The ART of treatment

The hospital on the outskirts of Nairobi wasn’t built because of its proximity to the Kenyan capital’s massive townships, although the chaotic slums do provide it with an overflow of patients.

It wasn’t constructed using millions of dollars of donor funds, which is why it consists completely of cold, grey cement, overcrowded wards and medical equipment dating back to the 1960s.

The wind created Mbagathi Hospital.

”It blows a lot on the hill here. We treat many people with airborne diseases, like TB [tuberculosis]. And we believe the wind provides good ventilation so that bacteria don’t flourish. It sounds simple, but it’s the truth. That’s why this location was a good choice for a clinic,” says Roselyne Okumu, the institution’s sole social worker.

But as much as Okumu lauds the wind, it can’t blow Aids away. Kenya is a country where at least 1,2-million people are HIV-positive and about 300 people die every day as a result of the epidemic.

Yet these days at Mbagathi, a new breeze is stirring up old beliefs and the much-maligned hospital is a shining example of how anti-retroviral therapy (ART) can be rolled out, even in an under-resourced, impoverished setting.

Kenya is wracked with infighting in the ruling National Rainbow Coalition — a government consisting of largely conservative politicians who are anti-abortion, pro-death penalty and support abstinence — yet it is also fully in favour of ART.

Last year Kenya got a bigger share ($75-million) of US government funds to fight HIV/Aids than any other African country because of the cooperative way programmes are being rolled out.

With far fewer resources than South Africa, Kenya has given ART to 25 000 of its HIV-positive citizens who require the drugs. In contrast to South Africa, the Kenyan government has clearly defined and publicised roll-out targets: by April next year, it plans to provide 45 000 people with ART; and 75 000 by the end of 2005. If this objective is indeed attained, Kenya would be providing access to ART to more than 40% of its HIV-positive people who need it.

But beyond the cold statistics and bold intentions, Okumu puts a human face on the revolution at Mbagathi: before the hospital started giving ART, few people visited the social worker’s clinic to be tested for HIV.

”They didn’t want to know their status, but now that they know that ART gives them a chance to live, they come for testing and they have the courage to face up to Aids,” Okumu enthuses.

”Far fewer patients seem to feel stigmatised by being HIV-positive. They are now quite open, which was not so a year ago.”

And until recently, Mbagathi’s wards were filled to capacity with disease- ridden HIV-positive patients. But now that ART is being administered, these people no longer fall ill with chronic opportunistic infections, freeing up much-needed beds. But the hospital has also become a victim of its own success: its achievements with ART have doubled staff workload, yet the government has so far failed to appoint additional personnel.

”It’s difficult,” Dr Shobha Vakil, a provincial ART officer, admits. ”Patients need to be closely monitored; ART won’t work if patients don’t take the drugs at the same time every single day. It takes a lot of time and effort, and a lot of counsellors, nurses and doctors to make sure this happens. There is great pressure.”

It’s easy to elevate the Kenyan example, yet imperfections remain: patients are expected to pay up to 1 300 Kenyan shillings, about R100, for ”pre-ART” tests that determine whether or not they need the drugs, and the government also charges individuals KSH500 (about R38) a month for the therapy.

Patricia Atieno isn’t bothered with analysis of perceived failures and successes. For her, the country’s ART roll-out is ”only about life!

”My kids are no longer scared of their mummy dying.”