Bad medicine
“My father died last week, and now my mother has been hospitalised with the same problem. I swear to God, if something happens to her, I will burn this hospital down,” says Yasmin, as her eyes well up with angry tears. She is among the hundreds of people whose family members have been affected by the contaminated drugs doing the rounds at Lahore’s hospitals.
The news of these mysterious deaths has been doing the rounds since early January, and the current death toll (at the time of reporting) stands at 75, with over 200 patients (from all over Punjab) admitted in Lahore’s Mayo, Jinnah, Services, General and Ganga Ram hospitals. Medicines issued by the Pakistan Institute of Cardiology (PIC) remain the common link among these patients.
While it remains to be proved, common consensus is that the December 2011 batch of the medicine was the main cause of these mysterious deaths. It is feared that of the 46,000 patients to have been issued the medicine (from the latest batch), a large number could have fallen sick and died at home, with the number of hospital cases also feared to rise.
The Services Hospital has, in fact, seen an increase in the number of bereaved relatives, who have been filing in papers for their deceased family members. Coming to terms with the tragedy at hand, carrying certificates of death, they stand around confused and muddled. No one, they say, comes to their help.
Puzzling symptoms “My father was admitted on January 1, after he started throwing up blood,” says Saquib. When his father was admitted, Saquib believes there must have been at least 50 other patients with the same symptoms at the Services Hospital.
“My mother began bleeding from the nose and mouth,” adds Shazia.
“Her face was dark like coal, she couldn’t eat or drink anything, she kept complaining of a dry throat, and her mouth smelled like a decaying corpse…as if something inside her was dying.”
Shazia is back at Services Hospital now, seeking a death certificate for her mother. The registration of her mother’s death may also allow her to receive the compensation money announced by Chief Minister Shahbaz Sharif. The hospitals, however, seem to be avoiding registering any more deaths over the next few days, especially those caused by this mysterious illness. Officials at the hospital, she alleges, are misleading her.
Several grieving relatives have not received death certificates, while others complain that their loved ones were forcibly discharged while they were still seriously ill.
“My father was very sick and weak, with blood in his urine and a constant nose-bleed,” says a young man, requesting anonymity. “But they administered a drip which stopped the vomiting for some time and told us to go home and carry on with the medication. No one bothered to check what was actually wrong. Some days later, my father died.”
Nothing, really, was meant to be wrong with medicines being used by the heart patients since they had been using the same pills for, in some cases, decades. Nothing had happened then, and they fail to understand what is happening now.
Saquib’s father had been admitted by early January, with the symptoms. By mid-January, the death toll had climbed up to 27. Only after January 20, 2012, did the constant media coverage wake up a slumbering Punjab Government and bring it on the forefront, unprepared. At first, tests conducted at a government-run lab showed no irregularities in medicines. However, with increased media coverage, a further test proved the presence of a toxic chemical.
Fatal formula According to sources, a blood-thinning drug called ‘clopidogrell’ was initially believed to be the cause of the mysterious illness. However, reports showed that four to five of the affected patients were not using this drug. Later, it was strongly suspected that “cardiovastan” (brand name, drug formula: Simvastatin), which is a cholesterol-lowering drug was the reason.
The drug, which was being distributed to the patients, is being locally manufactured by Mega Pharmaceuticals.
Drugs, sources say, are tendered by private companies but only after being tested by labs for pre-qualification and are then re-tested before they are paid for – a procedure followed by the manufacturing company.
“Usually drugs are only assembled in Pakistan, with the raw materials being imported from abroad,” says the source. “The raw material used for this batch was perhaps not imported and was instead produced locally, making it sub-standard. Or, the arsenic used in the paint on top of the pill was in excess and resulted in poisoning. We are not sure what the cause is.”
Catching the culprits Among the owners of the factory, who have been sent arrest warrants, one name that is repeatedly emerging is that of a PML-N parliamentarian, who is allegedly the ‘real’ owner of Mega Pharmaceuticals, while the ‘paper-owner’ is someone else, who is also involved in the chemicals business. While the matter remains puzzling, if the allegations are proven to be true, it may turn out to be a case of the Punjab Government trying to cover up the involvement of their MNA. In a more serious development, it has been discovered that another medicine, manufactured by the same pharmaceutical company, is being sold in the same packaging by the name of Megasar (formula: Losartan potassium, with international name Cozaar), which is prescribed for hypertension.
Packaging two drugs in a similar manner is dangerous and misleading, according Dr Asma Zaman Faruqi, one of the United Kingdom’s (UK) top consultant pathologists.
“The two drugs are not similar in their actions and should not be packaged identically,” she says. “Both simvastatin and cozaar have been associated with haematological disorders, one of which isthrombocytopaenia – a condition in which the platelet-count falls, leading to bleeding disorders. It is a rare complication in both the drugs. It also needs to be investigated whether the patients involved were taking any other medicine or substance, which could have interacted with their medication.”
“The patients,” Dr Faruqi says, “could have been taking blood-thinners such as aspirin” and recommends a close study of the outbreak.
Mysterious moves Earlier this week, the Medical Superintendent (MS) at Services Hospital, Dr Rehana Malik was stressing out in her office. Stealing a few minutes away from the pressures of the work outside, Dr Malik was in her office faxing figures to the health secretary of the Punjab Government and arranging for more beds and blankets for the medical wards, where the PIC patients were admitted.
However, in a swift and sudden action, Dr Malik was removed during the night shift by the chief minister, without announcing any replacement.
PML-N spokesperson Khwaja Salman Rafique, who arrived at Services Hospital on Wednesday morning, told reporters that the CM removed Dr Malik since he was not satisfied with the regulation of the wards and believed there monitoring was not up to the mark. Without any further explanation, the MS was nowhere to be found, even by aggrieved relatives, who wanted to carry out the paperwork.
Samples of the medicine, Salman said, had been sent abroad for testing, under the directives of the CM, who had taken ‘serious notice of the situation.’
A police FIR was lodged at the Shadman Police Station under Section-321, and the FIA have already caught four manufacturers, who are currently on remand.
“We must also note that more than 100 people have left and have recovered,” Salman insisted.
Meanwhile, another order issued by the chief minister – to serve the patients free of cost – has gone unnoticed by officials.
“I have to run around to get this injection for a bone-marrow,” says Waheed, whose wife is ill. “It costs about 60 rupees, but with the way things have gone, these people should not charge us with even a paisa.”
His wife has suffered from severe bruises on her skin, and her platelet level is below normal. Many other patients complain of chest pain and lack of oxygen.
Blame game The President of Pakistan Medical Association Punjab Dr Ashraf Nizami, has condemned the CM for his carefree attitude towards health-related issues in the province.
“He (Shabaz Sharif) holds a portfolio of Health Minister, when there should be a separate ministry for this purpose," says Dr Nizami. “He has failed to make any improvements in the health standards in his province. In fact, this is the second epidemic outbreak during his tenure, where people are dying in dozens,” he adds, referring to the dengue outbreak from last year.
The enquiry committee set up by the CM is headed by Dr Javed Akram, who also owns a pharmaceutical company, called Don Valley Pharmaceutical. “It is technically owned by his wife, but how can we exclude him from the issue?” questions another doctor at PMA.
The 48-member committee’s other members include PIC Chief Executive Professor Muhammad Azhar, Services Institute of Medical Sciences (SIMS) Principal Professor Faisal Masood, Professor Irshad Hussain, Professor Farzana Chaudhry, Professor Bashir Ahmad, Professor Farkhanda Kokab, Additional Secretary Health (Technical) and Dr Muhammad Anwar Janjua.
The hospitals are making attempts to retrieve the contaminated drugs, but some patients or mourning relatives are not complying.
“This is proof that we have in our hand,” says Waheed, pointing to the medicine. “We are going to keep it.”
PPP MNA Uzma Bukhari has vowed to keep the issue active and predominant during national assembly sessions. “We want an unbiased inquiry,” she says.
“It is disgusting the way the CM simply puts price tags on lives by compensating them with money. The man holding both portfolios should at least face the assembly and be held accountable for this crime. He never bothered to attend assembly sessions during the dengue epidemic, and he is still acting as if nothing has happened. The figures are simply alarming,” she adds.
Meanwhile, at the hospitals, patients and their relatives are left in the lurch - not knowing whether to remain hopeful of seeing their loved ones recover from the mysterious, or, to expect the worst.
The author is a freelance journalist.