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 The Lazarus Effect:
treating HIV/AIDS at St. Francis Hospital in 2005
Shelagh & Ian Parkinson
SFH executive director & manager
The AIDS team based at the hospital was formed in the late 1980’s and by 2003 had reduced the infection rate amongst the local population from 16% to 10% . The Bishop Oliver clinic was built in the early 1990s to provide the specialised counselling and care needed by those who are immuno-suppressed. About three years ago Sandy Logie’s name was added, remembering one who had given his life when working amongst these patients.
Anti-retroviral drugs (ARVs) have been available at Saint Francis’ Hospital since 2002. Though sold at cost, the price of the drugs still proved too high for nearly all HIV patients. However in June 2004 the clinic secured funding for drugs supplied by the WHO Global Fund. Through a system of means testing, those patients who could not afford ARVs were exempt from paying. This represented a huge step forward for the clinic; but cost was still a barrier to some. Then, in November 2004, the hospital was awarded AIDS Relief drugs, allowing them to lower the cost greatly to those who still had to pay a substantial amount for them. Even better, since March 2005, all ARVs prescribed through the Sandy Logie Clinic can be provided completely free. Now, about 500 people are receiving ARVs.
The benefits of ARVs, when the treatment plan is strictly adhered to, are difficult to over-estimate. Doctors report seeing numerous examples of the ‘Lazarus Effect’, whereby extremely ill patients improve to the extent that they can return to work and live relatively normal lives.
One Lusaka businessman tested positive for HIV and his condition was deteriorating rapidly, and he was admitted to the hospital.. As the sole breadwinner of the family, his wife and two small children were left with little to live on. He was unable to afford ARVs. Since he has been able to access them through the hospital the change has been remarkable. He has returned to work and can once again provide for his family.
Many patients have repeated a similar story: for example, a nurse was dying. Thanks to ARV treatment she is now back at work at a local hospital, allowing her to earn a living and to continue caring for other patients. Numerous teachers, nurses, farmers, villagers and others have been able to return to work. They are once again contributing to society and the economy, and to live positively.
However, there are still many challenges. There is concern about the continuing supply of affordable ARV drugs. Only recently India, a country that currently produces drugs for the Global Fund, stopped manufacturing generic drugs because of pressure from companies holding the patents. A continuing supply of ARVs is crucial. If patients miss even one dose the virus can build up resistance, making the treatment much less effective.
Each patient started on ARVs must be able to adhere strictly to his/her regime. This requires counselling, training and follow-up appointments, every 2 weeks initially and later at least every three months. For many patients this means travelling long distances to the hospital. The cost of transport is very high so people often use bicycles or come by foot, sometimes travelling for most of the day for an appointment.
However, there is hope for the future. As people see the benefit of ARVs, they are more willing to come for voluntary counselling and testing (VCT). ARVs represent the benefit of knowing your HIV status. Although they cannot cure AIDS, they often enable people to live a relatively normal life for several years. The clinic is focusing on preventing mother to child transmission; thereby creating the possibility of a generation free from infection. Having enough clinical staff to do this is essential. If you would like more information about volunteering to Saint Francis’ Hospital please go to the “Volunteering” page on the website.
\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/ STOP PRESS June 9th 2005
There is no doubt that the decision by the Indian government through international pressure to forbid the production of generic ARV drugs in India is a serious blow. Especially we need to treat pregnant HIV positive mothers both to prevent mother to baby transmission and to prolong the mother’s life so she can continue to care for her infant. Unfortunately many of the patients being treated in the Sandy Logie Clinic are relatively older, better educated and wealthier. While these patients are often compliant, their treatment does nothing to help the orphan situation. More mothers delivering in the hospital are now being treated thanks to an opt-out policy for antenatal HIV testing.
Meanwhile the rest of the hospital goes on. There is now a relative abundance of surgeons, and more expatriate doctors are expected. Shelagh, Ian and family are taking an overdue leave to the UK. If only more Zambian doctors were available.
There has been publicity in the British press about "poaching" of doctors and nurses from African countries. At present there is really no way of preventing this. My view is that the UK Government could help as follows: limit visas to 2 years for medical staff, at the same time finding suitable training posts as soon as possible and helping with repatriation costs; also to copy the utch example of supplementing the salary and allowances (eg educational ) of African doctors willing to stay in-country and to work in understaffed hospitals. As always at St Francis’ the morale is high and cheerfulness breaks through. Looking forward to our next visit soon.
Andrew, and Brenda Porter
Each year since 2002 Andrew, a retired Paediatrician, has returned to Katete for locum appointments of three to six months.
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