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‘Too late to save him’: Indonesian children killed by cough syrup

Medan, Indonesia – When Siti’s son, Mohammad Fajar, fell ill for the first time at the end of August this year, the housewife and cleaner did not think much of it.

The five-year-old had just celebrated Indonesian Independence Day with his family at home in the city of Medan, playing with his mother’s mobile phone to make videos of himself dancing and laughing.

As far as Siti, who like many Indonesians goes by only one name, knew, her only son was healthy enough to fight off a cold.

She gave him cough syrup bought at the local pharmacy to relieve his symptoms. But on September 15, Fajar died.

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It wasn’t the cold that killed him, but suspected kidney failure caused by the widely available drugs that were supposed to help him get better.

“It’s so lonely without him,” Siti told Al Jazeera, asking for a photo of him in hospital to be published so others could see how sick he had become. “We were too late to save him.”

Fajar is one of dozens of Indonesian children who have died since August as a result of taking cough syrups suspected of being contaminated with chemicals used in antifreeze products. The deaths have prompted the government to order a recall of syrup-based medicines and revoke permits for more than 1,000 of those products.

Malahayati, president of the Indonesian Child Protection Agency in Langkat, North Sumatra, told Al Jazeera that the agency was “very concerned” about the recent spate of deaths.

“We ask the government to immediately find out how this came about and provide a solution so that there are no more victims,” ​​he said.

Empty shelves in a pharmacy with a sign telling customers that cough syrups have been withdrawn from sale
Chemists in Medan have emptied their cough syrup shelves as a result of the deaths. [Aisyah Llewellyn/Al Jazeera]

Indonesia recorded more than 269 cases of acute kidney failure as of October 26, said Mohammad Syahril, a spokesman for the Indonesian Ministry of Health. Some 157 of those affected had died, he added.

Experts suspect both numbers are an undercount, noting that some early cases may not have been recorded as kidney failure because the children suffered from other illnesses and the fact that many were unaware of the potentially contaminated drugs.

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Suspected antifreeze contamination

After an investigation, the ministry said it had discovered that some medicinal syrups, used to lower fevers and relieve symptoms of coughs and colds, had been contaminated with chemicals including ethylene glycol, diethylene glycol and ethylene glycol butyl ether.

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The World Health Organization (WHO) says that such substances, which are typically found in antifreeze products and used in refrigerators, air conditioners, and freezers, are not safe for use in medicines.

Last month, he ordered cough syrup products made by a company in India to be withdrawn from sale after the deaths of 66 young children in The Gambia from acute kidney failure.

According to Indonesia’s Food and Drug Supervision Agency (BPOM), the chemicals were found in locally produced products, including fever medicines Termorex Syrup, Unibebi Fever Syrup and Unibebi Fever Drops, as well as Unibebi Cough cough medicines. Syrup and Flurin DMP Syrup. .

To treat the surge in cases of acute kidney failure, Indonesia had to ask neighboring countries including Australia and Singapore for the antidote, a drug known as fomepizole, but the potential treatment came too late for Fajar, whose illness, like that of many other children affected. across the country, at first he seemed innocuous.

“I thought it was a normal fever but it wouldn’t go down, so I went to the local pharmacy and bought him some liquid paracetamol,” Siti told Al Jazeera.

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But every time Fajar’s temperature dropped, it would rise again within a few hours, so Siti decided to take him to the hospital. There she was told that Fajar probably had dengue, a disease caused by mosquito bites, and they gave her an IV. Unfortunately, Siti, who like many Indonesians does not have health insurance, could not afford to keep her son in the hospital for further testing and observation.

“After he received a bag of drip medication, I decided to take him home and try to raise some more money for his treatment,” she said.

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While trying to get funding from friends and neighbors, Siti continued to treat Fajar’s fever with locally purchased syrups, buying two different brands in addition to the fever syrup prescribed by the hospital.

Mohammed Fajar lying in a hospital bed with a cannula in his hand and a breathing apparatus over his face as a family member comforts him
When Mohammad Fajar was admitted to hospital for the second time, he was seriously ill. His parents asked for this photo to be published to show how sick he was [Courtesy of Mohammad Fajar’s family]

As the days passed, Fajar appeared briefly as if he might be on the mend, regaining his appetite and a bit of his energy, only to deteriorate again several days later.

This time, Siti called Fajar’s father, who works as a laborer in the neighboring province of Aceh, and asked him to come home. When he arrived, Fajar could no longer move and was lying on the bed staring at the ceiling and gasping for breath.

When the family was able to get him back to the hospital, the doctors told them that Fajar would have to be admitted to intensive care.

“It’s very bad. It’s critical, so it would be better to pray,” Siti recalled one of the doctors saying.

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seized drugs

Siti could not bear to see Fajar, now on a ventilator, in the hospital bed, so her cousin, Sri Wulandari, kept vigil at his bedside. “Her breathing became irregular and a doctor came in and said, ‘Wait, we’re doing our best,’ but five minutes later he was dead,” the 30-year-old told Al Jazeera.

“He didn’t know how to tell his mother. But she was crying and as soon as she saw my face she knew it.”

Wulandari and Siti told Al Jazeera that the doctors who treated Fajar at Adam Malik Hospital said the boy had died of kidney failure and if he had not been so weak, they would have put him on dialysis.

At the time, the family had not heard of young children dying from acute kidney failure and did not know about the potentially poisonous syrups. Siti said officials from the local health department went to her home two weeks ago and took the fever medicine she had given Fajar.

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When contacted by Al Jazeera, the health department confirmed that it had seized drugs from the homes of patients with suspected kidney failure for testing, but said it could not release any of the test results. A spokesman for the health department confirmed to Al Jazeera that 11 patients, all children, had died of acute kidney failure in North Sumatra province, which includes Medan, to date.

The health department and the Adam Malik hospital, where the patients were treated, declined to answer questions about the status of any ongoing investigation into the seized syrups or how they might have been contaminated.

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According to BPOM, two pharmaceutical companies are currently under investigation after it was suspected that they had switched to sourcing ingredients from pharmaceutical suppliers to chemical suppliers, perhaps leading to contamination.

“There are indications in their products that [chemical levels] they were excessive, highly toxic and suspected of causing kidney damage,” Penny Lukito, director of BPOM, said at a news conference in Jakarta in October.

Mohammad Fajar's mother, Siti, in a pale pink scarf and turquoise shirt with her cousin Sri Wulandari in a navy blue scarf and white dress sitting inside Siti's house
Siti and her cousin Sri Wulandari. Siti was so distraught to see her son in her hospital that she asked Wulandari to stay with him. [Aisyah Llewellyn/Al Jazeera]

Meanwhile, back in Medan, Siti says that no one has contacted her to clarify if they found anything suspicious in the medicine Fajar took, and that she keeps passing out from the stress of the situation and when she remembers her son.

Just a few months before her death, Fajar had started kindergarten and was still sleeping in bed with her mother. For Siti, the feeling of loss has been almost unbearable.

“It’s like she died too,” Wulandari said.

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