Jamie on HIV in Lesotho
Jamie sent a very interesting e-mail summing up his experiences this past year working in Lesotho as an HIV nurse.

Some good insights into the problem of HIV in Lesotho specifically, and HIV in Africa more generally, that I think some may be interested in.

Peace. Thoughts?



Hey Everyone,

Its been a few months since I sent out an update and after several of you have sent me emails asking for another one, I am happy to oblige. I have been talking a lot with a few of my friends here who similarly stopped sending their email updates after awhile, and we agreed that the reason is a feeling of truly not knowing what to say. Several times I have sat down to write out the events of the week, or another observation I have made but it always feels as I am leaving something out, or not entirely describing the situation in the way it deserves. So, with this email I will attempt to let you know where the project stands, but also some of the observations I have made about Lesotho.

As I approach a year here in Lesotho I am also starting to think about life in August when I leave. It is a difficult position to be in as I am trying to both live here with the people and yet simultaneously prepare myself for another posting or reintegrating into North America. The project has progressed since I last wrote, with almost 6000 patients now receiving HIV care and almost 2000 on ARV treatment. This is an incredible number for the government HIV program here and yet it is only a handful of the HIV infected population in Lesotho (approximately 500,000 confirmed). With that reality FINALLY being realized the government has posted local staff to the clinic which has allowed me to travel into the mountains to assess the situation at several of the small regional clinics. These clinics are typically staffed by one or two nurses and are responsible for total care of the mountain populations. One nurse clinician I am working with spends her day treating 100+ patients independently, the roof of the clinic literally falling in, a hole in her wall looking onto the driveway and her cleaning staff dispensing medications in the absence of a pharmacist. As always, I am blown away by African strength in the face of adversity and wonder how quickly the HIV situation could be managed if there were more of these incredibly selfless and dedicated locals available.

Winter has arrived in Lesotho in ferocious fashion. Most of you are just entering summer in your area and you can relish in the fact that I am freezing in Africa! I am in the highlands of the Maluti mountain range which runs through South Africa and Lesotho, this means snow. It hasn't snowed in Lesotho since the early nineties and even though my mornings are spent running from room to room turning on gas heaters I am blown away by the snow tipped mountains and change in culture that has come with the weather. The Basotho walk the streets of our town wrapped in their traditional blankets, they stand in circles on the street corners around drums of fire and the usual plethora of people walking on the sides of the road is now a trickle of the brave and freezing. I make light of the cold, but its effects on the people in the mountains has been severe. With paraffin heaters being used to heat most homes, those who can't afford it use animal dung for their fires. In the furthest regions, that dung is used as food in the late months of the winter so keeping warm is a very real concern for many of my patients. For those of you in the know, the World Food Program is officially broke, and with food and dietary restrictions imposed on even the refugee camps in Darfur, those who depended on food supplementation here are out of luck. With all these new challenges entering a typically harsh time of the year, it is a time of both wonderous physical beauty and a crash course in human preparedness.

The most difficult question posed to me over the last few months has come time and time again from both the Basotho and all of you. Will Lesotho be able to recover from this epidemic? Is there hope? I have thought a lot about it, and think that I have finally come to a conclusion. As I look at the people of Lesotho I see strength that I am not sure exists except in societies that face this type of struggle. I see the unshakable grandmothers, perhaps the only reason Africa is standing at all. I see the families coming for testing, the children being started on ARVs which gives them at least a chance to survive. I see the Basotho trying to lead their lives, trying to move forward into a future of uncertainty and fear with the hand of death striking hundreds of their community members each week. In them I see hope, but lately I can also see that they are growing tired. There is a chance for Lesotho to survive, and for the rest of AIDS ridden Africa, but this chance depends on a total shift in mentality, a shift in the way Africans view AIDS and a shift in the way the world approaches it. AIDS is here to stay. In reality we must abandon this mentality of eradicating HIV and begin to envision regions successfully LIVING with HIV. The treatments must be sought, and the assistance must be offered in a manner which recognizes the urgency. We are in community development mode, we are slowly changing the way countries approach HIV, slowly changing the way Africans understand this pandemic. But this process is premature and effectively useless. This is a genocide. This is a disease which is literally crippling nations and erasing cultures.

I am convinced that even though disease has always struck the poor, even though the world has gone through population shifts and pandemics, this is different. The conditions contributing to the HIV pandemic in sub-saharan Africa and the barriers preventing its remission are in part externally created. While African nations must be held accountable for their mismanagement of the problem we must recognize that the challenging economic, political and many cultural conditions in Africa are products of both old and new colonialism (both physical and economic), and a failure of the worlds powerful to take responsibility for an epidemic that they helped create and perpetuate. Lets be honest, a black life is not worth as much as a white life in this world. The sooner we face this horrible truth and the sooner we understand the desperation of the situation, the sooner we can begin to discuss hope in Africa.

Focusing strictly on community development during the Holocaust, the Rwanda genocide, and the civil wars of Latin America and Africa would not have been appropriate, and it is not appropriate in the face of the AIDS genocide. This is an emergency and needs to be approached as such. I am part of the machinery of incompetence myself. Yes I work at an HIV clinic, and yes we are prolonging life by providing ARVs, but this is not enough. Is it enough that there are five Canadians running the countries largest ART centre? Is it enough that only an estimated 13% of the countries infected have access to treatment? Is it enough that there are clinics staffed by one elderly woman caring for entire communities? Is it enough that we congratulate ourselves for providing ARVs that are 20 years old, which were only brought to Africa when the pharmaceutical giants determined the profit well was empty on the patents? I say no, I hope you all say no. It is not enough. I doubt that during genocide or civil war those involved close their doors at 5pm or spend their time having countless meetings to discuss future plans that will never be introduced. We (the west) are wasting time in this crisis and providing only insincere assistance to silence the critics. Not one nation has met their commitment to the HIV/AIDS, Tuberculosis and Malaria fund, and while those same nations discuss the millions of AIDS dead and bleak outlook they continue to do nothing. Is inaction in the possession of knowledge worse than ignorance? I believe it is. I hear our nations, I hear ourselves saying that if we had only known about the holocaust, only known how terrible it was in Rwanda or Sudan, that we would have acted. The truth is that we DID know, and we failed to act. That we DO know what's happening here and we are failing to act. Just as our current generations look on the past and criticize the perpetrators and complacent, future generations will look on ours as culpable non-actors in the annihilation of continents. I realize I sound angry, and I am. I work with these people everyday, and after being here for a year I am struck at how little progress is being made. HIV is treated as if it were any other epidemic, not as a threat to nations and entire peoples. The sooner we make this shift in mentality the sooner Africa can begin the process of recovery.

On a personal note, I finish my work here in two months and as I mentioned I am both looking forward to moving on, but also leaving this place knowing that I have created bonds here and seen things which have effected me to my core. It will be hard to leave many of them, hard to determine if I have truly left this place in a better position through my involvement. In early June I will be traveling to Mozambique for a quick vacation with my girlfriend Jean and best bud Greg. With Jean and I finishing our time here, and Greg with a year left it will be a great chance to spend some time outside this place gaining perspective. In August I have tons of travel planned. I am spending a week in Amsterdam, a quick trip to Paris for an interview with Medecins sans frontiers/Doctors without Borders and then a week in Scotland before heading back to Toronto. I think it will give me a chance to contemplate this experience in new and exciting places. So there it is…another update…if you have read this far I congratulate you. I can't wait to catch up with all of you soon, and hope everything in life is going well. Keep it real.

Peace.

Jamie