CIA, polio drives and responsibility

Published: July 16, 2011
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This whole CIA fiasco, if proven true, impinges upon medical ethics at multiple levels.

In April 2011 I was made part of a World Health Organisation (WHO) team to monitor effectiveness of a community vaccination drive carried in different districts of Karachi. I spent the day with my team visiting a set of clusters in the Baldia Town area of the city.

At the cost of sounding alarmist, I’d regard it as my firsthand experience of observing the enormity of community vaccination in Pakistan – it almost felt undoable. I was seeing the face of Karachi I had never seen before – rural, ethnic, rugged and a whole lot more like Afghanistan on CNN.

We went door-to-door in each cluster, directly observing all kids, younger than a year, for vaccination marks, as well as interviewing parents.

To begin with, there are no house numbers (or doorbells). Then, the number of kids left out for some reason was appreciable (basically, if more than three kids in a cluster are left out, it’s too many). Finally, the professionalism of the health personnel who carried out the drive was below par, pointing to the lack of proper training.

We kept moving, traversing landscapes, ethnicities and languages, to get to our seventh and last cluster by evening. This looked more like Karachi – a katchi/pakki abadi with a few parks and mosques dotting it, and the familiar chanting in Urdu, on the streets.

And here, while nearing my threshold of anguish at the futility of it all, I found myself explaining to a bunch of neighbours that the polio vaccines are in fact, for the good of the kids; that Pakistan is among the only three nations with residual polio, and that I am representing WHO and have been scouring this place since morning.

One of them, who was educated enough to quote a newspaper, said to me that door-to-door vaccines are spreading untold diseases in some rural areas.

Community perceptions form an integral part of planning and execution of any health initiative. If such opinions are rubbished or disregarded, we run the risk of alienating the very communities that we are meant to serve. Given this vital importance of keeping the community on the same page, I felt deeply disheartened to read that the Central Intelligence Agency (CIA) driven vaccination campaign was meant to obtain Bin Laden genes.

This whole fiasco, if proven true, impinges upon medical ethics at multiple levels. To begin with, it contradicts with the patient’s absolute right to full confidentiality of his/her information (though medico-legal cases may need reporting to designated authorities via an official channel). Secondly, it gravely undermines what a doctor is supposed to do in the first place.

A physician’s primary moral obligation is:

1. ‘Do no harm or wrongdoing’ to the patient – termed as Non-Malfeasance

2. ‘Do good,’ also called beneficence – How is this particular physician upholding his patient’s right or his professional obligations by fraudulently obtaining DNA samples and passing it on to folks who have no business having it?

I am deeply saddened.

At a time when Pakistan is slipping behind on her resolve to get rid of polio, such brazen violation of the public trust at the hands of healthcare providers is criminal. This story has all the seeds needed to promote notions put forth against getting innocent kids vaccinated. Only that this time, I would have a tougher time refuting them.

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Hasan Iftikhar

Hasan Iftikhar

A final year medical student interested in public health and legislation, acute care and trauma surgery. He tweets @hasandoctor

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