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The unsung heroes in the war against HIV

Celia Dugger

MASHAI — At a clinic in Lesotho’s mountains, reached only by crossing a churning river in a rowboat, Dr Paul Young, a paediatrician raised in the housing projects of Savannah, Ga, soothed a fussy baby.

She stared at him, fascinated, as he made soft popping sounds with his lips and listened to her heart through a stethoscope.

“I used to be afraid to look at the babies’ test results,” he said after examining a bunch of children, who were born healthy despite having HIV positive mothers.

“But now, most of them are negative.”

Dr Young, 33, and the nurses he trained here have persuaded many pregnant women to get tested and take the drugs that prevent them from passing the disease to their newborns.

It is all part of a charitable effort he joined in 2008 for US$40 000 (M276 000) a year and the chance to work in this Aids-afflicted country, which has just one pediatrician in its entire government health system.

“If this was the last thing I did, if this was the only job I ever had in life, I would have served my purpose,” he said.

Dr Young represents the surging interest of young Americans in combating the deadly epidemics ravaging the world’s poorest countries, fuelled in part by the billions of dollars that the American government, the Bill & Melinda Gates Foundation and other organisations have poured into international health in recent years.

Across sub-Saharan Africa, an extreme shortage of health workers remains a critical barrier to fighting illness.

The region bears a quarter of the world’s burden of disease, but has only three percent of its health care workers, according to the World Health Organisation (WHO).

Public health experts say efforts like the one involving Dr Young have proved particularly useful on a continent that sorely needs paediatricians, surgeons and other specialists to train African doctors and nurses in the field.

And demand for such opportunities is rising.

More than 70 universities in the United States and Canada now offer formal academic programmes in global health, most of them developed in just the past five years, according to the Consortium of Universities for Global Health.

“Today’s students really want to make a difference in the world,” said Michael Merson, director of Duke University’s Global Health Institute. “They have a passion for sacrifice and service. It reminds me of the ’60s.”

The children of powerful politicians are part of this new generation of global health enthusiasts.

Vanessa Kerry, 34, a Harvard-trained doctor and the daughter of Senator John Kerry, Democrat of Massachusetts, is advocating a Peace Corps-like federal programme that would send American doctors and nurses to work and train health workers in developing countries.

And Barbara Bush, 29, daughter of former President George W Bush, co-founded the non-profit Global Health Corps, which this year sent 36 college graduates from eight countries to work with non-profit groups, mostly in Rwanda, Burundi, Malawi and Uganda.

More than 1 000 people applied for the year-long fellowships.

The Paediatric AIDS Corps that sent Dr Young here, largely financed by the Bristol-Myers Squibb Foundation and the Baylor College of Medicine, never advertised for applicants after the first class of doctors was recruited in 2005.

Word of mouth produced far more highly qualified physicians from universities all over the United States than the project could ever hire.

In addition to the salary, the programme paid down as much as US$40 000 of the doctors’ educational debt for each year of service — making it possible for Dr Young to join, though he owed US$170 000 after his undergraduate and medical studies.

His mother was an assembly-line worker, and in hard times the family relied on Medicaid.

Dr Young himself never had a steady paediatrician as a child.

With a laugh, he said that his friends back home asked him if he had running water or used an outhouse in Africa.

“We’re not roughing it here by any means,” he tells them.

He drives a 10-year-old Opel Corsa, but lives in a pleasant town house in the sleepy capital, Maseru, with wireless Internet and a housekeeper who comes twice a week.

For the first time in his life, he has gone skiing — in Lesotho’s breathtaking mountains.

But it is the work that gives the job its meaning, the doctors say.

Lineo Thahane attended Princeton University and got her medical degree at Washington University in St Louis.

It was a 2003 rotation in Lesotho’s main public hospital during her residency — when children were still dying of Aids for lack of antiretroviral treatment — that made her want to return to Africa.

Her parents were both from Lesotho, but she was born and raised in the suburbs of Washington, DC.

Dr Thahane, 35, joined the first crop of Paediatric Aids Corps doctors in Lesotho, and now helps her mother, Dr Edith Mohapi, 64, who for 20 years managed paediatric outpatient services at Arlington Hospital in Virginia, to run Baylor’s paediatric HIV programmes in Lesotho.

“I felt, ‘This is where the need is,’ ” Dr Thahane said.

Over the past five years, the corps has had 50 to 60 doctors working in Lesotho, Swaziland, Malawi and Botswana.

The hospitals and clinics they supervise now care for more than 50 000 HIV positive children, Baylor estimates.

The project’s impact should also last beyond its financing, which ends in June.

The 128 doctors who served in the corps in the past five years trained about 3 000 African professionals, who will carry on.

And in July, Baylor will start another project with 32 paediatricians to work on a broader array of diseases.

Dr Grace Phiri, an overworked Malawian who has been the only paediatrician in Lesotho’s government service for most of the past 17 years, said the
arrival of 10 Aids Corps doctors in 2006 — just as Aids drugs
for children were becoming more widely available — drastically improved the survival chances of HIV positive children.

Until 2005, not a single child with Aids was on publicly financed antiretroviral therapy in Lesotho.

“Every morning, I had to check on who is alive and who is not alive,” she recalled. “So many passed away. Most of those dying were under the age of two. It went on for years. You see, in the ’90s we didn’t even have enough kits for HIV testing.”

Dr Phiri, who spent every weekend on call for years, said the help from the corps doctors on the ward had lightened her load and improved care.

She dreads their departure.

“They have shared the weekends and covered me when I’m on holiday,” she said. “I’ve learned a lot from them.”

More than 6 500 children in Lesotho, a country with a
population of about 1.8 million and the world’s third highest rate of HIV infection, now receive the lifesaving medications.

While that is progress, it is still only about a quarter of those in need of treatment, according to Unaids, the United Nations Aids agency.

Dr Mphu Ramatlapeng, Lesotho’s minister of health, said the country could not have reached as many children without the corps.

“These were serious professionals willing to dirty their hands,” she said.

Dr Young set off one recent morning for a village clinic he visits one day a month.

He drove into the lush green mountains, past men drapped in traditional blankets, through hamlets of mud huts crowned with conical thatched roofs, over crystalline streams flowing down from the peaks.

“They know me here in the mountains,” he said.

When he arrived at the clinic, families were already waiting on wooden benches to see him.

Relebohile Mosehle, 27, an energetic nursing assistant he has trained, sat at his side in a small examination room.

She lives at the clinic, which has neither running water nor electricity.

She and a Kenyan nurse are the backbone of medical care in this area.

Tsiu Lerotholi, 49, and his grandson Mojalefa, nine, had come that morning, having hiked through the mountains for another month’s supply of antiretroviral medicines.

Mojalefa’s parents had died of Aids — and he and his grandparents have the disease.

The man and the boy took their almost empty bottles of pills from their backpacks.

Dr Young and Mosehle quietly calculated, by how many were left, whether they were taking them properly.

The pair’s adherence was nearly perfect.

“Inside you feel stronger?” Dr Young asked the grandfather.

“Bit by bit,” he replied.

Mosehle said the soft-spoken American doctor treated her like an equal and had taught her much.

“He is a brother,” she said.

But she did not yet know that his three-year stint in Lesotho would end in June.

When told, she could not speak for some minutes, pressing her fingers to her eyes to hold back the tears.

“We knew that he would go back home,” she said, “but our hearts are not ready.”

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