The Day AIDS Arrived at My Hospital

I received my education in AIDS from a patient who died before the doctors treating him learnt of his condition.



A poor, unemployed man in his late thirties, he showed up with a chest infection one evening in 1996 at Baghdad’s Al-Yarmuk hospital.



I had recently qualified as a junior doctor and was embarking on a medical career in a healthcare system crippled by drastic shortages, blamed by Saddam Hussein’s government on international sanctions.



Though we did not have the means to carry out chest x-rays at the hospital, we noted the patient’s symptoms – particularly the high fever and shortness of breath – and diagnosed severe pneumonia.



We prescribed strong antibiotics. Our patient did not respond to the treatment. The next morning, he was dead.



This did not ring any alarm bells at the time, though perhaps it should have. With hindsight, we might also have been alerted to the patient’s underlying condition by the fact that he was a haemophiliac, which placed him at greater risk of having contracted HIV, the virus that can cause AIDS.



Yet our hospital was desperately over-stretched, and with only one senior house doctor in charge of more than 60 patients, there was no time to investigate any suspicions. Equipment such as syringes, gloves and catheters were also in short supply and we exposed ourselves and our patients to a constant risk of infection by reusing them.



Two days after the patient’s death, a committee from the health ministry visited the hospital to inform us we had dealt with an AIDS case. They collected blood samples from medical workers who had been exposed to the patient.



As the disease takes several weeks to appear in the body, we were told to submit another sample in three months’ time, when further tests would confirm whether any of us were HIV positive.



What followed was a period of intense mental agony. My colleagues and I had, until then, known of AIDS only from textbooks. We replayed in our minds moments that night when we may have been exposed to the virus. Could fluids drained from the patient’s lung have come into contact with our broken skin?



What terrified us most were the social implications. While we did not have much direct experience of AIDS patients, we knew all too well the stigma that society attached to them.



HIV/AIDS arrived in Iraq in the mid-1980s. Although it spread rapidly over a short period, Saddam Hussein’s government did not officially acknowledge the outbreak.



Many in the medical community believed the disease was being spread through a contaminated blood product imported into Iraq for the treatment of haemophiliacs.



Eventually the government ordered blood tests on all patients who had received this product. Those who were found to have HIV/AIDS were quarantined at a centre for infectious diseases outside Baghdad.



They were effectively treated as prisoners, deprived of appropriate care and denied visits by their families.



In 1991, Iraq was defeated by United States-led forces in the first Gulf War and its economy collapsed. The government closed down the isolation centre and allowed those who were quarantined to return home.



Strict rules were introduced to curb their involvement in society, strengthening popular prejudices against anyone with the disease. People infected with the virus were barred from government jobs and from getting married. They were also prohibited from relatively banal activities such as visiting barbers or swimming pools, though these rules proved harder to enforce.



My colleagues and I spent the three months between the two blood tests in a state of constant alert. The mildest changes in our bodies filled us with the fear that we had been infected. When one of our colleagues developed a sore throat, we wanted to know whether he had any swollen lymph nodes, or a fever – anything that would indicate more than a mere throat infection.



We did not dare tell our families about what troubled us, even though they had noticed a change in our temperament. Luckily, none of us was married at the time so there was no need to worry about potentially infecting another person.



Among ourselves, we also discussed what we would do if the second blood test revealed we had been infected with HIV. Would our families believe we had fallen ill because of our work?



When the three months were nearly over, I took an oath with four doctor friends who were waiting with me for the results of the second test. Each of us swore he would not commit suicide if he found out he had the disease. We also promised to look after anyone in the group who may have been infected.



The second blood test showed none of us had contracted the virus. We heaved a sigh of relief and carried on with our lives.



Knowing what I do now, I think we panicked unduly over the risk of infection. AIDS is a very dangerous disease but the virus that causes it does not spread easily through ordinary contact. That night in 1996, other people at the hospital could have contracted HIV only if body fluids from the infected patient had entered their bloodstream.



Iraqi hospital workers today are more aware of the nature of AIDS and better equipped to stop its spread. But on the street, ignorance is widespread. Anyone infected with the virus is shunned, like lepers.



Some of the official restrictions imposed on people with HIV/AIDS have been relaxed. On paper, the government has pledged to improve their care. However, their treatment is far from a priority for a healthcare system that is only just beginning to recover from decades of war and deprivation.



The conflict in Iraq has scattered our group of five doctors. Some fled abroad as refugees, others relocated within Iraq. I live in Erbil in the north, having been driven away by sectarian violence in the capital some years ago.



I stay in touch with my old colleagues from Baghdad and every year, on World AIDS Day, I recall the three months we spent in the shadow of a disease that affects millions of lives worldwide.



Alaa Yousif teaches and practices medicine in Erbil.