It isn’t new. It’s the story of how tens of thousands ofimpoverishedvillagers and hospital patients were infected with HIV through contaminated blood in mid 1990s in Henan province, China. Entire villages and families were wiped out and many lives wrecked. And two decades later, the pain continues and has been documented here by retired Professor of literature and documentary maker Ai Xiaoming (艾晓明) in 2006. Recently I came across the account of Dr. Wang Shuping (王淑平), the very medical professional who first discovered the epidemic, alerted health authorities, and struggled in vain to stop the epidemic that would go on to infect approximately 300,000 people, mostly the rural poor, according to Zhang Ke (张可), a Chinese AIDS researcher and activist. Dr. Wang eventually left China for the US. And, in time, some of the most vocal AIDS doctors/activists, such as Dr. Gao Yaojie (高耀洁) and Dr. Wan Yanhai (万延海), were all pushed out of China. In September 15, Professor Chen Binzhong (陈秉中), former director of China Health Education Institute, wrote his third open letter to Chinese leaders, laying out a long list of officials, including two members of the Party’s Standing Committee of the Politburo Li Changchun (李长春) and Li Keqiang (李克强), who have engaged in covering up the epidemic and persecuting whistle blowers and activists. Dr. Wang’s account, simple and unadorned, is gripping nevertheless, not only because so much was at stake, but also because it offers a glimpse of Chinese officials in action. Even for a Chinese like myself who grew up in China and knows its impulses and vice inside out, it is still shocking, and painful, to observe the incredible smallness and barbarism of its “public servants” to whose hands the interest of the people was entrusted. If you wish, you can reach Dr. Wang by emailing her (firstname.lastname@example.org), and the Chinese original first appeared in Canyu.com, an overseas advocacy website. With Dr. Wang’s permission, we offer you a translation of her account. –Yaxue
I am Wang Shuping, one of the people mentioned in Dr. Chen Binzhong’s three letters. As a doctor who witnessed the earliest stage of the hepatitis C and HIV epidemics, I would like to talk a little about how I discovered the HIV epidemic among paid blood donors and what happened afterwards.
In mid 1980s, I was a doctor and researcher of hepatitis, diagnosing and treating hepatitis patients but also studying the spread of hepatitis in the population. My colleagues and I published our findings in a paper titled A Study on Post-transfusion Hepatitis B in Chinese Journal of Virology (S1, 1991). At the end of 1991, I was assigned to work at the station of plasma collection by the Epidemic Prevention Center in Zhoukou Administrative District (周口地区).
After working there for a period of time, I suspected that Hepatitis C was wide-spread among donors. At the time, the station only screened donors for Hepatitis B antigen, not for Hepatitis C antigen. With my specialized training in clinical medicine and epidemics, I tested 64 serum samples collected from current donors, in collaboration with the Institute of Virology, Chinese Academy of Preventive Medicine. The test results confirmed my suspicion with 34% of the samples tested positive for hepatitis C antibody. At the same time I had already learned that, long before 1991, there had been hepatitis C epidemic in Gu’an, Hebei province (河北固安), and Zhenjiang, Jiangsu province (江苏镇江).
Based on my knowledge of epidemics and clinical experience, I concluded that the station of plasma collection where I worked was seriously contaminated. I began to inspect the operation procedures of the station and found that there were serious cross contaminations in blood-drawing, centrifugation and plasma separation. I warned the station leaders to protect the donors and to clean up cross-contamination. But he told me that “This will increase cost.” Prompted by my sense of responsibility as a doctor, I reported the hepatitis C epidemic among donors to the Ministry of Health in July 1992, recommending hepatitis C antibody screening at stations of plasma collection.
As a result of my reporting, Dr. Yang Dongming (杨东明) from the Ministry visited Zhoukou to learn about the contamination in our station. She said she had already visited some stations elsewhere and found many of them contaminated. In February 17, 1993, the Ministry of Health issued the standard for collecting blood from healthy persons. Among other things, it requires hepatitis C screening for all donors. This policy was effective from July 1, 1993.
Because of my whistle-blowing, I was kicked out by the station leaders. Plasma collection was for-profit, and my actions impeded the business. To solve the conflict, section chief Shen of the District Bureau of Health discussed with Party secretary Song of the Epidemic Prevention Center, assigning me temporarily to work in the Office of Medical Affairs in the Health Bureau. There, I was very fortunate to work with section chief Shen, Bureau Chief Wang and a few other colleagues to inspect 17 Stations of Plasma Collection in Zhoukou District at the end of 1993.
We found that all 17 stations had been seriously cross-contaminated. For example, there were 20,000 donors at the time selling blood to the Epidemic Prevention Center in Taikang County (太康县), 45% of them were eliminated for being positive in hepatitis C antibody screening. There were 4 underground private blood stations that hadn’t been inspected, and their contamination status remained unknown.
The business of plasma collection had developed very fast in Zhoukou District. The number of collection stations increased from 1 to 17 between 1991 and 1993 in Taikang County alone. Most of these stations were run either by the local Epidemic Prevention Center or by the hospital, and they were for profit.
From the contamination situation I had seen in blood stations and from the scientific literature I had read, it was clear to me that there was a hepatitis C breakout in plasma collection stations in China. My own investigation found hepatitis C antibody positive rate to be as high as 84.3%. Being a doctor, I was very anxious. I talked to Huangpu Youfeng (黄浦友风), commissioner to Zhoukou District, and he immediately convened all the chiefs of the plasma collection stations and hospitals across the District. Around the same time, I had learned from the 1993 paper by Zheng Xiwen (郑锡文) that, “between 1992 and 1993, the HIV infection rate among drug users in Ruili municipality and its three counties [in Yunnan province] were 81.8%, 85.7%, 44.6% and 40.0% respectively.”
I knew that hepatitis C and HIV had the same routes of infection; if an HIV-infected drug user’s blood was mixed into the station, it would spread fast among donors just like hepatitis C virus. I didn’t want to sit in the office of the Health Bureau waiting for the arrival of an AIDS epidemic. I wanted to directly monitor it and prevent it. In 1994, I asked the Health Bureau to allow me to establish a clinical testing center. It was approved but with no government funding provided. The Bureau assigned another three people to work in the center. I raised money myself, essentially using my own savings to buy testing equipment, while the Bureau authorized us to exercise quality control on blood safety in hospitals and blood stations across the District.
In March 1995, I was sent by the Health Bureau to test a donor by the last name Guo in Taikang County. He had been tested HIV positive when he was giving blood in a blood station in Kunming, Yunnan province. Mr. Guo told me that, for the last two weeks or so since he returned from Kunming, he had sold blood in Tuocheng County (柘城), Huaiyang County (淮阳), and Taikang County. Our testing found him HIV positive. I recommended the leaders of the Office of Medical Affairs of the Department of Health, Henan province, to immediately test HIV antibody in all the blood stations across the province. But they said it would be too costly and couldn’t be done.
In order to prevent HIV spread among blood donors as early as possible, I bought test kits from three manufacturers using my own savings, and randomly collected 409 samples from current donors of these three stations. Testing each sample three times using one kit after another, I tested all the samples and found the HIV positive rate at 13%. I promptly reported this to Mr. Wei, the head of the Health Bureau. He said, “You and your colleagues did a great thing for the people; people will be grateful.” He also said he would quickly report this to the district Health Bureau and the provincial Department of Health.
Two weeks later I went to see him again. He was very impatient. When I asked him whether he had reported the HIV epidemic to higher authorities, he rejoined, “You don’t think your test results are wrong?” I said my results were correct, and I told him I was going to Beijing to make a final verification. He asked me to submit a written report, which I penned and gave to him shortly. On the third day I left for Beijing. I brought with me 55 HIV-positive samples, but at the Institute of Virology, Chinese Academy of Preventive Medicine, the researchers told me that each sample would be charged RMB700 yuan. By then I had used up all my savings. I left in dejection.
It just so happened that, on my way out I ran into the president of the Academy Zeng Yi (曾毅) at the gate. He asked me what I was doing there, and I told him and asked him to help me with the final verification. Warmly he asked many questions; he was very alarmed when I told him about the HIV epidemic in Henan. He ordered his researchers to test my samples immediately. He instructed them to test 16 samples and that would be enough to determine. The test results came in the next day: 13 positive and 3 suspicious. Mr. Zeng said to me, “you have done an extraordinary thing; we must report this to the Ministry of Health immediately.”
That very evening, I received a call from Director Zhao of my District Health Bureau. He asked me when I was going to return. You caused an earthquake for our District, he said over the phone. The next evening, as soon as I arrived home, one of the directors of the provincial Department of Health called, praising the good work I had done and telling me I could continue on my work. I was very happy to be recognized by that director.
The next morning the District Health Bureau notified me to attend a meeting, because leaders from the provincial Department of Health asked for a briefing on the situation. However, as I walked into the meeting room, a director of the Bureau shouted at me, “Stay out of here!” Saddened, I went home. The next day they asked me to attend a meeting held at the guesthouse where the leaders of the provincial Department of Health were staying. A Bureau director demanded me to cross out a sentence from the report a colleague of mine wrote: “We first reported the epidemic to the director of the Health Bureau, and then we went Beijing for verification.” I declined his demand; he then crossed out that name by himself.
The leaders from the provincial Department of Health asked me, “How come you could discover AIDS while others didn’t?” I understood very well that they wanted me to keep it secret, because exposing the epidemic would botch their job evaluation as officials. Dismayed, I said, “I hope you don’t upbraid me for now. You should go visiting the 17 stations of plasma collection that are collecting blood as we speak. In these 17 stations, there are at least 500 people who are being infected by hepatitis C and HIV every day.” According to newspaper reports at the time, Henan province alone had almost 400 stations of plasma collection, and most of the blood used in hospitals came from these stations. It was impossible to know how many hospital patients had been infected with hepatitis C and HIV. A police officer got hepatitis C from transfusion he received after being wounded in a chase. He and his family were deeply upset about it.
Following that, a retired leader of the Health Bureau came to my clinical testing center telling me, “You will be in trouble if you don’t close down the center.” The next day he came with a long baton and smashed the sign of the center with it. Then, he went into the rooms to smash the equipment. I tried to block him, and he hit me with his baton. Presently a lot of people crowded around us to watch. Some pulled him back. That way I got out of danger. I called the police station immediately, and when the officers came to get him, he cried and made a scene. He screamed, “Certain leaders sent me to beat her. Now that the police came, none of them is forthcoming!”
After being struck, I went to look for the new District commissioner to complain. She was not pleased with me at all. “You should be talking to your supervisors in the Bureau!” I knew that all of them were giving me the run-around; there was nowhere for me to find justice. I went home in tears.
In March 14, 1996, at the behest of senior leaders of the central government in Beijing, the chief of the Department of Public Security of Henan Province, with the cooperation of the head of the Department of Health, arrested leaders of blood stations that were currently in business. In April, all of the blood stations and stations of plasma collection across the country were closed down for “rectification.” When re-opened later, they all added HIV testing. I felt very gratified, because my work helped to protect the poor.
In July 1996, Henan held a provincial conference on AIDS prevention, and leaders of hospitals, Epidemic Prevention Centers and Health Bureaus at various levels attended the conference. Governor Zhang said in his speech that “someone reported the HIV epidemic directly to the central government, and that is not acceptable to us.” Following the plenary meeting on the first day, a group meeting of around 30 officials in charge of Medical Affairs was held on the second day. Zhang Maocai (张茂才), director of the Office of Epidemic Prevention, asked who was from Zhoukou. Two colleagues and I said we were. He asked forcefully, “I have asked your Health Bureau several times to close down that clinical testing center, has it been closed?” I was petrified. He went on, “That man in your district’s clinical testing center dared to report the HIV epidemic directly to the central government. Do you know how high the rate he reported is? 50%-60%! ” “He and that Zeng—what’s his name–Yi want to wreck the leadership of the Department of Health and the director of Epidemic Prevention.”
Representatives from Xinxiang District (新乡地区) and Nanyang District (南阳地区) countered him with their own numbers. “We also did testings, and the HIV infection rate among transfusion patients and blood donors is also as high as 50-60%, same as Zhoukou District,” they said. Director Zhang was very upset. “If this is exposed, all of the directors here will be thrown out!”
When it was my turn to speak, I told him that “I’m the ‘man’ from the clinical testing center in Zhoukou whom you just mentioned, but I am a woman.” I said I first reported it to the local Health Bureau before going for verification in Beijing. Presently several people surrounded me, coaxing and pushing me out of the meeting room. In the afternoon I went to the office of Liu Quanxi (刘全喜), one of the heads of the provincial Department of Health. I told him how Zhang Maocai accused me during the morning session. Before I finished speaking, he erupted in rage. “Out! Get out of here!” I left with tears running down my face. I was confused; I didn’t understand: How can a senior official be so rude and irrational? Why is he so afraid of the topic of AIDS?
In November, 1996, experts from the provincial Department of Health and a few leaders of the district Health Bureau, led by Zhang Maocai, came to our testing center to inspect. Zhang told us that our equipment didn’t meet the standard and we couldn’t continue our testing anymore. “I’m concerned with the health of the woman folk working here,” Zhang said, “I don’t want you to be infected.” I asked him to explain what he meant by saying, during the meeting, that our HIV testing aimed at getting the head of the provincial Department of Health and the director of Epidemic Prevention. I was angry. I said, “I don’t need your concern; if we were infected, it was just four of us and we are not afraid to die. Why don’t you care about those tens of thousands of AIDS victims?” I told him that he had perpetrated a crime for generations of Chinese! Enraged, he left my lab with his cohorts.
That evening, Mr. Zhang and the Party leaders of the district Health Bureau had a meeting and decided to close down the clinical testing center. As for me, I continued to go to countryside to work with patients. I received a few anonymous calls of threat. When the leaders at the Bureau learned that we were continuing our work at the center, they sent people and shut down our utilities. As a result, all of the blood samples from patients went bad. Next they changed our name from “Clinical Testing Center of Zhoukou District” to “Institute of the Prevention and Treatment of Chronic Diseases” and merged it with the Station of Epidemic Prevention of Zhoukou District. Bureau chief Wei notified me: “You don’t have to come to work anymore. Go home to take care of your husband.” During the year after the center was closed down, I didn’t receive any pay.
Fortunately for me, with the help of President Zeng Yi, I was able to work and study for four years at his side. In Beijing, I wrote three times to Zhang Wenkang (张文康), the Minister of Health, to tell him the story of my colleagues and me. But all my letters were re-directed to the Department of Health of Henan province or to the Health Bureau of Zhoukou District. The circumstances of my colleagues and me became even worse.
President Zeng had received a lot of pressure for keeping me, and I felt like a burden to him. I still needed a job, I was still young, and I had a lot of experience in preventing and treating contagious diseases. I had discovered an important HIV protective antibody during the many serological experiments I had conducted. I wanted to have a good environment where I could make use of my knowledge and talent. But that proved to be a mere dream. After searching online for six months, I found a job in hepatitis C research.
In 2001, I came to the United States to work. I have since been working over 10 hours every day. Hard as it is, I have learned a lot of new technologies and techniques. I am still hoping that, one day, I will be able to apply my experience and skills to serve the Chinese people.