17460: Feldman: NYT: Rural Haitians Are Vanguard in AIDS Battle (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: Janet  Feldman <kaippg@earthlink.net>


Dear Friends,
This article points to a ray of hope in the battle against a pandemic which has now killed 46 million people, with 14,000 people dying each day worldwide. Many of these could live a longer life with the proper medicines (not just ARVs specifically for HIV/AIDS but more basic meds like aspirin and anti-malarial drugs), and there are a number of efforts now being made to address that challenge--from the Clinton Foundation's recent moves to provide 2 million people with ARVs at half the lowest costs to date (from $300 to $140 per year, still a princely sum to many Haitians, Africans, and others in developing countries, where the total household income might only be $100-200) to the "3x5" WHO plan to get 3 million people on ARVs by 2005--but much more needs to be done. GFATM funding is at an all-time low (the contributions of governments not adequate to meet the need), though there are some miracles being worked by what is available.

In Kenya, money from the fund is being used for arts projects which emphasize HIV/AIDS education and prevention, and in Haiti, the Partners in Health project described below will bring invaluable assistance to people and communities struggling to cope with this disease. There are several arts projects, such as one at the L'Hopital Albert Schweitzer in Deschapelles, which are being used in conjunction with income-generation and general education projects to help youth address HIV/AIDS and other health matters, in addition to poverty, and with a country so rich in creativity, it is my own fond hope that this artistry will be used to improve life-conditions all around in Haiti, and in particular to improve HIV/AIDS prevention and amelioration efforts. If anyone is interested in working on a proposal we might submit to the GFATM--focusing on arts specifically--please do be in touch!

I will close by saying that one of the most heartening things to me in this article is the amazing courage, determination, and spirit of so-called "ordinary" people who are helping those in their communities to gain access to ARV medication, taking matters literally into their own hands, and doing what they can to address a situation which must seem so "hopeless" in some ways. On World AIDS Day 2003, this is indeed reason to celebrate, even as we mourn the losses and are angered by so much suffering, and gives one hope--on the eve of the Haitian Bicentennial as a Republic--that the spirit of liberation which produced the one will continue to inspire and influence this new struggle for life and for self-determination. I am much more confident that this will be so after reading this article, and my own work in this regard will be redoubled accordingly.  With many thanks and all best wishes,

Janet Feldman
KAIPPG/International
ActALIVE Arts Coalition
kaippg@earthlink.net
http://www.kaippg.org
http://www.actalive.org


New York Times
http://www.nytimes.com/2003/11/29/international/americas/30HAIT.html?hp

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Rural Haitians Are Vanguard in AIDS Battle
By CELIA W. DUGGER

Published: November 29, 2003

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 global race to expand drug treatment in dozens of
poor countries.

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 of it 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 Merçon, 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. Merçon, 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. Merçon, 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 that 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
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.