UGANDA–A high-level delegation led by Health and Human Services Secretary Tommy Thompson got a close-up look earlier this month at how life-saving, high-tech pharmaceuticals get delivered to HIV-afflicted Ugandans. The delegation visited remote and primitive regions of this poverty-stricken country, which has become one of the most successful in Africa at fighting AIDS.
Groups of four or five members of the delegation–including U.S. government officials, public-health leaders, and corporate and NGO executives (and a few members of the press, including me)–traveled in four-wheel-drive vehicles behind Ugandan health workers on Suzuki motorbikes to villages about ten miles from this eastern Uganda city, which itself is three hours by bus from the capital, Kampala.
Each of the health workers delivers anti-retroviral (ARV) drugs to HIV-infected Ugandans, most of them poor farmers living in mud huts with thatched roofs. Each health worker drops off a week’s supply of the drugs, interviews the patients to determine their condition, and reports back to medical teams at a provincial hospital.
It was a “life-altering experience” for those in the delegation who followed the health workers out into the bush along rutted dirt roads, said Randall Tobias, the U.S. global AIDS coordinator. Tobias directs the dispersal of the $15 billion that President Bush, in an unprecedented measure, has dedicated to fighting the disease in 14 African nations, including Uganda.
On my own visit, I accompanied William Haseltine, CEO of Human Genome Sciences; Louis Sullivan, former secretary of HHS; and several others on a slow, bumpy ride to a tiny village, where we watched as the health worker on the motorbike dispensed drugs, first to a family that included an HIV-infected grandfather, father, mother, and infant. The family lives on a subsistence farm that grows yams, groundnuts, beans, and a few other crops. Along with three other children, the family lives in a small mud hut sealed with cow dung and covered with a straw roof.
But despite the backward surroundings, the drugs delivered are state-of-the-art anti-retrovirals, and they are saving the lives of people grateful to have the support of this program, run by the U.S. Centers for Disease Control and the Uganda health ministry.
My small group next traveled to see another heart-breaking victim, also in the village of Chegen: a 33-year-old woman, whose husband had died of AIDS. Because of his death, she was banished by in-laws, who saw her as the cause of the man’s demise and took her house away. Destitute, she was given a small space for her mud hut by a church. She now lives there with her two daughters.
The woman, debilitated by AIDS, received her weekly supply of ARVs from the motorbiking health worker, and told us that both her daughters had tested negative. She says that she struggles to find the money to pay their school fees, and must beg for food.
“She is very grateful,” translated Sam Okwaare, the remarkable physician who accompanied us. Okwaare, who is Uganda’s commissioner of health, grew up in a village nearby and, because he excelled in local schools, won the chance for an education in the United States, where he received both an M.D. and a degree in public health.
Okwaare explained that, by local tradition, the widow would have been banished no matter what the reason for her husband’s death. “It is seen as her fault that he died,” he said. The result was tragic, and the beautiful woman’s eyes were sad and tired, but it was clear that the story would have been even more tragic without the ARVs.
The availability of these drugs–which arrest the progress of the virus in advanced stages of the disease–has been a controversial issue throughout the visit of the delegation, which includes such key figures in the battle against AIDS as Richard Feachem, executive director of the Global Fund to Fight AIDS; Julie Gerberding, director of the CDC; Elias Zerhouni, director of the National Institutes of Health; Anthony Fauci, who directs NIH’s Institute of Allergy and Infectious Diseases; and Hank McKinnell, CEO of Pfizer.
Most of the experts on the trip, including Thompson, stress the importance of developing a health-care infrastructure in African countries. For example, the group traveled to Kisumu and Kisian, in Kenya, to tour large installations, staffed mainly by 400 Kenyan employees of the CDC. The provincial general hospital in Kisumu treats many pregnant women with AIDS, and conducts experiments on therapies for malaria, including the testing of new vaccines.
Of the 1,400 people identified by the hospital as having HIV, 700 are deemed eligible for ARV treatment, we were told, but the drugs are being administered to only 35 patients. Why so few? Is the answer a lack of funds to buy the drugs, whose prices have come down sharply? Or has the distribution of more ARVs been reasonably delayed because of a lack of trained personnel and good delivery systems?
In Tororo today, a woman who is a board member of the Global Fund, herself HIV-positive, handed out a statement which claimed, in part, that “the allocation of funds for anti-retroviral therapy for 30,000 patients through the Global Fund’s current contribution to Uganda is unacceptably low, and does not cover more than 80 percent of those already tested and ready to receive treatment.”
But, separately, Feachem told me that a substantial proportion of the next round of grants from the Global Fund would be used to purchase ARVs.
In other words, the drugs are coming as methods of distribution and care–like the motorbike angels we accompanied today–are being devised. Currently, worldwide, about one million people are receiving ARVs. The goal is to bring three million under treatment by 2005. The cost of two million more annual ARV therapies is not excessive–only a small part of the Global Fund’s money.
The problem, at least for now, is not the drugs. But there is deep concern, voiced by many experts on this trip, that today’s ARVs–especially if they are administered without the proper safeguards–will lose their effectiveness in a short time. If that happens, will drug companies, under severe attack from political activists (but not from afflicted Africans here on the ground), continue to devote huge sums to research for the next generation of ARVs?
That’s a question no one here can answer. But one source in a position to know said that two of the six key research-drug companies that make ARVs have decided not to continue in the field.
What is clear is that the experience of the past few days has had a powerful impact on members of the delegation–notably Thompson himself. With tears welling in his eyes, Thompson told the stories of the two AIDS victims he visited with a motorbiking health worker. “Samson and Rosemary,” he said, “will be with me forever.”
Samson, a man who earns $5 a month making chairs, told Thompson, “Thanks. Thanks to God. Thank you. Thank you, Mr. Bush.”
Thompson told a crowd assembled at the hospital after the visits: “If you really want to change the world, do it through bringing health and clean water to people who need it. Nothing is more powerful than a foreign policy based on health and clean water.”
He’s right. This “door-to-door diplomacy” is not only saving lives. It is winning friends for the United States, a nation that, for inexplicable reasons, has hidden its good works from the view of both Americans and others around the world.
“I am absolutely moved and transformed,” said Thompson, describing the day’s events. Me, too.