‘AIDS family’ grasps for hope (PPP) + Families devastated by Cambodia HIV outbreak (Kevin Doyle AJE)

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‘AIDS family’ grasps for hope

Mon, 22 December 2014

May Titthara

Battambang province

In Battambang's Sangke district, the outbreak that has seen more than 100 people test positive for HIV has devastated a community.

And for one family, the pain has been intensified by the sheer number of those infected – 15 out of a possible 16 have tested positive.

“It’s just unbelievable,” said Chhay Yav, 78, who herself has contracted HIV. “I am old, it is OK. But I pity my grandchildren; some of them are 6 months old, 2 years old, 18 years old.”

The only person in Yav’s family who has not tested positive for HIV since health authorities sensed something highly unusual in the village is her husband, 82-year-old Ta Em.

“The whole village, if they talk about our family now, they will know us as the AIDS family, because now everyone carries the virus, except for Ta Em – he is rarely sick.”

Like many others, the family believes they have been infected with HIV, the virus the causes AIDS, through treatment from the village doctor, the type a healthy Em has not needed.

“My family is often ill, so we call the doctor to give us intravenous injections. We prefer injections to [oral] medicine, which is less effective,” Yav said.

Police yesterday sent Yem Chroeum, an unlicensed village doctor, to court, after he was detained at the provincial police station on December 17, amid death threats.

“We have sent him to court for negligence and for working as a doctor without gaining permission from the Ministry of Health,” said provincial deputy police chief Chet Vanny.

“Any charges will be dependent on the prosecutor.”

Nuon Sang, provincial prosecutor, would not confirm the details last night, but suggested that Chroeum would be charged.

“The court is still questioning him. We will know tomorrow what the charges will be,” he said.

A 74-year-old man tested positive for HIV in Roka village, in Roka commune, in late November. A rash of testing and retesting followed as it became clear that scores of people, from babies to the elderly, had been infected.

The Pasteur Institute has said that it has confirmed at least 119 cases in a third round of testing, while one of its doctors, Didier Fontenille, has reportedly told local media outlet Voice of Democracy (VoD) that the figure has risen to 140. He was not available to confirm this yesterday.

Some experts have described the situation as highly unusual, casting doubt on whether a single doctor could infect so many people.

Authorities raided Chroeum’s house last week, seizing used and unused needles but have said a full investigation could take months.

But many villagers are certain that Chroeum’s needles have contaminated them. Their reactions range from violent anger to compassion for a practitioner who has answered many of them in their hour of need.

“I feel so much pity for my family,” Yav said. “But I am not angry with the doctor; he has not injected us to kill us, but to try to make us better.”

Yav’s family lives in three houses that border each other. Close to where the 78-year-old spoke, her granddaughter, San Sophy, 25, cried as she swung solemnly in a hammock.

“My daughter found it difficult to take medicine,” Sophy said. “We called the doctor to inject her when she had a temperature, but now she is infected with HIV.”

Sophy’s husband, unable to accept the news that he, too, has tested positive, has fled to a nearby banana plantation. He has spent days crying and refusing to eat, she said.

“My husband feels pity towards the children and shame that the whole family is infected,” Sophy said.

Villagers, she said, always called on Chroeum when they experienced high temperatures, dengue fever, typhoid or influenza. The doctor would see them immediately and sometimes hold off on billing them until they could afford to pay.

“We wanted to go the village health centre, but it’s too hard,” Sophy said. “We would get sick early in the morning and would have to wait until 9am to see them. We were in a hurry to get out to the fields, so we preferred the private doctor.”

Yav’s son, Em San, 48, said that he had stomach pain about five months ago, which led to the doctor injecting him with 20 needles.

“I just appeal to the government to provide us with medicine – or all of us in the village will die,” he said.

Like others, San has been replaying his appointments with Chroeum over and over in his mind.

From what he can remember, the practitioner always tore the packets containing new needles open in front of him.

“I am still wondering whether it is possible for the needles to have infected us,” he said.

Roeun Vun, 28, Yav’s grandson-in-law, was the first in his family to learn that he had HIV. In response, his family members turned on him. His wife even packed his bags for him and ordered him out.

Now they seek solace in each other.
“I wanted to commit suicide, because in my life, I have never gone anywhere but the rice fields,” he said. “My wife didn’t believe me . . . but now the whole village is infected.”

As sorrow continues to consume these households and the village as a whole, the authorities keep testing more potential victims.

“We can’t get people to come, it’s up to them,” said Dr Mean Chhivun, director of the National Centre for HIV/AIDS, Dermatology and STDs, who declined to give an official number of those infected.

James McCabe, director of operations at the Child Protection Unit, said a child as young as two months old had tested positive.

“It has yet to be determined whether or not it was passed from the mother.”

ADDITIONAL REPORTING BY SARAH TAGUIAM AND SHANE WORRELL

http://www.phnompenhpost.com/national/aids-family-grasps-hope

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Families devastated by Cambodia HIV outbreak

Despair, confusion and disbelief runs through small community in northwestern Cambodia hit by surge in HIV infections.

Kevin Doyle Last updated: 21 Dec 2014 10:05

Sokha holds the papers that show the results of his family's HIV test [Van Rouen/Al Jazeera]

Roka commune, Cambodia - Sokha held the small bundle of paper in his trembling hands. Written on each sheet was information that no father should ever have to look upon.

He could barely bring himself to look at those papers again on Saturday.

On each was the name of one of his three children: the eldest, a 14-year-old boy; his two normally giggly girls aged 6 and 11, and his 46-year-old wife.

Those papers told him that all had tested positive for HIV.

A doctor who conducted the tests also told Sokha that his newborn infant son was likely infected too.

"I want the world to know what happened," said Sokha, 49, struggling to keep his shaking hand, and inner despair, under control.

"I want the world to know my name, and we want help."

This is the poor rice farming community of Roka in northwestern Cambodia - ground zero for an unexplained mass infection of HIV that has so far seen a reported 140 people, from young children to the elderly, test positive for the deadly virus in the past month.

Unusual suspect

International health organisations, the United Nations programme on HIV/AIDS and Cambodia's Ministry of Health are baffled by the concentration of infections, and a full epidemiological investigation is being launched in this neighbourhood of some 9,000 mostly subsistence farmers.

Though the source of the infections is not yet known, many residents are blaming one man: Yem Chrin, a local medical practitioner who received healthcare training in refugee camps in the 1980s and for the past 20 years has treated a vast array of illnesses for a large number of people in this community.

Yem Chrin was trusted and liked, villagers said, particularly as he allowed the poor families here to pay him what they could, and when they could. Flexible payment made his medical services, even without formal medical training, more popular than getting treatment at state-run health centres.

One of Yem Chrin's daughters said that her father, who was called for questioning by police last week, remains in police custody. She declined to comment further.

"We suspect him because most of the people who received treatment from him are HIV positive," said Sokha, who was the only one in his family to test negative for the virus.

More tests

On Monday, Sokha, his wife, and four children will go for a second round of blood tests at a hospital in Battambang town. They are not optimistic.

"I believe our result is positive and I have very little hope that they will turn negative," said Sokha's wife as she rocked her infant son in a tiny orange hammock at their rickety home of rough wood, bamboo and tin roofing.

"I just don't know what to do," she said, surreptitiously wiping a tear from her eye. "We told the children not to worry. We will have the medicine and they will be OK."

How his children will cope in the long term remains to be seen, Sokha said, explaining that he fears they will be discriminated against, first at school and later in work.

"I don't think they understand it. But we are trying to explain to them," he said.

Strange signs

On the unpaved village path that runs through the nearby village and past Sokha's house, bright yellow signs with evangelical Christian messages in Khmer were mysteriously nailed to trees some months ago.

Corruption paralysing Cambodia healthcare

At the time no one knew who had put up the signs and no one paid much attention to their exhortations, until now.

"The day of God's judgement is approaching."

"The blood of Jesus cleans our sins."

Chief of Roka commune Sim Pov said she is going to take the signs down.

"I have no idea where the signs came from."

On Saturday, the people of Roka commune received a stream of VIP guests: Cambodia's Interior Minister Sar Kheng and Minister of Health Mam Bun Heng arrived by helicopter in the morning, locals said, and gave out donations of sarongs, bread and noodles.

In the afternoon, several members of a parliamentary commission on public health arrived in cars and addressed several hundred residents, promising to facilitate access to HIV testing and life-preserving antiretroviral treatment.

One of the mysterious signs that appeared a few months ago on a road in Roka commune [Van Rouen/Al Jazeera]

Mixed messages

Cambodia's Prime Minister Hun Sen was apparently so taken aback by the reports of more than 100 HIV infections in Roka commune that he gave a speech on Thursday saying he simply did not believe it was true, while also announcing a full investigation.

And that may explain why, in a country where the prime minister's word is often considered law, government health workers are at pains to not comment on the number of possible infections - though the Pasteur Institute in Phnom Penh has reportedly confirmed, in a third round of tests, some 140 people in Rokha testing positive for HIV.

Mean Chhivun, director of Cambodia's National Centre for HIV/AIDS, Dermatology and STD, would not comment on Sunday on the number of possible infections as reported by the Pasteur Institute, saying that still further tests need to be conducted and samples are now being sent to the US and South Korea.

Some in Roka are confused by the mixed messages.

"We don't know what the government will do because [the prime minister] said he doesn't believe it," said Sokha, as two neighbours stopped by on Saturday afternoon to offer him support and to console themselves as they had tested positive for HIV earlier this month.

New normal

So, a 45-year-old mother of three, said she was the only one in her family to test positive earlier this month. And father of three, Tha, 38, was the only one infected in his family. In three months time, however, Tha's wife and children must be tested again for the virus.

There are so many people now infected with HIV in the area that Tha said it almost feels normal.

"At first I felt dispirited. But, in the few days after I was tested, more and more people found out they were infected, so I felt a little bit normal after that," he said.

"I just hope that I am well enough to feed my family in the future."

Sokha and his neighbours, one of whom is 80 years old and tested positive for HIV along with his nearly 60-year-old wife, said they want the public to know what has happened, and they want concrete help.

"When parents are infected and fall sick they cannot work, and their children cannot get a good education," Sokha said.

"I appeal to the international community to help our children."

Additional reporting by Van Roeun

Follow Kevin Doyle on Twitter @doyle_kevin

http://www.aljazeera.com/indepth/features/2014/12/families-devastated-cambodia-hiv-outbreak-201412215536411268.html