By FRANKIE EDOZIEN

October 28, 2008

Kampala, UGANDA

In the 1980s, when the disease dubbed ‘slim’ was first spotted in villages on the shores of Lake Victoria, it seemed a stretch that Uganda would one day get her hands around the pandemic that would go on to decimate much of Africa.

And yet for millions of Africans, a beacon of hope has emerged here. In large part, due to the work emanating from a clinic nestled in the hills of this dusty, traffic-choked metropolis.More than 25 million African lives have been lost to AIDS but since its doors opened in 2004, the Infectious Diseases Institute (IDI) has been on the forefront of the continent’s AIDS war.
Founded by academics, the multi-million dollar facility was built to provide, research and first-world patient care.  The Global Fund, and the President’s Emergency Plan for AIDS Relief (PEPFAR) are primary funders of its programs.
After being pulled back from the brink of death, many IDI patients are regaining their foothold in society.
“People are well. They are going back to work, they are looking for spouses if they’ve lost their loved ones and they are looking to live life again,” said Andrew Kambugu, head of clinical services at IDI, where operating costs are about $2 million annually.
African doctors are flocking here for training to help them replicate Uganda’s success, and Western doctors keep coming.
“It’s like Piccadilly Circus! Everybody comes to Uganda and everybody comes to IDI,” said Phillipa Easterbrook, who left London’s Kings College run IDI’s research department.
But just a few yards from the ultra-modern IDI with its controlled temperatures, freshly scrubbed floors, and myriad water coolers, sits the famed Mulago Hospital.

Mulago Hospital

The gargantuan Mulago, is Uganda’s premier teaching hospital. Whatever puzzles doctors, they send to Mulago.
Moviegoers might recognize its blue and white walls and lush grounds, since many scenes from The Last King of Scotland were shot there.  From the outside, it seems serene and tranquil like a quintessential place to heal.
But once inside, it turns tragic.
Especially in ward 4-A, the infectious disease ward that feels like a morgue-in-waiting. Patients, who happen to the poorest of the poor, once admitted, rarely make it.
There are hardly any facilities and what’s there, is threadbare. The few ripped, paper-thin mattresses, that seem to be four decades old, propped on aging rusty metal beds aren’t available for all.  There aren’t any sheets or even pillows and so some make do with the concrete floor.
Oxygen tanks, sit there not functioning. Drip stands? There are a few that are barely working.
There aren’t drapes on the windows, so birds routinely fly in. And the walls appear not to have been repainted since 1962 when the hospital opened by the Duchess of Kent with working faucets and proper lighting.
On any given night, one single nurse has to take care of some 50 to 80 patients, whose families simply resort to prayer.  When young expatriates come to IDI, and then volunteer at Mulago with AIDS and tuberculosis patients, that grim reality knocks them for a loop.
And some decided ‘enough was enough.’

Dr Shevin Jacob

“We just decided we weren’t going to take it anymore,” said Shevin Jacob, 32, from Chicago. He and other colleagues  asked IDI’s director, Alex Coutinho to visit the nearby ward.  Coutinho did and left his plush office into to see what had become of 4-A.

Over the years many Uganda physicians have trained at the infectious disease ward but hardly get to return and so the thinking among some is that few know how bad it has deteoriated.

“He probably hadn’t been here since his student days,” Jacob added.

Despite millions in donor funding for miracle drugs, Uganda’s entire health care system is challenged.  Mulago is mandated to give care at low cost and the 800-bed facility routinely faces 1,000-plus patients who need admission daily.
“Patients deserve their dignity, regardless of income,” said Mohammed Lamorde, a physician/researcher, who left Nigeria to settle in Kampala because of IDI.
Yet many doctors cannot reconcile the flush facilities of the Infectious Disease Institute and the decrepit infectious disease ward at Mulago.
Even though dusty dirt roads lead up to the IDI campus, its labs are only one of three certified by College of American Pathologists (CAP) in Africa.  Officials were elated when they were picked as the second runner up in the annual ‘Lab of the Year’ 2008, by Medical Lab Observer, an industry trade publication.
“Have you seen how much bottled water we have? And just across the way patients are starving. What’s this supposed to do to our mental health?” fumes one doctor.
By April, after the quiet but steady and forceful complaints from several staffers, IDI brass settled on a ‘4-A project.’  An appeal to donors to funnel some funds to the ward was instituted. 4-A has been adopted by IDI.
Officials say $122 could get life saving medicine for four patients for a week, $600 would get them an oxygen system; $1,223 could get a new hospital bed; and $12,232 for a total renovation. Money has begun to come in.
Jacob who decided to take position at a Seattle hospital last summer, vows to follow up on the progress.

“I will be back to see it through.”

This report is supported by the Project for International Health Journalism Fellowship Program as part of the Henry J. Kaiser Family Foundation’s Media Fellowships Program.  Edozien is the director of New York University’s ‘Reporting Africa’ program.

Useful links
IDI:  www.idi.ac.ug
Mulago: www.mulago.or.ug
Donations can be made by contacting idi_communications@idi.co.ug

 

Fight Against AIDS in East Africa

WORLDPRESS

By Frankie Edozien, October 1, 2008

KAMPALA, Uganda: For the millions of Africans dealing with HIV/AIDS, a beacon of hope has emerged from an unassuming single story clinic, nestled in the hills of this city.

Since its doors were open in 2004, the Infectious Disease Institute (IDI) has been on the forefront of Africa’s response to the pandemic, quietly and methodically conducting scores of clinical trials while treating thousands.

IDI and its staff have proved through their outreach, and treatments that high-quality care can be given without having to build brick-and-mortar infrastructure in every rural area.

And the friends _ as the patients there are called _ are regaining their foothold in society, living healthier, with their heads held high and some even heading back to the workplace after being pulled from the brink of death.

“When this clinic started in a small room, a HIV clinic was a specter of a lot of depression and sadness, people laying on the floors. Now as you will see it’s a vibrant population,” said Andrew Kambugu, IDI’s head of clinical services.

“People are well, they are going back to work, they are looking for spouses if they’ve lost their loved ones and they are looking to live life again. For me as a young African professional I think there are fewer places that give more satisfaction,” the doctor, 35, added.

IDI’s success in rolling out anti-retroviral therapies while simultaneously conducting high level research work began as dream. American and African Academicians wondering how to deal with Africa’s AIDS crisis, came up with the idea to open up a state-of-the-art regional center of excellence to serve the continent.

Thus the Academic Alliance for AIDS care and prevention in Africa was born. The Alliance got the Pfizer foundation to pony up funds for the building and operational cost for the first few years and IDI opened it’s doors in 2004. It cost $2 million a year to operate.

Article Continues

When we came here in 2001, it was very clear that we would never be able to accomplish the vision with the physical infrastructure that was here at the time,” said W. Michael Scheld, a medical professor at the University of Virginia who has been involved with IDI since it was an idea.

“We had the [nearby] Mulago clinic but it was only open a half day at a time. They saw about 100 patients a day and almost no one ever came back because there was nothing to offer.”

Today thousands are treated, given medication, taught new activities to help them generate income, and most are smiling on any given day you find them at IDI. Indeed the miracle drugs paid for by the Global Fund; the President’s Emergency Plan for AIDS Relief (PEPFAR) are partly responsible.

But anti-retrovirals (ARVs) were just the beginning.

“Two and a half years ago, we had trouble in the waiting area. It was a very stigmatizing environment. Friends (patients) would come in and hide in the waiting area. Not wanting to be noticed. Some of them would actually cover their heads. There was a lot of stigma in that waiting area,” said Caleb Twijukye, 32, coordinator of IDI’s creativity initiative.

“So we saw a need to start something that would engage those friends and something to fight that stigma. We began by creating communes in those waiting rooms.” Music, games, spiritual healing, sharing, each patient found a place to perk up.

“They come in now dance and sing, and they happy. By the time they get in to that doctor’s room they are already happy and treated. It really works,” Twikujye added.

IDI, at its core is a clinical research facility that holds its own with other such facilities the world over, despite being smack in the middle of a relatively poor country in East Africa. Dusty dirt roads lead up to the hills where IDI is yet, its laboratories are only one of three College of American Pathologists (CAP) certified on the continent.

Stepping into the sterile environment with its international cadre of medical professionals, its easy feel like one is in a Western capital.

“We’re not here to train Europeans or North Americans to have their African experience,” insists Phillipa Easterbrook, the head of research.

Easterbrook is a medical professor who took a leave from Kings College in London to work at IDI.

“We are here to train the next generation of clinicians, teachers, researches in sub-Saharan Africa. The era of scientific projects emanating from the West with Africa being the receptacle is ending.

“It will be us in sub-Saharan Africa saying these are the questions we want to ask together. We will write the grants, we will do the programs, we will do the analyses, we will write the papers. And that’s the spirit I’m trying to engender in IDI.”

In just a few years, 27 African nations have sent close to 2,000 medical professionals to be trained in the latest in HIV care. Yet some trainees have come from Europe and Asia.

IDI insists that those it trains go to their home country and trains others. They keep regular communications and have staff waiting to take queries about difficult cases.

Taking a short break from one of the intensive month long training sessions, Zambian physician, Patrick Makelele, said he was drawn to IDI by the caliber of clinicians lecturing.

“My expectation is to update my skills in ART management, get the latest if there is any and also to learn from the huge experience of Uganda,” he said. “I wanted to know more [see] what is going on, on the ground … realize my gaps.”

Nigerian military physician, Nathan Okeji, said he planed to return to his home facility and turnover how he’d been doing things.

“I’m very impressed with what I’m seeing here, I think we are going to bring an entirely new face to HIV management in Nigeria especially among the military,” the doctor said. He said he immediately wants to begin testing infants born of HIV positive mothers at six weeks rather than wait 18 months as he’d been doing.

“The standard here is exactly almost what I’ve been seeing going abroad the in the UK or USA. As far as I’m concerned the USA is now here in Uganda.” He also plans to use an IDI inspired method of shifting medical tasks to competent nurses.

“The doctors are doing everything and we are overwhelmed. We are seeing about 40-something patients, daily. You go from your house to the hospital. Then you are fagged out and you go to bed.”

Easterbrook who has brought a strong focus on epidemiology to all staff and trainees at IDI insists that Africa is the place to get answers for HIV now.

“My role is to really make sure we’ve crossed every ‘t’ and dotted every ‘i’, in having a rigor in our procedures that rival those in North America and Western Europe.”

Yakari Manabe, a doctor from John Hopkins Medical school decamped to Kampala to run the labs here, said simply that “IDI has the ability to answer questions that cannot be answered in the states.”

The New Jersey doctor added that: “If you want to look at HIV and tuberculosis co-infection and understand better the collision of those two infections and the devastating epidemic that comes from it, it is best done in places like this.”

While IDI serves some 10,000 friends, it has partnered with Kampala clinics and heads out to different clinic sites ach week to treat hundreds of other patients.

“My dream is maybe to see a negative generation. A new, negative, generation,” said Zam Nakawooya, 35, a former teacher now peer counselor at IDI.

IDI is part of my life now,” added Peter Kamlimba, 38. “I can’t relate it to anyplace. This is where I found my life. I’d lost my life and now I’ve gained my life again. I’m strong, I’m healthy, I can do anything.”

For IDI’s board, the goal is to replicate its success across the continent. Already similar centers of excellence are planned for Ethiopia and Nigeria.

This report is supported by the Project for International Health Journalism Fellowship Program as part of the Henry J. Kaiser Family Foundation’s Media Fellowships Program

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