Four women emaciated by Aids, perilously close to death and abandoned by the state healthcare system, cling tenaciously to life at a remote clinic where doctors give them one last fighting chance.
The women, sent home to die by doctors at a state hospital, arrived critically ill. Their immune systems barely registered in tests and their blood was brimming with the virus that causes the disease.
”These are people who were already in the coffin but forgot to fall down,” said Dr Hugo Templeman, the Dutch physician who founded the Ndlovu Medical Centre a dozen years ago in the remote and dusty crossroads of Elandsdoorn in the South African countryside.
Remarkably, Templeman said about 85% of those admitted to the clinic’s small ward in critical condition not only survive, but also recover. Over months of treatment with antiretroviral cocktails their viral load drops dramatically and their immune system revives.
The patients are not cured, but are restored to the manageable status of HIV-positive.
”This is all about hope,” said Templeman.
Here among treeless, rock-strewn hills and the abject poverty of dusty, rural townships 160km north-east of Pretoria, the Ndlovu Medical Centre offers a blueprint on how to bring a successful Aids treatment and awareness campaign to remote corners of the African bush.
It also offers something rare in South Africa: a hopeful Aids programme in a country where the president has questioned the link between the virus and the disease and the health minister has been pilloried for questioning the effectiveness of antiretroviral drugs and instead promoting garlic and African potatoes.
‘Not the end of the world’
”Many people still think that HIV-positive is a death sentence; it is the end of their lives,” said Dudu Nkosi (28), who was sent home to die by a state hospital in 2003. At the time, she weighed just 28kg and her immune system had collapsed.
Today she counsels patients at Ndlovu. She helps them overcome the shock of discovering they are HIV-positive and to commit to a lifetime of treatment and monitoring. ”Being HIV-positive is not the end of the world. The patients believe me when I say this because they know I survived,” said Nkosi.
The clinic has its own laboratory for monitoring treatment and adherence. It has its own X-ray machines, pharmacy and a remarkably successful maternity programme designed to prevent mother-to-child HIV transmission. Teams provide testing, counselling and treatment to farmworkers on their farms; others take HIV education to schools and remote townships. Some go to patients’ homes to count out pills and ensure treatment programmes are followed.
Templeman and the clinic also carry out research on Aids treatment with the University of Utrecht in The Netherlands.
Roads leading to the clinic are littered with hand-painted signs with slogans promoting safe sex, HIV testing and adherence to treatment and monitoring.
”We still have two or three deaths a week in the waiting room,” said Templeman, adding that the Aids stigma makes many wait too long to seek help.
In October, Deputy President Phumzile Mlambo-Ncguka was appointed to take the lead on Aids policy, sidelining the much-criticised health minister. On Friday, World Aids Day, the government was expected to outline a new plan to increase access to treatment.
But the government’s slow response so far has contributed to the epidemic’s spread, said Templeman. ”They have confused the whole population by not giving the right information. We have lost something because of it. People think ARVs are poison.”
‘Dying like flies’
South Africa has an estimated 5,4-million people infected with HIV, the second highest in the world after India. Aids kills more than 900 South Africans a day. The World Health Organisation says about 26% of the economically active adults are HIV-positive, but Templeman says the rate is higher among South Africa’s rural poor.
”The prevalence is over 30% among farmworkers. With a prevalence of 30%, nobody can keep up,” said Templeman. ”They are dying like flies out there.”
Ndlovu takes its programme to the farms because so few farmworkers have the means to get to the clinic. With so many farmworkers dying of Aids, Templeman said farmers have been convinced it is in their economic interest to pay for treatment.
Of 130 births by HIV-positive women at the clinic since 2003, 128 of the newborns were HIV-negative. Templeman said the two women who transmitted their virus to their babies joined the programme too late. Without the treatment protocol, there is a one-in-three chance the mother will pass the virus on to the child.
HIV-positive women are given good prenatal care and put on antiretrovirals immediately to try to reduce the levels of the virus to almost undetectable levels in the bloodstream. The babies get antiretroviral treatment and the women are prevented from breast feeding and given formula for the first year.
”What we do here is insignificant if it is not reproducible,” said Templeman.
New clinics
With financial help from the United States President’s Emergence Plan for Aids Relief, Anglo-American and Sir Richard Branson’s Virgin Atlantic, among others, Ndlovu is establishing another clinic at Bushbuck Ridge, 160km further north-east. Eventually it could sponsor up to 20 clinics in rural South Africa.
Templeman does not want to expand too rapidly to ensure the success of each new clinic. The formula, he said, will also be replicated at government community centres all over the country and copied in remote areas in the rest of Africa.
Ndlovu treats a maximum of 200 outpatients a day for any medical problem. In partnership with another NGO, it helps run numerous development projects in the townships, such as providing water, preschools, nutritional help and education and a computer school.
It has also helped create a sports centre, a bakery and a solid-waste management system.
”We are really lucky to have this clinic in this community,” said Lettie Wendy (26). ”I was at a government hospital. I was really sick and they sent me home to die. My aunt brought me here in 2004 and they put me on antiretrovirals.”
When she was admitted she couldn’t walk and was little more than skin and bones. Her immune system had collapsed and she had three large bed sores that forced her to lie only on her stomach.
Two years later, Wendy is still confined to a wheelchair, but she has gained weight, her sores have healed, her immune system has rallied and the clinic treats her like a poster child for the success of the treatment.
From her wheelchair, Wendy pointed toward the women in the critical-care ward. ”When they see me,” she said, ”they know you don’t have to die of Aids.” — Sapa-AP