TCS Daily

It's the Infrastructure, Stupid

By Eric Bovim - December 3, 2003 12:00 AM

KIGALI, Rwanda -- What Tommy Thompson, the U.S. Secretary of Health and Human Services, and his delegation of scientists and industry leaders are learning here is helping to put the scope of Africa's HIV/AIDS crisis in perspective. There are no simple solutions. Much of the problem begins with something as basic as doctors.


In Zambia this morning, our delegation toured the Maramba Clinic. Hundreds of women and their babies gathered for a ceremony in which they received vitamin A supplements, known to build the immune system and eyesight. The ceremony took place next to a stand selling mosquito nets which are used to protect the poor in developing countries from mosquitoes carrying malaria and other diseases. Nurses in crisp white gowns gathered at the entrance.


The grim realities faced by clinic employees became apparent quickly. One nurse told me that the clinic, which employs 25 nurses, does not have a single full-time doctor on staff.


Congressman Dave Weldon (R-Fla.), who was a physician before reaching the House of Representatives, is visiting Africa with Secretary Thompson's delegation. He said that the doctors who visit the clinic in Zambia every two weeks treat up to 150 patients per day. "Back in the U.S., doctors treat on average 30 patients per day."


Near the malaria net display at the clinic was a pool of standing water the size of a basketball court, filled with mosquitoes. Across the street was a dingy concrete building housing public showers and toilets. Unemployment is 80 percent in Zambia. Our bus driver, who earns 50 dollars a month, tells me he cannot afford the 3 dollar mosquito net sold at the clinic.


No amount of charity -- and that includes President Bush's $15 billion plan and lower drug prices -- can make much of a difference until Africans are able to bolster a weak and underdeveloped healthcare infrastructure.


"The most important thing is to build the infrastructure," says Sec. Thompson, repeating a phrase that has become a mantra on this trip. "We don't have the doctors, we don't have the clerks, we don't have the nurses, we don't have the high school graduates" required to tackle the AIDS problem in Africa.


Stigma is another significant obstacle to Africa beginning to overcome its AIDS pandemic. Discrimination here for HIV patients is far worse than, say, what was ever depicted in the movie "Philadelphia." One newspaper here reported the story of a young man who was thrown out of his house and lost his job because he had AIDS. The South African government only recently fessed up to its AIDS epidemic.


Due of stigmatization of the disease, "we have not been able to get people in for testing," says Dr. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Disease. "They don't want to find out because its hurts their families and they lose their jobs."


Education and awareness about AIDS and about prevention and treatment options needs to take root firmly and spread into the broader culture here. More importantly, however, African countries need dynamic, growing economies and the resultant wealth creation to strike at the heart of their healthcare problems, HIV/AIDS included. One key obstacle hindering African economies are European and American agriculture subsidies. Some estimates suggest Africa could gain as much as $70 billion in annual income if it boosted its share of agriculture exports to wealthy western markets by one percentage point.


Elias Zerhouni, Director of the NIH, outlined in stark terms part of the problems facing Zambians and other Africans. Standing on the tarmac before boarding the bus for Rwanda, Zerhouni said, "[Zambia] has 80 percent unemployment. The market for its top export, copper, has collapsed."  Under those circumstances, he said, "Who can afford [anything]?"


Eric Bovim, former international correspondent for Reuters, is a contributing writer to TCS. He is traveling with HHS Secretary Tommy Thompson's AIDS fact-finding delegation in Africa.  See his first installment from Africa here.

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