Behind the Headlines...
First Hand Account: Africa's Deadly AIDS Crisis

by Cecil Maranville

Because of the shockingly candid details related below, the author, a physician, has asked that we delete any comments that might reveal his identity. Warning: This account is sobering and distressing.

Sub-Saharan Africa, early 2001—"The main reason I can't wait to get out of here is that my personality is suddenly altering. They say it's called 'becoming a doctor.'[Here] that means your main emotion when a patient dies is relief.

"The AIDS [epidemic] is becoming alarming. Most of our beds are filled with HIVpositive patients. They talk about the 'package deal'down in the emergency department. An extremely skinny patient comes in, coughing, complaining of tiredness. On examination, they have oral thrush, often so bad that even their lips are covered with a white fungus as it climbs out of their mouths. And immediately you know that they have HIV, TB [tuberculosis] and oral candidiasis [a fungal infection].

"We go through the motions of testing them, but I don't know why. We admit them, rehydrate them, and all that we succeed in doing is prolonging their death by a week or two. We are now at the point where we refuse to give them any active treatment (antibiotics, antifungals, even blood), which includes resuscitation. It's quite simple—even with active treatment, the only difference you make is a few weeks. (They always wait until they are terminal before arriving at the hospital.) So why waste money you don't have to begin with?

"The other day I caught myself saying out loud that we should start refusing to admit HIV-positive patients, since we're only prolonging the inevitable. We're turning away patients with asthma and diabetes, patients with controllable diseases who could contribute to the economy, because AIDS patients are taking up all the beds.

Playing God

"And then it hit me: I'm playing God. If we start doing that, we might as well start denying medical care to old people and premature babies, because they no longer contribute to society. We might as well start turning away patients with other terminal illnesses, like cancer and multiple sclerosis, because we're only prolonging the inevitable.

"You have no idea what kind of hell it is to do ward rounds in [this city] in the morning. You walk through rooms of skeletons, their chests rattling with each cough . . . Many of the patients lie in beds [soaked with] their own urine . . . Their lips are caked with white fungus, their faces mottled with blood-flecked sputum. They watch you from their beds, their eyes often the only body parts they can still move. Some of them still beg with their eyes for help . . .

"Some are beyond caring. Their eyes are already dead, which is why you check each patient's pulse before discussing them. We use pseudonyms like 'retrovirus'or 'high five'for HIV and 'Koch's bacillus'for TB in an effort to maintain privacy. But they all know the telltale wailing following the post-test 'You have HIV'speech.

Haunting experience

"Not all of the deaths here go unnoticed. One of my patients will always haunt me. As I mentioned, most of the AIDS patients have pretty typical appearances (skinny and coughing).

"Some (especially the children) never reach that stage. This particular young girl (19 years old) didn't fit the typical profile at all. She was educated, eloquent and still looked very healthy. She had known she was HIV-positive for three years prior to her admission. (Her boyfriend had told her that he was monogamous, and so he was. Unfortunately, his previous girlfriend had not been.) She came after she suddenly started battling to breathe, rather like a severe asthma attack. In well-fed HIVpositive patients in Africa, this normally is due to pneumocystis pneumonia. This was the diagnosis in her case.

"If we could pull her through the pneumocystis pneumonia, she could still have a few good years left. So we put her on oxygen, nebulizations and antibiotics. For two days I had to walk into the ward and watch her struggling to breathe. For two days she couldn't sleep for fear of forgetting to breathe. The [nurses] were unfortunately 'forgetting' to give the full dose of antibiotics. On the morning of the third day, she looked worse than even when I arrived. I can't describe the feeling of powerlessness when you realize that you can't give anything to 'make it go away.'The only option left to us was to give her small doses of opioids to make the struggling for each breath at least seem less painful.

"When we came round later in the day with the consultant, the patient had finally fallen asleep. He was impressed by her improvement and decided to forgo the opioids. As we moved on to the next patient, I suddenly knew that I would never see her alive again. She died that night.

But for the grace of God

"Most of all, you wander between the patients and know that, but for the grace of God and a single needle-stick wound, that could be you.

"I'm beginning to hate medicine [here].

"Diagnostically it's no challenge, because they all have HIV. Therapeutically it's no challenge, because we do nothing. Emotionally it takes you to places where you simply don't care about life anymore. And still we work . . . [with] the constant danger that the next time you draw blood or put up a drip you could get HIV.

"And the state doesn't . . . [care]. They no longer even provide us with free anti-HIV drugs (AZT, etc.) following a needle-stick injury . . . We can't afford that.

"And . . . they wonder why we're leaving the country.

"I hope [these letters get] people thinking twice, whether it's about unsafe sex or an awareness of human fragility" (end of letters; emphasis added throughout).

No easy way to say it

There's no easy way to describe the desperate situation that grips Africa. While this eyewitness account does not describe all hospitals there, it does point out that the epidemic is made all the more disastrous because of i0nadequate infrastructure.

A recent report from one African government revealed that one in every nine of its citizens and nearly 25 percent of pregnant women are HIV-positive. The same report forewarned that, by 2016, the country's population would begin to shrink, because the number of deaths due to HIV will surpass the number of births. (Regrettably, this country is not alone. In several others overall infection rates are even higher.)

A single faint glimmer of hope appeared in statistics that show a marginal decline in HIV infection rates in regions where there have been sex-education campaigns—no easy task, given centuries-old taboos and traditions.

Promiscuity is the major reason, but not the only one, for the rapid spread of AIDS on the African continent and in other countries around the world. Many diseases that have been largely controlled in the West by advanced medicine are rampant in Africa and other regions. They include malaria, syphilis, gonorrhea, tuberculosis and pneumonia. Such diseases weaken the immune system and apparently ease transmission of the AIDS virus. Diseases that involve open sores and exposure to bodily fluids also boost the proliferation of AIDS.

In December 2000 the United Nations announced its estimate on the African-AIDS condition. It said 24.5 million people in the sub-Saharan region are HIV positive. Contrast that with the total figure worldwide of 36 million infected. Seven out of every 10 cases in the world are in the sub-Saharan countries of this plague-stricken continent.

A race to develop an AIDS vaccine is underway in the international medical community. Billionaire philanthropist Bill Gates has personally donated $100 million to the research, challenging other wealthy people to contribute generously as well. Mr. Gates' Microsoft Corp. has raised nearly a quarter of a billion dollars for the project so far.

AIDS drugs are notoriously expensive, out of reach for the average African government or private citizen. However, cheaper, generic versions of the patented drugs are available.

No effective anti-AIDS drug has been developed. Even if it were, and could be made available in generic form to the afflicted African nations, could AIDS be stopped?

Between the dead and the dying

Numbers 16:4-48 tells of a plague that struck Israel when Moses and his brother, Aaron, governed it. At Moses'urging, Aaron literally ran between the dead and the dying with the means to stay the plague.

African governments do not work as efficiently.

Michael Ledeen, who spent many years in sub-Saharan Africa and has seen AIDS firsthand, wrote in his March 27 column— titled "Fighting AIDS Is a Losing Proposition"—that distributing medicine through African governments would never work.

"There is no infrastructure capable of delivering medicine to those who need it, nor to ensure that patients take the full course of treatment."

Unless the West virtually creates and imposes the missing infrastructure, Mr. Ledeen continues, "no matter how generously we donate medicine to Africa, a huge bloc of Africans will never receive it . . ."

Many African leaders, he warns, would enrich themselves by selling cheap medications at a markup. Further, they would probably use medicine as a political weapon. Those who ally themselves with the leaders would receive medication while those who did not would be frozen out of any supplies. Witness that type of political manipulation in the distribution of food relief in famine-stricken African countries.

"Is it hopeless, then?" Mr. Ledeen asks. His answer: "Most likely, it is, at least in the sense of 'solving the problem.'"

Hope for the hopeless

We hope that Mr. Ledeen is wrong and that ways will be found to bring relief to the millions suffering from this dread disease. However, our hope doesn't rest in man's capabilities.

The example of Aaron mentioned above is, in some ways, a forerunner of the coming Jesus Christ, who will be forced to intervene in a devastated, sin-sick world to prevent the extinction of human life. As He warns us in Matthew 24:22: "If that time of troubles were not cut short, no living thing could survive; but for the sake of God's chosen it will be cut short" (Revised English Bible).

As Aaron interposed Himself between the dead and the dying, Jesus the Messiah will intervene at His return to bring healing to the nations (Isaiah 35:5-6; Luke 4:17-21).

Clearly, our world desperately needs two kinds of healing—an immediate intervention to restore physical health and soundness to the millions who suffer and a spiritual healing of the character of individuals and their governments that have brought on the dark days in which we live.

Therein lies the hope of Africa. God speed the dawning of that day of healing. GN