17455: (Craig) In the Vanguard Fighting AIDS, an Army of Haitian Villagers (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: Dan Craig <hoosier@att.net>


In the Vanguard Fighting AIDS, an Army of Haitian Villagers
November 29, 2003
NY Times
By CELIA W. DUGGER

CANGE, Haiti - In the cool mist of daybreak, hundreds of
villagers fanned out across the forsaken reaches of this
nation's remote interior, fording rivers swollen by
torrential rains, slogging through muddy cornfields and
clambering up slippery mountainsides to reach people
sickened by AIDS.

At each home, they handed out the little white pills that
have brought their neighbors, wasted by the disease, back
to robust life.

"If the medicines weren't here, I'd be dead," said Manesse
Gracia, 39, a mother of six who was plump in a workday
dress the color of orange sherbet. "My children would live
in destitution. My husband is a farmer, but the earth gives
back nothing."

Mrs. Gracia is part of a pioneering program run here by a
Boston-based nonprofit group, Partners in Health, that has
become an influential model in the frenetic race to expand
drug treatment in dozens of poor countries across Africa,
Asia and the Caribbean.

More than two decades into the pandemic, 22 million people
have died of AIDS, and 40 million people are infected with
H.I.V., the virus that causes AIDS. Millions will perish
next year unless they get the medicines.

"Bringing antiretroviral therapy to all who need it is the
most medically challenging task that the world has ever
taken on," said Dr. Richard Feachem, executive director of
the Geneva-based Global Fund to Fight AIDS, Tuberculosis
and Malaria.

The fund has approved $800 million for AIDS treatment, but
that is only enough to supply antiretroviral drugs to just
700,000 people in five years. The World Bank is increasing
support, and the United States Congress is close to
appropriating about $2 billion, more than half for
treatment.

No program to treat people in the poorest countries has
more intrigued experts than the one started in Haiti by
Partners in Health - which has succeeded by enlisting help
from hundreds among Haiti's vast pool of unemployed and
underemployed workers.

It is the rainy season now. So each morning and evening,
700 villagers strike out across dirt roads turned into a
morass of mud and dung to deliver medicines to people with
AIDS and tuberculosis. They tramp through muck and wade
through streams on foot; a lucky few sit atop mules or
donkeys.

Margareth Guerrier, wearing a jaunty, broad-brimmed hat,
set out on a recent morning from her small concrete house,
threading her way past squatters' shacks up a steep,
treacherously slick mountain.

At the top, she stopped at a small house and took the AIDS
medicines from a black case slung over her shoulder. A
9-year-old girl named Fanise, ready for school in a navy
dress, swallowed her pills dutifully as her grandmother
looked on.

Then Mrs. Guerrier walked on to deliver pills to another
grandmother, two mothers and a father. "There were some
among them who seemed more dead than alive," she said.
"When they start taking their medicines, they get better."

The AIDS treatment program here, one of the first of its
kind in the world, was started by Dr. Paul Farmer, an
American, and the group he founded, Partners in Health. It
began giving antiretroviral drugs to patients here in 1999,
when such efforts were virtually unknown.

"We didn't do it to be a model program," said Dr. Farmer,
44, a Harvard medical professor and anthropologist, who is
also the subject of a recent book, "Mountains Beyond
Mountains," by Tracy Kidder. "We did it because people were
croaking."

Adeline Mer?on, who tested positive for H.I.V. in 1991,
took a terrible turn for the worse in 1999. When Dr. Farmer
hiked through jagged hills to her home, he found her
bedridden and withered to about half her usual weight. Her
father drew him outside to the rickety stoop and showed him
the planks he had gathered to build her coffin.

Dr. Farmer promised to return with medicines to save her.
Back in Boston, he scavenged drugs from AIDS patients,
doctors and clinics. Partners in Health bought more with
money donated by Thomas J. White, a retired Boston
businessman, and raised yet more cash by selling its
headquarters in Cambridge.

"We couldn't get anyone to support us," Dr. Farmer said.
"In 1998, 1999 and 2000, we went to Unaids, the World
Health Organization and the World Bank and they said
treatment is not cost effective or sustainable. We went to
some of the drug companies and asked, `Can we have
medicines?' Every single one turned us down."

In the early days, Dr. Farmer carried the pills back to
Haiti in suitcases.

On Oct. 28, 1999, a shrunken Mrs. Mer?on, weighing only 69
pounds, was brought to the hospital here on a stretcher.
She was put on the drugs. "I haven't been sick since," said
Mrs. Mer?on, 37, who now weighs 120 pounds.

The Spartan model of care used by Partners in Health was
born of necessity, but its very spareness is now seen as a
virtue by many experts who want the scarce dollars for
treatment to stretch as far as possible. Doctors here
grafted AIDS treatment efforts onto the existing program
for tuberculosis control.

AIDS patients, who will have to take the drugs daily for
the rest of their lives, are visited in their homes every
morning and evening by a health worker who hands out pills
and watches as they are gulped down. Ensuring the medicines
are taken properly reduces the risk that drug resistant
strains of H.I.V. will emerge.

One of the biggest obstacles to rapid expansion of
treatment in poor countries is the extreme scarcity of
doctors, nurses and high-tech equipment. And the program
here has minimized reliance on them. Generally, there are
no lab tests done once treatment begins. The only monitor
is a scale to weigh patients monthly.

Peasants have been trained to dispense the medicines, draw
blood, take X-rays, clean bedpans, measure vital signs and
spread the word about condoms preventing H.I.V. infection.
Most of the workers who visit patients' homes are paid a
small stipend of $38 a month.

Last year, Partners in Health won a $13 million grant from
the Global Fund - money now being used to build clinics,
laboratories and drug warehouses, and to install generators
and satellite dishes in a region largely bereft of
electricity and phones.

While other countries can copy the Partners in Health
model, they cannot clone Dr. Farmer, a charismatic and
chatty healer, and the small, idealistic band of American
doctors he has brought to Haiti.

As Dr. Farmer, tall and whippet thin, drove through a
village one recent day, jouncing over boulders and
crevasses, a low murmur wafted in the window along with the
dust. "Paul, Paul, Paul," chanted the women peddling wares
at the roadside.

Dr. Farmer has been here since he was in his 20's. He lives
most of the year in Cange, a squatter settlement, and
regularly commutes about 35 miles - three hours over some
of the worst roads in the world - to reach the airport in
Port au Prince before flying on to Boston and his teaching
job at Harvard.

The example set by Dr. Farmer has helped inspire a similar
dedication in Haitian colleagues.

"When I was in my family planning residency, I heard about
this white doctor who visits sick people in their homes,"
said Dr. Roland Desiré. "I'm from a peasant family myself.
I came to see what he was doing." Dr. Farmer listened to
the young doctor, choking back tears.

He had made this recent visit to the group's clinic in
Lascahobas, where Dr. Desiré was at work, hobbling on
crutches. In August, Dr. Farmer broke his leg in a bad fall
while hiking uphill in a drenching rain to reach a patient.
Surgeons sawed his thigh bone in half and put in a titanium
plate to repair it.

With his slight build and boyish face, Dr. Desiré, 31,
looks more like a laid back high school student in his
jeans and T-shirt than a briskly efficient doctor.

Among those who had come from great distances to see him in
Lascahobas were two women - symbols of how far Haiti still
has to go and of how far it has come.

Imitane Pierre had brought her baby daughter Francesca from
Port au Prince. Both are H.I.V.-positive, and Francesca had
developed painful lesions on her face. Hospitals in the
capital had turned them away because the mother was too
poor to pay. After two weeks in the clinic in Lascahobas,
the bright-eyed girl had gotten better. But now she and her
mother had to return to Ms. Pierre's other children in Port
au Prince, where treatment programs are not yet
established.

"We send them home, but who will take care of them?" Dr.
Desiré asked. "There's no one."

Later that day, the doctor turned to Ipoline Occeus, 26. He
had to break the news that she was H.I.V.-positive but he
coupled it with hope, because she lives in the area served
by the clinic.

"You can die from it," she whispered.

In most developing countries, Dr. Desiré's diagnosis would
indeed have been a death sentence. But he replied with the
words that promised her life: We have the medicines. We can
treat you.

http://www.nytimes.com/2003/11/29/international/americas/30HAIT.html?ex=1071133874&ei=1&en=4c707c2efa87e436
Copyright 2003 The New York Times Company