The President of the US is talk and bluster and since he is a lawyer he little interest in science and/or art but is interested only in the monetary aspects of healthcare and not how to treat and/or improve the lives of human beings.
ISIS has been spotted in South Africa as plain old multidrug resistant TB has overcome the limitations of TB aerosols from the old days eg. it could be cured and did not kill reliablly
VERENA,
South Africa — A fading roadside ad for Selala Funeral Service here
captures what was, until recently, the essence of South Africa’s AIDS epidemic: “Tombstones Are Available,” it reads. “Buy One, Get One Free.”
Not long ago, even places like Verena, a blip on the roadside northeast of Pretoria, supported several funeral parlors.
But
in the last few years, “we’ve managed a miracle,” said Dr. Salim Abdool
Karim, one of the country’s leading AIDS researchers. “Undertaking is
not a business you want to go into anymore.”
As
recently as 2008, the AIDS epidemic in South Africa was out of control,
hampered by the indifference of President Thabo Mbeki, Nelson Mandela’s
successor. Death was everywhere.
Now
the country has won high praise from world AIDS experts for its
response, especially at a time when the Ebola virus has spread in West
Africa.
South
Africa has 2.4 million people on antiretroviral drugs, far more than
any other country, and adds 100,000 each month. Five years ago, 490
clinics gave out those drugs; now 3,540 do. Only 250 nurses were trained
to prescribe them then; now 23,000 are. (The figures, from the end of
2013, are the most recent available.)
Mother-to-child
transmissions have dropped by 90 percent, new infections have dropped
by a third, and life expectancy has increased by almost 10 years.
“South Africa takes this very seriously and has made major, major progress,” said Michel Sidibé, the executive director of Unaids, the United Nations agency fighting the disease.
But experts say much of that progress is now in jeopardy.
Though
few Americans or even South Africans realize it, the nation owes much
of its success to a single United States program, the President’s Emergency Plan for AIDS Relief,
or Pepfar, started in 2003 under President George W. Bush. It has
poured more than $3 billion into South Africa, largely for training
doctors, building clinics and laboratories, and buying drugs.
Now
that aid pipeline is drying up as the program shifts its limited budget
to poorer countries, so the South African government must find hundreds
of millions of dollars, even as its national caseload grows rapidly.
The
country has six million infected and 370,000 new infections a year.
That is seven times as many new infections as in the United States,
which has six times the population. Condom use is dropping, according to a new survey, and teenage girls are becoming infected at alarming rates.
Still,
Dr. Aaron Motsoaledi, the national health minister, says he is
confident South Africa will find the money and the political will to
fight on.
“It’s
a logistical problem,” he said. “Any country in the world would be
shaken by putting 2.4 million people on treatment quickly. But it’s not
as if we have any choice. If we don’t, they fill up the hospital beds
and I.C.U.’s. It’s becoming easier for Treasury to give me what I ask.”
Clandestine Philanthropy
Dr. Ian Sanne’s “Right to Care” chain of clinics, which treats 203,000 patients in five provinces, is an example of the fruits of American largess.
In
a country where public hospitals use hand-scribbled paper records and
are infamous for long waits, Right to Care’s Johannesburg headquarters
has an electronic medical records system so fast that a nurse can read a
tuberculosis test result delivered by a $17,000 GeneXpert machine and
click a box that types a prescription directly into the patient’s
record. Within 17 seconds, a German-made robotic arm in the clinic’s
pharmacy can pluck that drug from the shelf, print a label, and drop it
down a chute to be handed to the patient.
“We opened in 2004, with 100 percent Pepfar money,” Dr. Sanne said.
Right
to Care, like many other AIDS treatment programs here, owes its
existence to a decision that year by Pepfar to help South Africa
quietly, almost clandestinely, while the Mbeki administration was still
in power.
In poor countries with broken health care systems, Pepfar paid American medical schools to run its programs. South Africa, by contrast, had excellent doctors and hospitals, but Mr. Mbeki’s health minister, who claimed garlic, beetroot and lemons could cure AIDS, forbade public hospitals to give out AIDS drugs.
Mr. Mbeki was finally ousted in an internal African National Congress power struggle in 2008; by that time, Harvard researchers calculated, his policies had cost 365,000 lives.
In the interim, Pepfar had supported private practitioners like Dr. Sanne, Dr. Hugo Tempelman of the Ndlovu Care Group and Dr. Helen Rees of the Wits Reproductive Health Institute in Johannesburg.
“It
was a gracious, unpretentious and right thing to do,” said Justice
Edwin Cameron, a judge on the country’s highest court who began taking
AIDS drugs back when they cost him a third of his salary. “You empowered
us and let us get on with it.”
Because
South Africans are sensitive about needing any foreign help, the aid is
still given with little fanfare. Many clinics have only one sign of
their roots: a modest brass plaque with Pepfar’s globe-and-red-ribbon
logo.
“I’ve
had visiting congressional delegations upset that America gets no
recognition for saving lives while China gets visibility for building an
airport in Mozambique,” Dr. Rees said.
The
country received $350 million from Pepfar last year, according to Dr.
Eric Goosby, who ran the program until last November. That figure will
shrink to $250 million by 2016.
“We need to move on to places like Burundi and Cameroon,” Dr. Goosby said.
While
very poor countries rely almost entirely on donors, South Africa now
pays 83 percent of its own costs. But it struggles to do so. Patients
overwhelm understaffed public clinics. And as evidence mounts that it is
best to put patients on drugs as soon as they test positive rather than
waiting until their immune systems falter, the national caseload will
triple.
Dr.
Sanne complained bitterly about cutbacks, Dr. Goosby said, and got
“bridge money” to prevent layoffs from his well-trained staff.
“Our stay of execution,” Dr. Sanne said, laughing.
‘Corruption and Pilferage’
Closing
private clinics can have dangerous consequences. When one Durban
hospital abruptly went bankrupt after its Pepfar grant expired, its
4,000 H.I.V. patients were told to report to public clinics near their
homes — places that many H.I.V. patients avoid for fear of being spotted
and shunned by their neighbors.
A Harvard-sponsored survey found that nearly 20 percent of those 4,000 patients did not renew their prescriptions at their local clinics.
In
theory, because Pepfar pays for the care of about a million South
African patients, a similar dropout rate nationally would mean that
200,000 patients were not in care and were at risk of developing
drug-resistant strains, said Matthew M. Kavanagh, the author of a study of South Africa for Health GAP, an American medical advocacy group.
Dr.
Motsoaledi, South Africa’s health minister since 2009, has won high
praise from AIDS experts and even from advocacy groups that are often at
odds with him.
Asked
if there was any chance that the United States, having received little
credit for helping from 2004 on, would now be vilified for pulling out,
he said: “No, I personally will never allow that. Because this would
never have happened without America.”
Michel Sidibe
A video interview with the executive
director of U.N.AIDS on the importance of diplomacy and social change in
fighting the AIDS epidemic.
Video Credit By Thomas Lin and Tony Cenicola on
Publish Date February 20, 2012.
Image CreditTony Cenicola/The New York Times
How well the country can do on its own remains to be seen. It has world-class doctors; the first heart transplant
was done in Cape Town in 1967. But public hospitals and the drug supply
chain are overseen by local governments, where corruption and
incompetence are common.
The country was recently scandalized by the death of “Baby Ikho,” a chubby 1-year-old who was hospitalized with simple pneumonia but died slowly because the hospital administrator ordered oxygen only after it ran out.
The doctor who reported the death, blaming the administrator, was fired for doing so.
Last year, Section 27,
a health advocacy group, surveyed the country’s pharmacies and found
that 20 percent had sometimes run out of drugs for AIDS or tuberculosis.
Mark
Heywood, Section 27’s executive director, said the problem was theft
from government warehouses by local officials. Some of those officials
stayed in office even while facing criminal charges because they
supported President Jacob Zuma’s wing of the deeply factionalized
A.N.C., he said.
Dr.
Motsoaledi agreed that those warehouses were sites of “corruption and
pilferage” and said that he was making hospitals order directly from
manufacturers or from one national warehouse. Corrupt officials would
not be protected by connections, even to the president, he said.
“My hands are not tied by any faction,” he said. “We will destroy them.”
His
greater worry, he said, was that forces outside the country would push
up the prices of newer AIDS drugs by preventing the import of generic
versions. Some South Africans still receive older drugs no longer
prescribed in wealthier countries.
In January, Doctors Without Borders released documents it obtained outlining a secret campaign
planned by a Washington lobbying firm hired by the pharmaceutical
industry. It proposed forming a fake grass-roots organization called
“Forward South Africa” advocating stronger patent laws against generics.
Dr. Motsoaledi publicly denounced the plan as “satanic” and “genocidal,” and the pharmaceutical lobby dropped it after some of its members quit in protest.
Dr. Motsoaledi said he was confident that he would eventually be able to pry enough money out of government to treat everyone.
“If we don’t,” he said, “we make TB worse, cervical cancer goes up, even leprosy
returns. From whatever angle you look at, it’s cheaper to treat people
early. The treasury minister understands that. It’s becoming easy for
him to agree.”
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