14175: Craig-NYT Article: A Haitian Doctor's Success in the Fight Against Disease (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: Dan Craig <dgcraig@att.net>

A Haitian Doctor's Success in the Fight Against Disease
December 22, 2002
By DAVID GONZALEZ

PORT-AU-PRINCE, Haiti - Hope is an elusive commodity here.
But Dr. Jean W. Pape has found enough of it to confront one
of the world's highest AIDS rates.

He has managed to slow the epidemic here, one of the worst
outside Africa, by nimbly adapting his medical techniques
to the country's political upheaval, withering poverty and
crumbling infrastructure.

Dr. Pape has been so successful, in fact, that the world is
now recognizing the work he and others have done by making
Haiti the first country in the Western Hemisphere to
receive a grant from the new, United Nations-initiated
Global Fund to Fight AIDS, Tuberculosis and Malaria.

In awarding Haiti $25 million, international officials
called the treatments and methods devised at the Gheskio
Centers, which Dr. Pape directs, and other clinics a model
for how poor countries with few resources can combat AIDS,
and the tuberculosis and diarrhea that often attack people
with the disease.

"Haiti's work has shown conclusively that you cannot use a
lack of infrastructure as an excuse not to treat patients,"
said Anil Soni, adviser to the fund's executive director.
"We want to show you can adapt what is being done in poor
settings to stabilize patients. That is a lesson for the
world."

The award carries a double distinction, since it is going
to a network of clinics like Gheskio in a consortium that
includes the Haitian government itself.

Although direct foreign aid to the government has been
frozen because of a political deadlock, the award is seen
as a much-needed injection of money at a time when
government-run clinics have decayed.

The funds will increase treatment and prevention in a
country where more than 250,000 people are infected by the
virus, out of a population of about seven million. Last
year, AIDS claimed 30,000 lives.

"We are using this project to say you can't do such a
program by ignoring public facilities," Dr. Pape said. "We
still have the greatest presence of H.I.V. outside of
Africa. What is important is we have been able to control
this epidemic in a place that people usually talk about as
being in chaos."

Gheskio has had impressive results fighting severe diarrhea
with antibiotics, has developed methods of diagnosing
sexually transmitted diseases and has found some less
expensive drug combinations to treat AIDS.

It and other private groups use funds provided by
foundations and foreign governments to buy the medicines,
which are priced far beyond the reach of most Haitians. The
Global Fund grant will provide medication for about 1,200
more people.

The United Nations Development Program and the Sogebank
Foundation, the philanthropic branch of Haiti's leading
bank, will manage the funds, which are expected to arrive
this month and to be used over a two-year period.

Mr. Soni said the arrangement aimed to maximize efficiency
and nurture cooperation between the public and private
sectors. If it works, the fund could eventually provide
Haiti as much as $67 million over five years, he said.

Haiti's Health Ministry will receive about $1 million to
help develop its planning ability and to coordinate the
various projects.

"AIDS is not a political problem," said Dr. Henri Claude
Voltaire, the minister of health. "It is a public health
problem that affects all of society. The vision is clear,
we need a strategy that includes everyone."

Mr. Soni said the government had shown its willingness to
work with other sectors of the often-fractious society as
it convened a series of meetings to discuss how to fight
AIDS. The chairwoman is Mildred Aristide, wife of President
Jean-Bertrand Aristide.

"The money is going to be used mostly by nongovernmental
organizations not despite the government, but because of
the government, which sat down with them to submit the
proposal," Mr. Soni said. "We did not get an application
saying, `Give us a lot of money and we'll do what we want.'
We got an application that said, `Give the money to
organizations that will make the best use of it and keep us
accountable.' "

Although the country faces a host of problems with water
and electricity as well as public health and poverty, a
number of clinics have managed to flourish.

Paul Farmer, a founder of Partners in Health, which runs a
clinic in the Central Plateau town of Cange, said that
although the vast majority of Haiti's AIDS patients live in
areas where advanced laboratory tests are unavailable,
doctors have relied on simpler blood tests and detailed
medical histories to determine who is most in need of
medication.

His group, which will receive part of the grant, sends
health educators to villages to visit patients and help
them to stick to their medical regimen. It has also
sponsored educational programs, including video
presentations and informal public talks, to increase
awareness of the disease and how to avoid it.

Dr. Pape's group now plans to train staff from government
clinics as part of his project's activities financed by the
Fund. He is confidant that with enough resources, the
country can hold the line on the disease until a vaccine is
discovered.

And maybe, they can teach the politicians something, said
Rene Max Auguste, a businessman with a foundation that
helps Dr. Pape.

"The Global Fund process was easier then the political
process," Mr. Auguste said. "It showed us we can work
together. What is the other choice?"

http://www.nytimes.com/2002/12/22/international/americas/22HAIT.html?ex=1041566772&ei=1&en=001870a031137adf
Copyright 2002 The New York Times Company