Patients start queuing at 6am outside the two steel portable buildings of the Princess Marina Hospital in Gabarone, some standing, others supporting themselves on a stick or a child’s arm. The queue looks bleak but is actually testimony to a remarkable success story in Botswana which suggests it may not be too late for Africa to start fighting back against its ferocious Aids epidemic.
Inside the buildings, reminiscent of a rather overcrowded NHS clinic, doctors are giving patients blood tests. If their CD4 cell count is lower than 200, which denotes a weakened immune system, they will receive the antiretroviral (ARV) drugs needed to stay alive. For some it is too late but others get better, and return to work.
President Bush is expected to visit the hospital when he makes a whistlestop trip to Botswana this week as part of his five-nation African tour. He will be told the doctors have treated more than 6 000 patients with the drugs, and plan to open up new clinics. For Bush, who has pledged $15-billion over five years for Aids treatment and prevention, this is the kind of project he needs to see to know such initiatives are worthwhile.
There are 120 000 people eligible for these drugs in Botswana, a southern African country where an estimated 36% of the population has the disease. Aids arrived in the early Nineties, but very few will put themselves forward for diagnosis, knowing friends and family may shun them. Life expectancy for a Botswanan, which was due to reach 72 by 2010, will have flipped back to 27.
Dr Ndwapi Ndwapi left his job in America to come back to his native land and help run what is now the busiest Aids clinic in the world, seeing 120 patients a day. ‘The first came here thinking they were going to be given a death sentence. Now with the drugs, we have a new beginning,’ he said, squeezing between patients as they queued in the corridors.
It is not an easy career choice. ‘I try not to get too tied up in the daily suffering — but it is tough. I’m aware I could do more, and I feel frustrated. Still, before there were ARVs, it was hopeless, you just helped people to die as comfortably as possible. Many, many lives have been changed with this treatment,’ he said.
This project, the first full attempt to prevent and treat Aids ever undertaken in Africa, is known as the African Comprehensive HIV/Aids Partnerships, (Achap). It involves the government working with the Bill Gates Foundation, and pharmaceutical firm Merck, each putting in $50-million into a five-year-initiative. The drugs are being bought by the government at cost price from the pharmaceutical companies, and one of the medications is being given free by Merck. The total package of care per patient costs $1 000 a year.
Some see this kind of joint partnership as the most realistic way forward; one is Professor Brian Gazzard, Aids physician at the Chelsea and Westminster Hospital in London, who comes here every six months to oversee the training of staff.
‘HIV is rooted in poverty and ignorance and poor infrastructure,’ he said. There is no GP system in Botswana, where 30 000 traditional healers have to be persuaded the new drugs do work.
‘In some ways, Africa is caught in this time warp. It is so far behind the West in being able to provide basic healthcare. But I am optimistic because if you can treat 10 000 patients really well in Botswana you can say to the rest of the world, ”For Christ’s sake, this can work.”’
But there remains great uncertainty over how the rest of Africa will find the money for such projects. The drugs companies are fighting a battle for their right to keep patents on HIV drugs, preventing others from copying them, as part of global trade negotiations. It has left companies like GlaxoSmith Kline facing accusations of denying the poorest nations life-saving drugs.
There is also cynicism over their new found philanthropy. In Botswana, Merck and Bristol Myers Squibb are putting in $200-million over five years for medical projects. But is their beneficence any more than an expensive attempt to win good publicity, against a backdrop of protests about drug pricing? The companies insist they want to help, and are well placed to do so, but only if they are able to work with governments to set up a proper health infrastructure — hospitals, clinics, trained staff — to deliver the drugs safely.
On the other side of the continent, Tanzania has $6 a year to spend on each resident’s healthcare and has not even talked to the pharmaceutical giants about drugs. Instead, it hopes the Bill Gates Foundation or the UN Global Fund might come up with some money.
As part of a trip funded by the International Federation of Pharmaceutical Manufacturers Associations, The Observer was taken to see various projects around the country, where companies and health officials were working together to cure river blindness and elephantitis. Important projects, but small beer compared with the financial and organisational challenges presented by the two biggest killers, malaria and Aids.
In stark contrast to Botswana, Tanzania has no access to antiretroviral drugs until someone is wealthy enough to pay $60 a month for them through a private pharmacy. The drugs companies argue they cannot come in unless the government negotiates with them, and the government says it cannot afford them.
One couple are managing to bring in Aids drugs, in order to save the lives of their own staff. Doctors Richard and Carolyn Collins came out to Tanzania two years ago to work for the Teule Hospital in Muheza. They found hospital staff were dying of Aids at the rate of one a month. With the help of friends in Britain, they started a charity providing enough money to enable them to pay for imported generic HIV drugs which have saved 16 lives so far. But there is no money to pay for treatment for partners of staff, or for children.
The generic drugs from the Indian company Cipla cost $30 a month, half the price of patented medicines. ‘Thank goodness for the generics, because otherwise we would have nothing,’ said Carolyn Collins.
She laughs at the idea that they might get financial aid from the West. ‘For it to work, we would need to give them the drugs for free, because there’s nothing these people can afford. People in high places say, ”Why are you bothering, because these people are going to die anyway?” But back home, we give people with brain tumours another nine months of life with treatment. It’s about the value you place on life.’
Nowhere is that value more apparent than in the orphanage in Otse, back in Botswana, where 50 children sit down to a meal of chicken stew.
There is a sense of hope and purpose here at the Dula Sentle Trust, as the children, from five to 17, are taught ways of coping with the loss of their parents, and given skills to survive. The girls are taught how to say no to a boy who wants sex, but in a charming way, using funny songs.
Its founder, Gill Fonteyn, said: ‘At the moment we have 50 kids. Within five years, that’s likely to be over 200 orphans. At the moment, everyone has someone they can go home to at night, even if it’s a distant relative. But soon there will be a few with no adult to look after them.’ – Guardian Unlimited Â