December Issue 2005

The tragic death of a young lady doctor of the Civil Hospital, Karachi, on November 20, after reportedly contracting Congo-Crimean Haemorrhagic Fever [CCHF], sent alarm bells ringing in the country’s medical institutions.

Nearly 450 house doctors in the Civil Hospital alone, immediately went on strike, demanding that the government take urgent necessary precautions, particularly against poor sanitation and hygiene prevalent in most wards.

The strike was called after a young lady doctor, Dr Yusra Afaq, was admitted to the Aga Khan Hospital on November 15, with fever and profuse bleeding from her mouth, ears and nose. She died five days later at the AKUH. Though investigations to determine the actual cause of her death are still underway, her colleagues insist that she died after she contracted the deadly Congo virus. According to them, Yusra Afaq did not catch the virus abroad as she had not travelled recently and had been working at the Civil Hospital for the last three months.

Even though provincial health officials claimed that the newly-wed doctor was not suffering from the Congo virus, but from a virus having similar symptoms, they still took the precaution to seal her body in a coffin, fearing the virus was contagious. They requested the family to bury her as soon as possible in the coffin, without even administering the traditional “burial bath.”

Dr Yusra Afaq is the second doctor to have died with similar symptoms during the last two months. About two months back, a young doctor, working at the Neuro-Surgery Ward of the Civil Hospital Karachi, died of similar symptoms. Despite strong conclusions that the young medical practitioner had died after contracting a Congo-like virus, if not the actual Congo virus, health authorities failed to put into place any precautionary guidelines or safety standards.

On May 11, 2004, it was reported that four members of a family had died after contracting the Congo virus, in Balochistan. “Three members of the family died in Qila Saifullah while another member of the family — a boy — breathed his last at the Chest Hospital in Quetta. All of them suffered from Congo-Crimean haemorrhagic fever,” said the hospital’s medical superintendent, Dr Tariq Khosa.

Meanwhile, provincial health officials claim they are investigating the actual cause of both the Karachi deaths, and have also put all hospitals in the city on high alert. Doctors in Karachi have been ordered to take special protective measures, as the disease can be spread by the massive bleeding caused by the Congo virus.

According to reports, there are 33 more patients suffering from similar symptoms, who have been admitted to the Aga Khan Hospital, while five others are in government hospitals. All are, reportedly, in isolation wards. Health officials maintain that they are not aware if these patients are suffering from CCHF or any other related virus. However, the deaths have caused panic among the doctors and the paramedics working in both government and private hospitals. Figures given out by the AKUH confirm that in the last three months, 50 cases of haemorrhagic fever have been reported, of which five have died.

Dr Mashoor Alam Shah, director of the Jinnah Post Graduate Medical College [JPMC], said that a 14-year-old boy who was bleeding from the mouth, was admitted at the JPMC. “Given that there has been so much negative publicity about the spread of the Congo virus in the city and in the media, none of the doctors were willing to treat the boy, for fear of contracting the disease,” said Dr Shah. “All the doctors and paramedics left the ward refusing to offer any kind of medical assistance to the boy.”

The boy had been treated earlier at a private hospital, but was discharged after he started bleeding from his mouth and was brought to the JPMC. However, investigations later revealed that he was suffering from leukaemia and not from the Congo virus.

According to Dr Shah, so far not a single case of the Congo virus has been diagnosed at the JPMC and most of the reports published in various newspapers are incorrect. He feels that the death of the two doctors in Karachi could have been caused by dengue fever. “Dengue fever has similar symptoms,” he said, adding, however, that this will only be confirmed after the investigations are over.

The Congo virus originated in some African countries and such haemorrhagic fevers are a group of illnesses, including Ebola and Marburg, caused by a tick-borne virus. The CCHF is caused by a flea bite from fleas in goats or sheep. The disease is highly contagious. Symptoms begin with headaches and vomiting, followed by bleeding through the nose, mouth and ears and in the internal organs. There are few effective treatments and no known cure.

Doctors working at most government hospitals have decided to continue with their ongoing strike, till proper protection measures are ensured. Doctors are also sceptical about the make-shift arrangements being made at Civil Hospital in response to their complaints. There is no basic protective gear available, even to handle severely ill patients with contagious ailments, including viral diseases.

Many house doctors say that gloves and masks have yet to be arranged in adequate numbers. Those available are of substandard quality and do not meet the criterion required for hospitals.

Though provincial health officials claim that a 10-bed isolation ward has been set up at the old Burns Unit, to separate such patients, ironically, the existing isolation wards at Karachi’s Civil Hospital, apart from a few beds, offer no other facility. There is apparently no medical staff or even a sterilisation unit.

The government has set up a committee comprising three senior doctors to look into the possible causes of Dr Afaq’s death as there are 12 varieties of the Congo virus. Dr Illahi Bux Soomro, Dr Khalid Mehmood and Dr Agha Nadir have been assigned the responsibility of determining the exact cause of death. Health officials, meanwhile, have appealed to the public to take their own precautions against the lethal virus