In The News
Turning Monday into Tuesday in Kampala
October 2004: By Warner C. Greene, Director, Gladstone Institute of Virology and Immunology - The gentle touchdown of the night flight from London to Entebbe International Airport in Uganda proved to be the only "normal" thing about my trip to Kampala last October. Although I knew all about the HIV pandemic in sub-Saharan Africa and had treated many patients with this terrible disease, I confess that I was not prepared for the scope of the problem or the possibilities that exist there.
My wife and I had traveled from San Francisco to attend the dedication of the new Infectious Disease Institute (IDI) at Makerere University and for me to participate in the first Academic Alliance Foundation (AAF) board of directors meeting held in Africa. The AAF is a nonprofit organization dedicated to promoting AIDS care, prevention, and training in Africa, and its activities are centered at the IDI.
During the 30-minute trip by car from the airport into central Kampala, I was swept away by the natural beauty of Uganda. Although it was a Monday morning, very few cars were on the road, but the sides of the road were crowded with both adults and children walking briskly to work and school. Uganda is a country on the move. Although the average citizen earns only $240 per year, literacy rates are improving, there is increased access to clean water, and the economy and political structure are stabilizing. However, AIDS remains a serious threat. Life expectancy has dropped to 45 years because of HIV infection. We passed several vendors selling coffins-a burgeoning business in Uganda fueled by the huge numbers of people dying from AIDS.
I distinctly remember walking into the clinic at the IDI and seeing benches and hallways overflowing with patients, yet I hardly heard a sound. Why is the clinic so quiet, I asked. Because it is Monday and not Tuesday, I was told. On Tuesday and Thursday, the fortunate few patients on antiretroviral therapy come to the clinic. Patients not yet receiving antiviral medications are seen on Monday, Wednesday, and Friday.
In the cancer ward, the physician in charge presented the case of a young man with Kaposi's sarcoma, an AIDS-associated cancer, that had spread to his lower extremities. Because he did not have the money for chemotherapy, the treatment plan was simple: amputate both legs. Although common in the early days of the AIDS epidemic here in the United States and Europe, Kaposi's sarcoma virtually disappeared with the advent of effective antiretroviral therapy. The same will almost certainly occur in Africa, but the global effort to save this continent from the ravages of HIV comes too late for this young man.
When I returned to the clinic on Tuesday, the difference was striking. The laughter and chatter of mothers and their children filled the halls, emphasizing how the broad availability of antiretroviral therapy could quickly transform the lives of millions of Africans infected with HIV-replacing despair with hope and enabling people to begin living instead of dying. Antiviral drugs clearly work well in Africa. In fact, African patients take their medications more faithfully than patients in United States.
Of course, drugs are not the only need. Equally important are physicians, nurses, and others trained in the care of AIDS patients, as well as adequate facilities for their work. The training of African physicians is a primary mission of the Academic Alliance. Already, more than 300 physicians from 13 African countries have completed intensive AIDS care training at the IDI. This training component is essential to sustain efforts aimed at curbing and ultimately halting the AIDS pandemic that is sweeping through Africa. More than 25 million Africans are infected with HIV, and more than 12 million children have been orphaned by AIDS. My personal goal is to turn Monday into Tuesday for the more than 10,000 patients attending the IDI clinics.
Wednesday proved to be an uplifting day, full of hope for the future. The AAF board of directors met to continue refining and executing its plan to ensure sustainable funding of the IDI programs. Dr. Keith McAdam, the newly appointed director of the IDI, and Dr. Nelson Sewankambo, dean of Makerere University School of Medicine, joined in the discussions. This meeting was focused and productive; clear short- and long-term plans were established, and an action plan was put in place.
Later that day the dedication of the new IDI, built with monies generously donated by Pfizer, was hosted by His Excellency Yoweri Museveni, president of Uganda. President Museveni more than any other African leader has led the fight against AIDS. His efforts have met with success. The prevalence of HIV in this country has dropped from 15-20% to 4%. Countless lives have been saved, but too many are still dying. With the ribbon cut and the inspiring speeches delivered, it is now time to realize the full potential offered by this wonderful new Institute. This will require a dedicated effort by all involved.
I plan to visit Uganda annually to teach in the IDI's training program and to work in its clinic. I hope to base as many appropriate research projects as possible there as well. Along with the others on the AAF board, I am firmly committed to securing the IDI's future. As was brought home to me so dramatically during my trip to Uganda, the tragedy unfolding in sub-Saharan Africa is too broad in its scope and tragic in its consequences for us to do anything less.
