Detention of PLWHAs: Respose of Maharashtra SACS

[Guest guest]

6th November 2003

RESPONSE OF MAHARASHTRA STATE AIDS CONTROL SOCIETY (MSACS) & MUMBAI

DISTRICTS AIDS CONTROL SOCIETY(MDACS) TO PLWHAs QUARANTINED AT SAHAR

INTERNATIONAL AIRPORT

The team of PLWHAs had gone to Kampala, Uganda to participate in the PLWA

Conference held from 26th to 31st October 2003. Any person visiting

Uganda is required to take Yellow Fever Vaccination and for some reason if

such vaccination is not taken, the person is quarantined for 6 days as per

the laws.

The group visiting Uganda did not inform either Directorate General of

Health Services, Executive Health Officer of Mumbai, Project Director,

MSACS or Project Director, MDACS, before leaving the country.

The incidence of quarantine of PLWHAs at Sahar Airport on 1st November

2003 was informed to project Director MSACS on 1st November 2003 at 3. 00

am. The Project Director MSACS,Add..Project Director MDACS, Dy.Director

MSACS & MDACS visited quarantine center in the morning & in Evening to

know if the team wanted any help. The NMP+ representative was also

contacted immediately by Dy.Director MDACS to discuss if any further

help was needed.

Following actions were initiated :

1. A separate room was arranged for the female member of the team as soon

as it was noticed that she was kept with male members in the same room.

2. As per the norms of the quarantine hospital, no inmate is supplied food

free of cost. However, arrangements for food can be made for which the

inmate has to pay. Hence, Project Director, MSACS, made food arrangements

for the team through an NGO representative working in HIV/AIDS as partner

NGO. Also arrangements were made to buy food from nearby hotels, the

expenses were to be borne by MSACS for six days

3. On 2.11.2003, the Sunday, Addl. Project Director, MDACS, had again

visited to the hospital. She provided the group with the home-made idlis.

4. The arrangements were made for visit of a team of doctor’s everyday to

take care of any health problems of the PLWHA group. MSACS provided

required medicines for four of the group members.

5. The Project Director & Jt.Director MDACS along with Dy.Director MSACS

& team of doctors visited the quarantine hospital to meet the team members

and provided them with lunch on 3rd November 2003.

6. Posters are being developed to be displayed at the international

airport to reduce stigma and discrimination and sensitization of airport

authorities is in process.

7. The Matron of the hospital has been instructed to inform MDACS if any

PLWHA is admitted in future so that a physician’s visit will be arranged

to take care of their health. She was also requested to make arrangements

to provide them with breakfast, lunch and dinner and the bills shall be

reimbursed by MDACS.

PROJECT DIRECTORS

MSACS & MDACS

E-mail: <alkagogate@...>

[Guest guest]

I would just like to make a response to the list regarding the defensive

attitude of MSACS. I do so on the following grounds.

I too was a delegate to Kampala who lacks the capacity to have a vaccination and

I am a visitor to India so before leaving India I sent several emails to MSAC

followed by a phone call when the emails remained unanswered.

I asked for directions and the protocol for obtaining a vaccination exemption

letter in accordance with international protocols for same. I also indicated

that I along with others would be delegates to a conference in Kampala Uganda in

October and I was advised that the organization was only a municipal

organization and had no power to issue exemptions and I was referred to the J J

Hospital.

After several attempts at finding information at the hospital that resulted in

disconnecting dead ends I found no one who was aware of the need to advise

anyone, either the Directorate General of Health Services, Executive Health

Officer of Mumbai, Project Director, MSACS or Project Director, MDACS, before

leaving the country so don’t blame the delegates because enough Doctors at MSACS

knew that a conference was on in Kampala in October.

One would expect that any organization that has responsibility for the

management of epidemiological and quarantine matters would also be briefed on

the international protocols regarding patients with compromised immunity. This

of course does not only include HIV +ve patients but also those who have had

transplants and those having treatment for lymphomas and other types of cancer

therapy.

Another point to make is that there is no excuse for the way in which these

travellers were treated at the airport. There is such a thing as respect, good

manners and human rights entitlements that should have entitled these travelers

to a better service.

This also extends to the treatment at the Yellow Fever hospital. It shouldn’t

take the intervention of Directors General or assistant Directors General to

approve basic respectful care to patients offered by Matrons of such

establishments. I am sure that very seldom are Indian citizens subjected to this

kind of treatment. Most of the time it is nationals from other countries that

would be quarantined but in any event the care and support should be appropriate

and if the incoming passenger has the right to be here they should be supported

through the quarantine processes in a humane and respectful way.

The same cannot be said of course to the Medical Director of the Kerala SACC who

is a most informed person and one who eventually offered to supply me with an

exemption letter which is still caught up in the India Snail Mail and I will

obtain another copy when I visit Kerala later this month.

I trust that any one who is immune compromised and who determines to visit East

Africa to offer assistance in managing their HIV/AIDS pandemic will be afforded

more assistance both before and after they travel in the future. Not only was

support offered but valuable lessons learned by delegates which can help India

navigate its way through the pandemic which is as bad if not worse than Africa.

The only thing different about Africa is the numbers and in that respect their

sentinel surveillance is much more reliable than India’s as far as estimation of

infected people is concerned.

There are systems of home supervision to determine infectivity and also such

screening tools such as were adopted as a result of SARS which can help screen

for communicable diseases not all of which can be prevented by the Yellow Fever

vaccination.

Another issue is the fact that in Africa and many other places such certificates

can be purchased without actually having had the vaccination. I was offered one

for just a few shillings.

I am not convinced that the explanation is anything short of a knee jerk

reaction to the extensive amount of national and international publicity

associated with the issue but I guess it is just another way of fine tuning the

protocol and it took a dedicated team of long serving community volunteers to

put the system to the test.

I hope that we see a well known and understood pre and post travel protocol

being developed with inputs from those whose skills can help protect India and

at the same time be effective in enabling those people willing to apply their

skills in the African continent to continue to do so as they are willing and

able.

That’s my response to the matter.

Geoffrey

E-mail: <gheaviside@...>