{"id":82982,"date":"2023-11-18T10:39:21","date_gmt":"2023-11-18T10:39:21","guid":{"rendered":"https:\/\/www.estaql.com\/gambia-parents-fight-for-children-in-landmark-trial-on-india-syrup-deaths-health\/"},"modified":"2023-11-18T10:39:21","modified_gmt":"2023-11-18T10:39:21","slug":"gambia-parents-fight-for-children-in-landmark-trial-on-india-syrup-deaths-health","status":"publish","type":"post","link":"https:\/\/estaql.com\/seo\/gambia-parents-fight-for-children-in-landmark-trial-on-india-syrup-deaths-health\/","title":{"rendered":"Gambia parents \u2018fight for children\u2019 in landmark trial on India syrup deaths | Health"},"content":{"rendered":"<p><\/p>\n<h2>Gambia parents \u2018fight for children\u2019 in landmark trial on India syrup deaths | Health<\/h2>\n<p>Gambia parents \u2018fight for children\u2019 in landmark trial on India syrup deaths | Health<\/p>\n<div aria-live=\"polite\" aria-atomic=\"true\">\n<p>It\u2019s the happy memories of his toddler son playing around their home in The Gambia\u2019s capital that are most painful for Ebrima Sagnia to remember. When he tries to speak, Sagnia pauses mid-sentence, muted by grief.<\/p>\n<p>In September last year, Sagnia watched Lamin writhe in pain on a hospital bed. The four-year-old had developed a fever early that month, which was common in the rainy season. His parents had given him prescribed medication, hoping the high temperature would go away, but Lamin developed new symptoms instead, becoming drowsy and unable to pass urine for days. He was rushed to the hospital, but his symptoms persisted. Despite his discomfort, Lamin just wanted to return to their home in Banjul and play. He loved football and motorcars. When his dad drove, Lamin would sit in his lap and pretend he was the driver.<\/p>\n<p>By mid-September, about a week after his parents took him to the hospital, Lamin had died. Doctors told Sagnia the cause was complications from acute kidney injury (AKI). The condition, a sudden onset of kidney failure, causes swollen limbs, nausea, confusion and reduced urine flow.<\/p>\n<p>Lamin was one of 70 children killed last year by substandard cough syrups imported from India that the World Health Organization (WHO) said contained \u201cunacceptable levels\u201d of toxins. Most of the children were under five, and some were from the same family. The case has underlined the difficulties low-income economies like The Gambia face in sourcing quality medication and implementing local quality controls.<\/p>\n<p>\u201cEvery day reminds me of my son, how he kept saying to me, \u2018Daddy, take me home. Take me home,\u2019 and I told him I would,\u201d Sagnia said.<\/p>\n<p>Sagnia could not take his son home, but the 44-year-old is now leading a coalition of 19 aggrieved parents who\u2019ve dragged their government and private entities involved in producing and distributing the medicine in The Gambia to court. The parents, Sagnia said, are seeking justice and restitution for what they say were deaths caused by \u201cnegligence and breach of statutory duty\u201d. The Gambia\u2019s Ministries of Health and Justice, the drug manufacturer and distributors, and the country\u2019s Medicines Control Agency (MCA) are all listed as defendants.<\/p>\n<p>Court hearings began on July 21. At the second sitting on October 24, none of the government\u2019s representatives showed up, Loubna Farage, a lawyer representing the parents, said, and the court fined them. About nine of the parents chosen to represent the group were present along with their family members who had shown up for support. The group filled the courtroom, their faces long, their demeanor heavy.<\/p>\n<p>At another court hearing on November 7, government lawyers showed up, but representatives of the manufacturer and distributor were missing. The judge was forced to adjourn until late in November.<\/p>\n<figure id=\"attachment_2494302\" aria-describedby=\"caption-attachment-2494302\" style=\"width:770px\" class=\"wp-caption aligncenter\"><figcaption id=\"caption-attachment-2494302\" class=\"wp-caption-text\">Three-year-old Lamin Sagnia, who died of acute kidney injury in September 2022, is buried in Old Yundum, The Gambia [Edward McAllister\/Reuters]<\/figcaption><\/figure>\n<h2 id=\"deadly-doses\">Deadly doses<\/h2>\n<p>The cough syrups in question are four brands, all manufactured by Maiden Pharmaceuticals Ltd, an Indian drugmaker, and imported by The Gambia-based Atlantic Pharmaceuticals Co. On their colourful packaging, the syrups carried a logo saying they were WHO-certified. Officials of the WHO told Al Jazeera the claim was a lie.<\/p>\n<p>All four medicines contained high levels of diethylene glycol (DEG) and ethylene glycol (EG), officials at the WHO and the United States Centers for Disease Control and Prevention (CDC) confirmed. Both are sweet-tasting but deadly substances normally used to manufacture products like brake fluid and windshield wipers.<\/p>\n<p>Mass poisonings like this have more recently been recorded in India, Panama and Nigeria. Several cases in the past document how manufacturers intentionally swap out pharmaceutical-grade propylene glycol (PG), a mildly sweet additive used to improve the solubility of medicines for the similar, much cheaper and fatal DEG and EG.<\/p>\n<p>In a January alert, the WHO said it had recorded 300 child fatalities in 2022 across seven countries, including Indonesia and Uzbekistan, due to contaminated medication. Six deaths have also been recorded in Cameroon this year. It\u2019s the deadliest set of poisonings recorded since 1996.<\/p>\n<p>An Indonesian firm, Afi Farma, manufactured the syrups locally in that country\u2019s case while China\u2019s Fraken Group produced the syrups pulled off shelves in Cameroon. In August, Uzbek authorities began the trials of officials of Marion Biotech, another Indian manufacturer, for reportedly selling contaminated cough syrups believed to have killed 65 children in the Central Asian country.<\/p>\n<p>Health experts are not sure how the poisonings are occurring but believe substances or additives like PG used to stabilise the medications are likely contaminated. WHO officials said they have no evidence the cases are linked.<\/p>\n<p>In The Gambia case, Indian health authorities said the WHO failed to show a direct link between Maiden\u2019s cough syrups and the multiple deaths and accused the UN agency of trying to tarnish the country\u2019s image. Tests by Indian health authorities, the Indian government said, did not reveal contaminants in Maiden\u2019s products. Maiden has also said it did nothing wrong.<\/p>\n<p>But Parsa Bastani, a CDC epidemiologist who led an expert team to assist The Gambia in its investigation, told Al Jazeera the tests conducted left no doubt as to what caused the clusters of AKI deaths.<\/p>\n<p>\u201cI don\u2019t know what evidence the Indian government was reviewing,\u201d Barstani said, \u201cbut the evidence we found highly suggested that there was a link.\u201d His team had received a request to investigate from Banjul in late August last year and arrived in The Gambia just as the deaths peaked in mid-September.<\/p>\n<p>\u201cThe drug testing showed there were levels of DEG in all the cases and that that led to the deaths,\u201d Bastani said, clarifying that his team had not done a separate test but had analyzed tests done by WHO officials also on ground at the time. \u201cThat was a very difficult and sad process to be there and collect information from parents, some of whom had lost their kids within the past week.\u201d<\/p>\n<p><span class=\"embed-youtube\" style=\"text-align:center;display:block\"><iframe loading=\"lazy\" title=\"The Gambia probes child deaths linked to paracetamol syrup\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iALVPDCLcN0?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/span><\/p>\n<h2 id=\"industry-malpractice\">Industry malpractice?<\/h2>\n<p>Gambian authorities have flown into a flurry of activity since the tragedy.<\/p>\n<p>In October last year, three months after they started investigating the unusual spike in AKI deaths among children, the country banned Maiden and Atlantic. In June, officials went further, tightening import controls from India. All drug exporters from that country must now present clearance certificates from a designated Indian testing laboratory.<\/p>\n<p>Authorities also fired the head and deputy of the MCA, the entity in charge of certifying and monitoring imported pharmaceuticals, which should have stopped the drugs from going on the market. Children died in six of the country\u2019s seven regions, underlining the spread of the contaminated medicine.<\/p>\n<p>Banjul is also mulling legal action against Maiden and possibly the Indian government, the Reuters news agency reported.<\/p>\n<p>Analysts have also pointed out \u201cunacceptable\u201d lapses in the Ministry of Health itself that might have contributed to the steepness of the death toll.<\/p>\n<p>Although health workers at the Edwards Francis Small Teaching Hospital alerted the ministry about an unusual cluster of deaths in late July 2022, the first public warning to stop selling or using a list of suspected cough syrups did not materialise until September, more than 40 days later.<\/p>\n<p>A review of the timeline of events as well as information from the CDC team and government reports show that the contaminated medicines were imported about June 21 and that AKI deaths peaked in mid-September before tapering off in October.<\/p>\n<p>But there were already suspicions as early as August that the syrups were poisoned.<\/p>\n<p>One parent whose child used the syrup in July and died on August 5 said doctors in Banjul asked him what type of drugs he used and that he had presented the syrup. \u201cOne of the doctors told me that they were having these cases and that my son was the fifth case,\u201d Alieu Kijera, an eye nurse, said. Kijera said he was surprised when he continued to hear of many cases after his son, two-year-old Mohamed, died and was shocked to know the medication was still available on shelves in The Gambia at the end of August.<\/p>\n<p>Some children, including Sagnia\u2019s son, used the deadly drugs weeks after the authorities had been officially alerted.<\/p>\n<p>\u201cIt\u2019s unacceptable that after having some evidence, even if not confirmed, that the authorities there let it pass for another month,\u201d said Prashant Yadav, a health supply chains scholar and Harvard Medical School lecturer, who has researched pharmaceuticals in Africa for more than a decade.<\/p>\n<p>\u201cEven if it was a wrong call, what would we have lost by preventively taking a product off the market? Safety comes so much higher than anything else,\u201d Yadav said.<\/p>\n<p>The Gambian Health Ministry and the MCA did not respond to Al Jazeera\u2019s requests for comment. In a report by a government task force looking into the deaths, authorities said they \u201csuspected that the AKI could be caused by drug toxicity\u201d after the initial alert in July and that the Health Ministry \u201cdecided to ban these drugs even before receiving confirmation from the laboratory testing\u201d.<\/p>\n<p>Hiring people with vested interests in The Gambia\u2019s pharmacy sector may have also contributed to the deadly medicines going on shelves across the country.<\/p>\n<p>While fully employed elsewhere, Gambian pharmacists commonly double as supervisors in private dispensaries, local sources as well as the government task force report confirmed. The practice, referred to in local media as tantamount to \u201crenting out licenses\u201d, presents a potential case of conflict of interests, according to the government report.<\/p>\n<p>While unusual, it is not illegal for pharmacists in the civil service to double as private workers. The law requires that dispensaries wanting to import drugs provide the certificate of a licensed pharmacist to be allowed to ship products in and the pharmacist must provide technical advice to the importer, spending two to four hours a day at the dispensary.<\/p>\n<p>In several cases though, these supervising pharmacists are often full-time government staffers who don\u2019t spend time at the dispensaries. Some even work for the MCA or the Gambian Pharmacy Council, both industry regulators. Some pharmacists also supervise several private dispensaries simultaneously.<\/p>\n<p>At the time of the deaths last year, an MCA official was supervising Atlantic Pharmacy, the entity that imported the contaminated syrups, investigations by Gambian officials showed. The same official, speaking for the agency in the early days of the crisis, had claimed that floodwaters, not the contaminated medicines, caused the mass deaths. The man, who told authorities that another supervising pharmacist with Atlantic had signed off on the drug imports, did not respond to a request for comment.<\/p>\n<p>\u201cIt\u2019s not normal,\u201d Yadav, the supply chain scholar, said of the industry practice. But the multiple issues with the response to the deaths underscores a deep-seated issue in The Gambia and other low-income countries like it, he pointed out.<\/p>\n<p>\u201cIt\u2019s a country that has a very limited budget and the regulation is very weak,\u201d Yadav said. \u201cIn theory, there\u2019s what authorities should be doing, but the practicality is different. Saying that they could have removed those syrups earlier, for example, that\u2019s a matter of financial luxury. So in a way, I also empathise with the ministry because it\u2019s not straightforward.\u201d<\/p>\n<figure id=\"attachment_2494219\" aria-describedby=\"caption-attachment-2494219\" style=\"width:770px\" class=\"wp-caption aligncenter\"><figcaption id=\"caption-attachment-2494219\" class=\"wp-caption-text\">From left, twins Adama and Hawa. Their father, Ebrima Saidy, says he has not found a way to tell Hawa that her sister is not coming back home [Courtesy: Ebrima Sandy]<\/figcaption><\/figure>\n<h2 id=\"dependence-on-imports\">Dependence on imports<\/h2>\n<p>The Gambia, which has four public hospitals and 170 registered drug stores for a population of 2.6 million people, has no local drug manufacturers, meaning all of its medicines are imported. The country has no drug testing laboratories to authenticate imports either. To test the syrups, officials sent samples to Senegal, Ghana, France and Switzerland.<\/p>\n<p>Enter India. With about 10,500 drug manufacturers in the country, India is by far the world\u2019s biggest generic medicine maker, cornering a 20 percent share of global production. The country is often referred to as the \u201cpharmacy of the world\u201d.<\/p>\n<p>India provides half of Africa\u2019s generic drugs. Their comparatively low cost makes the country all the more attractive to middle- and low-income countries. As of 2019, at least 90 percent of The Gambia\u2019s pharmaceutical imports came from India.<\/p>\n<p>While it has recorded major successes, India\u2019s pharmaceutical scene is riddled with problems, including substandard production and a chaotic regulation process that often make it unclear who is in charge of what between its many state control agencies and the federal drug control body.<\/p>\n<p>The country itself has recorded five DEG mass poisonings. Experts linked the latest deaths in 2019 in Jammu and Kashmir to a failure of manufacturers to test raw materials as required by law. Twelve children died after their kidneys and other organs stopped functioning.<\/p>\n<p>Researchers have found that some Indian manufacturers produce substandard drugs specifically for export to African markets and to other low-income countries because of lax regulation. The Pharmacy Export Council of India (Pharmexcil), in one document, said Africa is particularly attractive because \u201cmarket access to these countries is simpler in nature as compared to stringent regulatory authorities of other developed nations.\u201d<\/p>\n<p>The string of recent DEG cases implicating at least two Indian manufacturers spurred authorities to crack down on drug producers with spot checks.<\/p>\n<p>After news of the Gambian deaths emerged, the Indian government confirmed that Maiden was not licensed to sell the syrups in India but was licensed to sell them to the African country. The company is also on a government list of \u201cWHO-GMP-certified\u201d manufacturers, a certification implying it met the WHO\u2019s \u201cgood medical practices\u201d standard for exports.<\/p>\n<p>But Maiden had been prosecuted by multiple Indian states in the years leading up to its fatal Gambia exports, mainly for providing substandard products. Top officials in the company were also handed jail sentences in an Indian court in February for exporting substandard drugs to Vietnam almost a decade ago.<\/p>\n<p>India suspended Maiden\u2019s production last year after the deaths in The Gambia. Allegations that a state regulator helped switch the samples Indian health authorities tested in The Gambia case emerged in June. India\u2019s anticorruption agency told reporters those claims are being investigated.<\/p>\n<p>WHO officials told Al Jazeera they\u2019ve ordered Maiden to cease using \u201cWHO-certified\u201d labels, as it did on the syrup bottles. However, Maiden still remains on the Indian government\u2019s WHO-GMP-certified list, meaning it still meets WHO production standards, according to the Indian government.<\/p>\n<h2 id=\"hopeful-for-justice\">Hopeful for justice<\/h2>\n<p>After the second court hearing in the Gambian parents\u2019 case, Sagnia felt hopeful, he said, even if the fight ahead looked daunting.<\/p>\n<p>He and other parents felt hurt by the no-show from government representatives at that hearing. It made them feel like the case was not important to them, he said, adding, however, that the authorities\u2019 attitude did not surprise him.<\/p>\n<p>\u201cNone of the government officials has ever visited us in our homes since this whole thing happened,\u201d Sagnia told Al Jazeera after the court session.\u201cThey only called us to meet them in their offices while we lost our children due to their negligence. It might be that the judge rules in our favour if they continue like that.\u201d<\/p>\n<p>The parents, who are spread across the country, have turned inward to find solace. They formed a WhatsApp group, so they can stay in touch about the case, and it has become a therapy platform of sorts with members pitching in when one person needs help, even outside the case. At the moment, Sagnia is trying to get a good doctor to see one member who has suffered a hand injury. \u201cAs the group leader, I feel like it is my duty,\u201d he said. \u201cWe have all become just like a family.\u201d<\/p>\n<p>Many of the parents are confident of a win. \u201cI believe there is hope for us, inshallah,\u201d Alassan Kamaso said, using a phrase meaning \u201cas God wills\u201d, which is popular in Muslim-majority Gambia. Kamaso\u2019s son, Musa, was 18 months old when he died in September last year.<\/p>\n<h2 id=\"an-unprecedented-trial\">An unprecedented trial<\/h2>\n<p>The mass AKI deaths are on a scale never-before experienced in The Gambia, but the trial too is just as historic, Farage, the lawyer representing the parents, said.<\/p>\n<p>Never before have parents bonded together to go after the authorities in such a manner \u2013 an unusually brave stand in a country where the courts have traditionally had little autonomy.<\/p>\n<p>For two decades, The Gambia was under the iron-fisted rule of Yahya Jammeh, who cracked down on dissidents and controlled the judiciary. It was Jammeh\u2019s electoral defeat in 2017 by President Adama Barrow that halted the dictator\u2019s plans to withdraw The Gambia from the International Criminal Court. The ongoing legal case to bring Jammeh to justice, involving dozens of witnesses, is one of the few that legally compare to the syrup deaths case.<\/p>\n<p>\u201cI believe this is why the government does not know how to deal with this matter since there is no precedent,\u201d the lawyer said.<\/p>\n<p>A lack of financial resources, Farage added, also often discourages many Gambians from seeking justice in a country where half the population lives in poverty. The average salary in The Gambia is $68 a month, so paying for legal fees costing about $250 an hour is almost impossible although there are legal aid programmes.<\/p>\n<p>\u201cOne needs to understand that poor people have no hope and often feel neglected by the system,\u201d said Farage, whose firm is providing assistance to the 19 parents free of charge. \u201cThey do not understand their rights. They do not understand that the government is here to serve the people. They will often be heard to say that God has a reason for their suffering. They are taught to be patient and leave everything in God\u2019s hands.\u201d<\/p>\n<p>Some of the parents of the children killed by the cough syrups are neither influential nor wealthy. Kamaso is unemployed and spent all he had on his son\u2019s treatment, he said. When Sagnia is not working at the bank where he is a chauffeur, he drives a taxi to supplement his income.<\/p>\n<p>Farage said these parents are bent on pushing for regulatory changes to ensure such a tragedy never happens again. They want accountability for the government agencies involved, and they want proper compensation, he said.<\/p>\n<p>Some of them are still angry that last year, when their grief was still fresh, authorities pressed them to take monetary compensation of about $200 even before investigations were concluded.<\/p>\n<p>Ebrima Saidy is one of them. His five-year-old daughter Adama died on September 19. The 23-year-old is currently in Italy, where he is studying the language to prepare for a computer science course, but he has been glued to his phone for updates on the case. His partner remains in The Gambia.<\/p>\n<p>\u201cWe want them to dismiss anyone who needs to be dismissed,\u201d he said in a recent call, his papery voice rising over the phone line. Saidy also acts as a spokesperson for the group and said that for many parents, the firing of the MCA head and deputy is not enough. And the money they were offered? It was offensive, he said.<\/p>\n<p>\u201cWhat is the life of my daughter to 14,200 dalasi?\u201d Saidy asked. The $200 sum, around the same price as 10 bags of rice in The Gambia, seemed the equivalent of hush money, he told Al Jazeera. \u201cWe are not here for the money. We want them to tighten their protocols and, if possible, to stop importing from India altogether,\u201d Saidy said.<\/p>\n<p>In addition to Saidy\u2019s grief and loss, there\u2019s the fear that grips him every time he calls home to speak to Adama\u2019s sister, Hawa, who won\u2019t stop asking for a twin she thinks is still coming home.<\/p>\n<p>\u201cShe will ask, \u2018Is she still at the hospital? Is she still with grandma?\u201d Saidy said. He has not yet found the courage to tell Hawa the truth. \u201cI\u2019ll say, \u2018Yes, she is still at the hospital. She is coming,\u2019\u201d he said.<\/p>\n<p>Although at least 70 children were killed, only 19 parents are involved in the lawsuit, Saidy said, because government officials would not release all the names of the affected families so he could contact them. Eight other parents have recently signalled that they want to join the case too, but some parents, he added, have already accepted the compensation money while others have simply given up on getting any justice in a system where malpractice is common.<\/p>\n<p>Not Saidy.<\/p>\n<p>\u201cSome of them said, \u2018I leave them to God\u2019 and they left,\u201d Saidy said. \u201cBut we said, \u2018No, we will fight for our children.\u2019\u201d<\/p>\n<\/div>\n<p><a target=\"_blank\" rel=\"nofollow noopener\" title=\"\u0627\u0644\u0645\u0635\u062f\u0631\" href=\"https:\/\/www.aljazeera.com\/features\/2023\/11\/18\/gambia-parents-fight-for-children-in-landmark-trial-on-india-syrup-deaths?traffic_source=rss\">\u0627\u0644\u0645\u0635\u062f\u0631<\/a><br \/>\n<br \/>\n<a href=\"https:\/\/lenkaed.com\" title=\"\u0623\u062e\u0628\u0627\u0631\" rel=\"dofollow noopener\" target=\"_blank\">\u0623\u062e\u0628\u0627\u0631<\/a><\/p>\n<p><a target=\"_blank\" rel=\"nofollow noopener\" title=\"Gambia parents \u2018fight for children\u2019 in landmark trial on India syrup deaths | Health\" href=\"\/\">Gambia parents \u2018fight for children\u2019 in landmark trial on India syrup deaths | Health<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Gambia parents \u2018fight for children\u2019 in landmark trial on India syrup deaths | Health Gambia parents \u2018fight for children\u2019 in landmark trial on India syrup deaths | Health It\u2019s the happy memories of his toddler son playing around their home in The Gambia\u2019s capital that are most painful for Ebrima Sagnia to remember. When he [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7678],"tags":[],"class_list":["post-82982","post","type-post","status-publish","format-standard","hentry","category-estaql"],"_links":{"self":[{"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/posts\/82982","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/comments?post=82982"}],"version-history":[{"count":0,"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/posts\/82982\/revisions"}],"wp:attachment":[{"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/media?parent=82982"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/categories?post=82982"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/estaql.com\/seo\/wp-json\/wp\/v2\/tags?post=82982"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}