By KEVIN SPURGAITIS
It is said that HIV/AIDS doesn’t recognize any national boundaries or sovereignty. In Sub-Saharan Africa, in particular, the pandemic still engulfs millions. However, there is a small beacon shedding some light for hundreds of thousands of people in southern Africa. It is a fledging clinic in Lesotho’s Motebang Hospital called Tšepong, a Sesotho word meaning “A Place Called Hope.”
The Ontario Hospital Association (OHA) and the Change Foundation have partnered with the Government of Lesotho, placing Canadian health-care workers at Tšepong, located in the city of Leribe. Launched on World AIDS Day, Dec. 1, 2004, the OHAfrica initiative was a response to the challenge made to Ontario hospitals by Stephen Lewis, the UN Secretary General’s Special Envoy for HIV/AIDS in Africa. Lewis encouraged the province’s medical practitioners to take a leadership role in curbing the widespread health calamity.
The OHAfrica teams support local health-care professionals treating People Living with HIV/AIDS (PLWHAs). They assist in the development of community programs and self-help groups. They collaborate with health-care decision-makers, drafting a sustainable plan for HIV/AIDS care in Lesotho. As well, OHAfrica helps with the blanket distribution of affordable, life-saving anti-retroviral drugs (ARVs). The Tšepong Clinic was the first public ARV clinic in the country.
“The pandemic (in Lesotho) is greater in numbers than anything ever seen in the early 1990s … There are endless, inexhaustible numbers of people in conditions of dying,” says Dr. Philip Berger, who was OHAfrica’s initial team leader between December 2004 and June 2005. The chief of the Department of Family and Community Medicine at St. Michael’s Hospital in Toronto, Dr. Berger has treated people with HIV/AIDS since the epidemic began in Toronto.
Staggeringly, there was only one local doctor and an AIDS-infected pharmacist at the Tšepong Clinic initially. There were no nurses, administrators, translators, regular cleaners or lab technicians. As well, there was a dearth of towels, toilet paper, examination sheets and curtains for privacy. On one occasion, scotch tape was used to fasten an IV tube instead of surgical tape.
“In Lesotho, there are not the health-care personnel or even community individuals to do the work …There is a severe depletion of highly skilled health-care professionals there, because people flee to (United Arab Emirates, U.K. or the U.S.) for jobs that are better paying and with better working conditions. Many more are also sick with AIDS, themselves.”
In total, there are only 91 physicians, 1011 nurses and 791 midwives serving nearly 1.8 million people in Lesotho. Dr. Berger says, “We came with the intent of leaving our expertise in the hands of local staff, but that idea had to be abandoned. If we waited for village health-care workers to educate, the ailing Lesoto would never get the drugs.
“The OHAfrica project demonstrated that, on very short notice, and with very little preparation, we can move in quickly and get the drugs out quickly …We saw what appeared to a miraculous recoveries by some people … Tšepong is a benchmark clinic, with staff there now prescribing half of the ARVs in the country.”
Lesotho is a small, land-locked country within South Africa. It has been dubbed the “Switzerland of Sub-Saharan Africa,” because of its picturesque, mountain scenery. However, it is also gravely impoverished, with families’ wealth mainly measured by the number of their livestock. Traditional houses are made of mud or sod walls, with thatched roofs. Lesotho only has a handful of manufacturing industries, so almost half of all men work in South African mines, factories, farms and households.
Generally, migrant workers fill contract positions lasting from several months to two years. The money they earn there is considered vital to Lesotho’s ailing economy. Nevertheless, many men get infected with HIV/AIDS while working abroad. They then return to their homes in rural areas, passing the virus onto their wives and unborn children, it is reported.
Gender inequality — and the vulnerability of African women— is widely considered the core reason for the spread of HIV/AIDS. Nearly two-thirds of Tšepong’s patients are married woman in their early 30s. Often, they arrive by ox-driven cart, wheelbarrow or on the backs of relatives — their withered frames hidden under layers of clothing and a traditional Basotho blanket. Health-care workers usually see them for the first time gasping from pneumonia. Candida, a yeast-like, parasitic fungus, is sometimes detected spilling from patients’ mouths.
“Those who came dying at the door, simply died at the door,” Dr. Berger remembers. At times, the tireless, outspoken clinician felt he was merely pronouncing people’s deaths. He could only apologize and extend his condolences to some families. Still, the clinic was an “island of respite from an inferno, which was engulfing the country everywhere else,” he maintains.
Sr. Christa Mary Jones, a nurse practitioner and former OHAfrica member, was equally dismayed. Having spent more than 34 years practicing maternal and paediatric medicine in Africa’s Sub-Saharan region, she recently returned to Toronto.
“People are dying. People are being cross-infected and debilitated. Yet where are we in sensitizing each other to the fact that we have this deadly thing among us,” says Sr. Jones.
“The citizenry, the people of Lesotho, have been so badly affected by the
disease that you don’t have high-calibre people to empower. It’s now a matter
of getting people healthy again and restoring staff to work with foreign and village health-care workers.
“ … But it’s really important you don’t go in as the great hero-saviour and say,
‘here we are.’ A partnership needs to exist between developed world and developing worlds. It’s not paternalism. It’s hand-in-hand work that retains the respect of the people receiving care.”
She recounts being a part of the small medical team. It was challenging, she says, “keeping the essential principles of good practice and maintaining high standards of care.” Sometimes, she couldn’t even set foot in the deluged clinic. Both angered and saddened by patients expiring on waiting-room benches, Sr. Jones desperately wanted to give people a reason for living, she recalls.
“It has awakened within me a compassion I did not know existed … At the end of the day, I didn’t just go out and serve; I was served by the incredible humility and
courage of the people that you are helping.”
Sr. Jones adds, “We had a lot to offer them and had a lot to learn.”
Sub-Saharan Africa is the world’s most HIV/AIDS-devastated region — home to more than 25.8 million people living with the virus. Lesotho is the fourth most affected country. According to UNAIDS, life expectancy here has dropped below 36 years-of-age. An estimated 79 Basotho die of the disease each day. In 2000, the Government of Lesotho finally declared HIV/AIDS a national disaster. By September 2005, there were five ARV clinics running, including Tšepong, and another nine in various stages of development. During a one-year period, the percentage of people with AIDS receiving ARV treatment in Lesotho rose from less than two per cent to almost 10 per cent, according to OHAfrica.
At Motebang Hospital, patients visit the clinic’s pharmacy to receive their first ARV prescription. They then return for monthly assessments and educational sessions. Twenty-eight-year-old Me Lipuo Booi was one PLWHA who got better. After four months of treatment and clinic aerobic classes, her weight soared from 37 to 55kg. There was also a dramatic increase in her CD4 count, which measures the strength of a person’s immune system. She is now a member of Phelisanang Bophelong, a grassroots support group for HIV/AIDS survivors.
She told Canadian health workers that HIV/AIDS does not have to be a sickness that causes people to die. “It is in my blood, but I am still strong … I’m so happy that I’m alive,” she said.
Booi is one of 56,000 Lesothoans living with HIV/AIDS, who require constant ARV treatment. With newly available generic drugs, the annual cost to provide one person in Lesotho with the treatment, is now roughly $170 — less than 50¢ cents a day. Critics charge that it is ‘harebrained’ to prescribe anti-AIDs drugs because a resistance can be developed by patients and supplies can be easily interrupted. However, Lewis has advocated tirelessly to make generic ARVs available in Africa. He argues that these life-prolonging drugs should be made affordable —preferably free — and accessible. It would go along way towards the World Health Organization’s 3 by 5 Initiative, which aimed, but missed, to treat three million PLWHAs with ARVs by December 2005.
In a March press conference at the UN’s New York City headquarters, Lewis commented on his February visit to Lesotho and Swaziland: “(Lesotho) is making frenzied efforts to provide anti-retroviral treatment. In the case of Lesotho, lamentably, they came nowhere near the target. In both countries, there is a fatal paucity of human resource capacity … There is a desperate shortage of health professionals. In both countries, many of the professionals they do have end up in Western nations, or in other countries in the sub-region such as South Africa. Both Lesotho and Swaziland are attempting to create new professional or semi-professional career lines to compensate for what’s been lost. And in both countries, the emphasis on training commands an almost supernatural zeal, intensity and commitment.
“ … How will we ever explain what we have wrought? …It is my contention that years from now, historians will ask how it was possible that the world allowed AIDS to throttle and eviscerate a continent.
According to OHA, this year is a crucial, historic turning point for Africa, with literally millions of human lives at stake. In August, Toronto hosts the International AIDS Conference, an annual event geared towards strengthen prevention, treatment and care efforts globally. An estimated 20,000 participants, including scientists, health-care professionals, political and business leaders, NGO representatives and people living with HIV/AIDS, are expected to attend.
With eyes on Canada, the OHAfrica team will continue to identify partners, communities and appropriate strategies for the long-term sustainability of its initiative. In order to place more Ontario health-care providers in Lesotho, it requires the support of the provinces’ hospitals. Additional funding from partners and individuals will also mean the extension of the ARV treatment program at the Tšepong Clinic. The continued presence of Western physicians, nurses, pharmacists and administers, is needed in Lesotho, says Dr. Berger, adding the country could use 30 equivalent health-care teams. This contradicts current capacity-building models where foreign professionals come in, share their expertise over a brief period of time and then, over decades, infrastructure is slowly built up.
However, Berger compares the HIV/AIDS crisis to a natural disaster: if there’s a landslide happening, one doesn’t have a committee meeting for a year to determine proper action.
“The Canadian government should meet its international development assistance goals (the Pearsonian standard for provisions — 0.7 per cent of the Gross Domestic Product — set in 1969). They should fund health care teams in Lesotho and other African countries on an emergency basis, to intervene with wide-spread distribution of ARVs and halt the pandemic that is pushing countries into civil chaos and non-existence.”
It’s not a Herculean task, he maintains. “As citizens living in the West, we have a moral duty and responsibility to bring to bear the remedies that are available in Canada, to people in Africa. And we have the wealth and the resources to do it.”
Originally published in the Catholic New Times, April 2006
