Protecting Our Valued Health Care Workers
By June Tavenor-Brake, RN BN
On December 19, 2006, after seven years of fighting, five Bulgarian nurses and a Palestinian doctor were convicted and sentenced to death. They were charged with knowingly infecting over 400 children in a Libyan hospital with the HIV virus. This was the second time the group had been convicted: this trial was the product of an appeal resulting from international pressure. I feel this is an unfortunate example of a country and an institution not willing to accept their own mistakes and taking advantage of an opportunity to blame contract workers.
Poor infection control practices in the Libyan hospital were documented in a report by the World Health Organization (WHO) in 1999 after the outbreak occurred. A similar outbreak of HIV in children occurred in Kazakhstan last summer, when 80 children were infected with the virus because of contaminated hospital equipment. Shortly after the Libyan outbreak occurred in 1998, WHO arrived and compared this event to similar ones in Russian and Romanian hospitals. The Bulgarian government adamantly insists that the infection of these children was due to unhygienic conditions, not a malicious act by these healthcare workers. Several European countries and several international rights groups have made statements indicating Libya has made scapegoats of these healthcare workers to make up for unsanitary conditions that exist at the children’s hospital.
A large part of the appeal in this case has been the documented lack of scientific evidence to support the claims of intentional HIV infection of children. Nature magazine published an analysis of the HIV and hepatitis samples obtained from the children infected in the Libyan hospital. The tests show that the children were infected as many as three years before these workers began their contracts, a finding supported in the highly respected New England Journal of Medicine. On December 25, 2006, the Canadian Broadcasting Corporation (CBC) reported that Libya’s supreme court heard the appeal of the health care workers and the death sentence had been thrown out. The case has been ordered to retrial. Unfortunately, Bulgaria has claimed the group has been tortured in jail by electrocution and beating, and that two of the women have been raped.
Universal Precautions
As a healthcare worker, I am very aware of universal precautions and how they apply to prevention of disease transmission. It affects my practice every time I handle a patient. By 
changing gloves and washing hands between patients, any illness that is transmissible through body fluids will never make it to the next patient. Sterilizing of surgical equipment and using new needles with each patient seem like obvious ways to prevent spreading a disease from one patient to another, but what if financial resources limit the amount of equipment you have, and the amount of time and resources you can spend on cleaning them?
A 2001 article in the Journal of Infectious Diseases describes how, in countries with limited healthcare resources, frequent outbreaks of blood-borne pathogens such as HIV can be linked to overuse of injections, frequent sharing of syringes, and poor enforcement of safety guidelines. The authors of the study feel that practices such as these resulted in the infection in the Libyan hospital. The article states,
“Our study reports the largest outbreak of nosocomial transmission of HIV infection associated with a high incidence of HCV and HBV transmission …. Higher interisolate variation was observed for the C2V3 region (0%
9%), which probably reflects a higher substitution rate due to immune pressure, but this variability corresponds to that reported for related samples within sexual or parenteral transmission.”
The word “nosocomial” is defined as an infection obtained from another patient in hospital. For example, hospital acquired pneumonia is a nosocomial infection. This means that the HIV infection in these children was the same HIV strain already present within the hospital. The reference to “parenteral transmission” means these children have HIV strains consistent with those found in patients who were infected with HIV through infected needles, such as IV drug users or health care workers who are infected through needlestick injuries.
What does this mean for Canadians?
Many of us may feel that the Libyan situation is a far away problem and has no bearing on our lives or our healthcare system. For a moment I would like you to recall an epidemic outbreak recently experienced in Toronto, Canada, that took the lives of 44 people and infected 375 more. I know that many infections were transmitted between patients before healthcare experts and workers were aware of how SARS was being transmitted. Even though the timeframe for the outbreak is much shorter, which left infection control people scrambling, it can be likened to the HIV outbreak. By the time the Libyan hospital became aware of the outbreak of HIV infection, over 400 children had been infected. Any infection control practices implemented after this discovery will prevent further spread. Once researchers discovered the SARS outbreak and how it was transmitted, infection control practices and personal protective devices were implemented to prevent spread to other patients and health care workers.
The entire world keeps catching up to current research and information as it is discovered, and because third world countries have less resources, they are less likely to use new practices, even those backed with scientific evidence. Lucky for us back here in Canada, our government is willing to spend lots of money on infection control to help contain outbreaks like SARS, to help be prepared for the next big respiratory illness outbreak, to provide new and sterile instruments, to educate healthcare workers, and even the public on how to prevent spread of HIV.
I believe that the bottom line is that these health-care professionals are being blamed for something that was not their doing, and there is mounting scientific evidence that the verdict is an exercise in scapegoating by the Libyan government to cover up their blame in this tragedy. According to the evidence, the government seems more interested in blaming these health-care workers than improving the conditions at this children’s hospital.
What can we do?
As members of a democracy and a country that feels a strong social responsibility for its residents, we should do something. Pressure is best placed on Foreign Affairs Minister Peter MacKay. I encourage you to contact Minister MacKay (Mackay.P@parl.gc.ca). Remind him about the nursing shortage in Canada, and how our government's lack of action in this case is not exactly encouraging for those considering entering the nursing profession. Remind him that Canadians have a long history of international justice and fairness, and that it is his job to speak on the international stage for us on these issues. There is also great strength in numbers. If you are a member of any larger organization like a public sector union or association, have your president compose and send a letter on behalf of the members to Mr. MacKay. Many doctors and nurses in this country work in conditions that include understaffing and lack of other resources. These convicted healthcare workers were treating sick children, and almost had to pay for it with their lives. We have a chance here to stand up for them and let our government and Mr. MacKay know that this kind of treatment should not be tolerated, and we want him to speak out against this injustice on our behalf.
References and For More Information:
"Lybia and Human Values." Nature. 445, 2 (4 January 2007)
"HIV and Its Transmission." Centers for Disease Control and Prevention
"Universal Precautions." Canada's National Occupational Health and Safety Resource
"HIV Injustice in Libya — Scapegoating Foreign Medical Professionals." Elisabeth Rosenthal, M.D.The New England Journal of Medicine. Volume 355:2505-2508 December 14, 2006
"Nosocomial Outbreak of Multiple Bloodborne Viral Infections." The Journal of Infectious Diseases 2001;184:369-372
The Government of Canada
- Bah HumBUG? (December 2006)
- Birth Control and Cancer Risk: A Connection? (August 2006)
- Good Day Sunshine (June 2006)
- Is Canada ready for the Next Pandemic? (April 2006)
- An Apple A Day (March 2006)
- "I’ve been waiting for 3 hours!” -- Wait times in Canadian hospitals (February 2006)
- Private Parts: The implications for women’s health in the federal election (December 2006)
