxic, therefore, ART guidelines state that the therapy should be initiated only when the CD4 count of the patient drops to 200, indicating a compromised immune system. Reshmi had a healthy CD4 count of 1226!

d) The most serious action of the hospital authorities was the fact that they declared baby Reshmi as HIV positive on the basis of an HIV ‘antibody’ test, at the age of 14 months, whereas this test is not considered reliable for infants under the age of 18 months to 2 years, and the HIV report of Reshmi also indicated that a HIV retest was needed after 6 months to confirm Reshmi’s HIV infection!

* HIV testing guidelines, as well as all national and international HIV/AIDS authorities, including NACO & UNAIDS, state that a child under the age of 18 months might carry passive antibodies which do not indicate infection and which might disappear once the child’s immune system develops.

e) Having declared baby Reshmi HIV infected under the most doubtful circumstances, the hospital leaked the news to the media, leading to an international, high profile “sympathy wave”, and a more covert but fatal medical and social discrimination of the child.

f) The hospital authorities washed their hands of all responsibility for the so-called infection through several state and national ‘inquiry committees’, even as the government, through the Chief Minister, Health Minister & Governor, singled out Reshmi ‘s family to dole out ‘compensation’ for the child’s HIV infection.

g) All three inquiry committees set up to investigate Reshmi’s case a) the Medical College, b) State government and c) NACO, unanimously ruled out blood transfusion as a source of infection. None of these inquiry committees bothered to inform the restless public/media what the source of Reshmi’s HIV infection could be then. No one bothered to correct the media speculation regarding the source of Reshmi’s HIV infection being blood transfusion

h) Even as all of the above medical irregularities were happening in full public knowledge and view, responsible agencies like the NACO, and Kerala State AIDS Control Society, which are otherwise at the forefront of all HIV/AIDS events in the state, did not bother to intervene at any stage and simply allowed the medical violations to take place.

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This then, were the circumstances under which Reshmi died. The ‘sympathetic’ gestures of the government as well as the flurry of activities initiated through the several inquiry committees have ensured that to date the cause of Reshmi’s so-called HIV infection and death remains a mystery to date. How many more unknown Reshmi’s are there? In SAT as well as in the many other lesser known institutions? It was the sheer shock value of the numbers that caused the report of infant deaths at SAT in April 2007 to become public. Did these babies escape HIV testing and toxic ART because they died too early – or did baby Reshmi become a victim of HIV testing and toxic ART because she survived early exposure to infections at the hospital? Where are we headed?

The real irony is that the (now suspended?) Superintendent of SAT hospital, Dr. K. Rajmohan, had the following to say in an interview in early January, “We could not confirm how the child (Reshmi) was infected in the inquiry committee. But it became an advantage to our hospital because it gave us an opportunity to evaluate our systems…”

Now again, after the latest figures of neo-natal deaths in SAT surfaced, the state government has announced a grant for the improvement of the hospital, as well as initiated an inquiry committee… Is this the pattern we have established for our institutions? We reward institutions with additional funding for activities akin to homicide while covering them up under inquiry committees?

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When will we wake up and take a call?

When we experience the senseless loss of someone dear to us?

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Reshmi’s well known case touches upon all aspects of the malaise we are faced with. We call upon the public, in particular the people of Kerala, who have always been at the forefront when it comes to understanding and addressing issues of public concern, as well as the media, who has consistently tried hard to get to the facts, to pick up the matter and get to the truth about what did really happen in Reshmi’s case, and take action accordingly to save other millions of innocent future victims.

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*Photos are screen shots from a documentary on the incident produced by JackIndia . For CD copy of the documentary please feel free to contact me

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