TCS Daily

Out of Poverty

By Eric Bovim - December 9, 2003 12:00 AM

KAMPALA, Uganda -- Far away from the capital, the Ugandan bush is a cemetery of unfinished homes, a solemn monument to the devastation AIDS has wreaked on the world's poorest continent.


These roofless brick structures, overgrown with grass and weeds, are the fitting symbol of the problem our delegation has sought to solve in Africa this week: how to fight a virus inextricably linked to economic ruin.


Poverty and AIDS were on full display everywhere that Health and Human Services Secretary Tommy Thompson went on this tour of Africa, which included a cadre of scientists, doctors, diplomats and politicians -- including the heads of the NIH, World Health Organization, The Global Fund and CDC and President Bush's newly appointed "AIDS Czar" Randall Tobias.


The trip yielded a plenitude of opinions on how to stem and solve the African AIDS pandemic. But, beyond the usual themes of condom use, abstinence, sexual fidelity, drug access and more doctors and nurses, Africa's inimitable poverty looms as the prime culprit.


Until you experience true, African poverty you cannot comprehend the obstacles it poses to HIV prevention and treatment. Many here claimed all week that poverty perpetuates the virus, and a three-hour drive from Kampala into the villages showed vividly how poverty leads to disease.


As our truck took 45 minutes to travel a mere 7 kilometers, from the wayward outpost of Tororo into the wilderness, it was like going back in time. "Out here this is the economy of the 18th century," said Elias Zerhouni, director of the NIH. Out here, there is no plumbing, no electricity, no real roads, no media, none of the elements that constitute society -- even as it's known in Kampala.


Our group, which included Zerhouni and Global Fund Executive Director Richard Feachum, penetrated deep within the bush to visit a homestead where a mother afflicted with HIV was receiving her weekly supply of anti-retrovirals by moped.


Africa's urban poverty that became familiar to us over the course of the week was now replaced by agrarian poverty. The family lived in mud huts with thatch roofs. Chickens roamed in and out of buildings; floors were made out of compacted cow dung, a breeding ground for tuberculosis. They drank rainwater collected from the roofs. Their bathroom was a patch of grass and a tree trunk, enclosed by walls of sticks. The toenails of two brothers I met were rotting away. Outside one of the homes, a baby duck, all yellow fur and the size of a child's palm, was dying in the shade.


Our group was invited inside one of these tiny huts. The mother slept on the bed and her four children slept on mats on the floor. Farm tools hung from the wall, and she kept her HIV medicines in a tin box beside the bed.


African poverty is not homogenous in a way that American poverty is: It features unique extremes. In Zambia, buildings were made of modern materials, whereas throughout Rwanda, everything seemed constructed from soil and wood. Downtown Kampala had a Mercedes Benz dealership and a smattering of decent Indian and Italian restaurants. Kigali, the Rwandan capital, was simply a sprawl of slums and shacks, the barefoot masses roaming the lush terraced terrain that could have substituted for Maui or Ireland.


Rwanda, only nine years removed from a genocide of 1 million people slaughtered by machetes and farm tools, was the worst place we visited. "My wife hates our house," one senior U.S. embassy official told me, who has done several tours of Africa and says this country is one of the 10 poorest in the world.


Three former butcher shops strung together constitute the American embassy in Rwanda. Police have shut down the road in front to form a security barrier, but now, he said, the local authorities want it back.


Information was scarce. I asked a group of 50 villagers gathered at the clinic to welcome Thompson to Tororo. They did not know, nor could any of them say, who was President of the United States.


As we traveled deep into rural Rwanda, it became clear that much of African civilization has yet to "tame" nature. Absent the infrastructure of telecommunications, electricity, clean water and paved roads, villages are mired in nature, and, therefore, subject to its disasters and diseases.


Africa's HIV/AIDS crisis, which afflicts 30 million on the continent (75 percent of the world total), is born out of this kind of poverty, though the West has been fixated on treating the symptom rather than the cause of the pandemic.


In Uganda, that theme has been delivered repeatedly to Western media by President Yoweri Museveni, who argued in a recent Wall Street Journal op-ed that tearing down trade barriers to African agricultural exports is the surest way to lift the country out of mind-blowing poverty.


Surely, these countries are grateful for and should be receiving our financial assistance to build hospitals, train doctors and deliver drugs. President Bush's $15 billion emergency AIDS plan comes just in time.


"What we see here is a model that seems to be working," said Feachum about the CDC-funded project of moped-delivered HIV/AIDS drugs. "We need to scale this up throughout Africa."


That's true, but it's important not to miss the bigger picture. It is fine to supply enough mopeds to deliver drugs directly to the dying, but this is an unsustainable plan -- it doesn't get people out of huts and into homes. Who is going to continually fund these vast projects? What happens when the aid runs out?


Foreign aid into Africa is big business for African leaders, employing thousands, constructing countless clinics and orphanages. Economic dynamism can improve the health in these countries, though it is a daunting question where and how to begin the rebuilding process in Africa. The President's $15 billion plan is praiseworthy and necessary, but visionary leaders in the U.S. and beyond should start asking: What comes next?


Editor's note: James K. Glassman and Eric Bovim of TechCentralStation are traveling with the Thompson delegation in Cameroon, Zambia, Rwanda, Kenya and Uganda.


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