Ben Solomon for The New York Times
HIV in the Mountain Kingdom
Nicholas Kristof and Jordan Schermerhorn recenty visited a clinic run by Partners in Health in the highlands of Lesotho. Jordan Schermerhorn, a recent graduate of Rice University, is the 2012 “Win A Trip” winner -- a contest featured in Nicholas Kristof's 'On the Ground' column in the New York Times. She is currently traveling with Nick through parts of southern Africa. In her first post, she writes about HIV treatment in Lesotho:
For my first trip outside of the United States, I felt amply prepared for new experiences traveling across southern Africa – for witnessing both the struggles of poverty and the optimism of burgeoning economic growth.
Then I saw the plane.
Suppressing nervousness, I scrambled into the tiny six-seat propeller plane that bore us on the first leg of our journey to a health clinic. It looked hardly bigger than a toy, and each of us was weighed before stepping inside so the pilot could calculate the amount of fuel necessary. The plane was to take us to the small village of Bobete, near the center of the southern African country of Lesotho. This country is aptly named the Mountain Kingdom: immense geographical barriers limit the construction of roads and airstrips used to reach patients in remote, rural villages, and our bird’s eye view provided some insight into the complexity of delivering health care in Lesotho. Health centers in the distant reaches of the country are often swarmed with patients, many of whom are unable to trek to the clinics in snow storms. Such weather also poses immense difficulties for planes attempting to drop off supplies: for instance, the clinic we visited was out of injectable contraceptives.
As we made our approach, buildings trimmed in bright red – characteristic, I later learned, of all health facilities in Lesotho – stood out sharply against grain-covered slopes. I was thrilled to spot solar panels on the periphery of the clinic. Along with a backup generator, this reliable power source allows the clinic to operate independently of regular blackouts that plague similar areas, keeping X-ray and ultrasound machines running for patients in need.
The Bobete clinic, an outpost tucked away in the mountains, is run by Partners in Health, the organization founded by Dr. Paul Farmer and best known for its work in Haiti. The clinic is used primarily to treat HIV patients in a catchment area of 30,000 people. In Lesotho, 23% of the adult population is HIV positive – most of them women of childbearing age – and treatment is undergoing a transformation. With a HIV diagnosis no longer considered an immediate death sentence, the stigma surrounding the disease here is vastly reduced.
One HIV-positive woman we spoke to said she was not scared when her test results first came back: she knew what HIV was, and that it was manageable with medication. After a few weeks of antiretrovirals, she felt well enough to head to the capital city of Maseru in search of a job – only to catch tuberculosis four months later. Though she was forced to retreat to the clinic that had first saved her life, she soon expects to be back in her healthiest state. Unfortunately, this cycle of concurrent infectious and chronic disease is not uncommon: HIV patients may catch tuberculosis time and time again.
It helps immensely that antiretroviral drugs are available for free here, but the question remains as to whether or not that will be sustainable as people with HIV live longer. Prevention is becoming increasingly important, and one of the most essential paths to eradication of the epidemic is the prevention of mother-to-child transmission. Pregnant women arriving at the Bobete clinic are HIV tested as a matter of course, and those who test positive are provided with a substantial support system to ensure their children are borne free of the virus.
We met another HIV-positive woman with a toddler whose squirming could not be suppressed even when strapped tightly to her back under a blanket. She had followed careful protocol while pregnant, diligently boiling water and cleaning bottles when opting to exclusively formula-feed her son. Though her mother had eight children, she says this one is quite enough for her; though she halted her education after two years of secondary school, she dreams of sending her son to university. This is the progress Lesotho can hope for in the next generation of the fight against HIV and AIDS: with effective prevention techniques, an educated population, and an expanding health system, all toddlers should be so lucky.
And, yes, the visit to the clinic was worth a bumpy flight in a tiny airplane. I even got to ride in the co-pilot’s seat on the way back for a free flying lesson.