Botswana sign of hope in AIDS battle

GABORONE, Botswana — Every morning before dawn, they begin lining up at the Princess Marina Hospital clinic, many having traveled for hours from remote villages.

By the time Dr. Ndwapi Ndwapi arrives, the green waiting room is jammed with bodies and fetid with illness, antiseptic, human breath and sweat, as overcrowded as a motor-vehicles office in the United States but eerily quiet and orderly.

By day’s end, another 250 AIDS patients will have been seen by Dr. Ndwapi or his two colleagues, had their blood sampled and their CD4 count and viral load re-determined, given another month’s prescription for life-saving antiretroviral (ARV) drugs and sent on their way. Many return to their one-room huts with thatched roofs and dirt floors, carrying another month’s supply of the world’s most sophisticated pharmaceutical technology.

“I go to a funeral every other week. It is either a friend or a relative. I don’t have a choice. I have to be here,” said Dr. Ndwapi after a long day in the clinic.

“Before we were doing this, we were doing nothing. … I hope, I believe what we are doing here is a model for all of Africa.”

Dr. Ndwapi, who spent 11 years in the United States studying at George Washington University and the Medical College of Pennsylvania Hospital, returned to Botswana to participate in his country’s full-scale assault on HIV/AIDS. He and his colleagues, several of whom also studied at George Washington, are passionate, obsessive and driven — working 12- to 14-hour days — by the need to do more, to test more people, to get more of them on ARV therapy and to teach more nurses in order to save their dying country and continent.

“Most of the patients I see, when they come in, are at death’s door with CD4 counts of less than 100,” he said, noting that 800 is considered healthy. CD is a measurement of the strength of a person’s immunity system.

“All of a sudden, they have three or four miracle pills, and they get better. They put on weight. This is a manageable disease. I ask myself everyday how we can get 100,000 people on therapy.”

In 2001, Botswanan President Festus Mogae, an Oxford-educated economist with experience in Washington at the International Monetary Fund, went before his parliament and announced that he planned to make life-saving ARV therapy available to every Batswana in need. The nation’s survival was at stake.

“I’m a development economist by training, with an emphasis on public health care,” the president said in his office.

“We were building rural clinics all over, we were fighting childhood diseases and attaining favorable vaccination rates. Maternal morbidity and infant mortality were declining and life expectancy was increasing to 65, 67 years,” he said.

“And then it began to stall … and everywhere we looked, we saw the impact of AIDS. It was killing our trained people — the nurses, teachers, engineers — the very people we need to fight this disease.”

The average life expectancy in Botswana now is about 45 years old and is expected to drop as low as 35.

And while the rest of Africa — where about 45 million people carry the human immunodeficiency virus (HIV) — dithered, Botswana got down to providing its developing-world population with the most sophisticated medical help on earth.

“President Mogae gets it. He understands the problem and what needs to be done,” said Dr. Dan Baxter of the University of Pennsylvania Medical School, who is in Botswana for two years to train local doctors and nurses in administering ARV therapy.

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