A Reflection on World AIDS Day from Zimbabwe

Yesterday was "World Aids Day", which reminds us of the tremendous number of AIDS patients we have cared for in Zimbabwe. In our Christmas Newsletter, we have this paragraph: "At St. Theresa Hospital, there are now over 1800 clients receiving on-going anti-retroviral (ARV) therapy. Nearly all of these are doing extremely well, and in fact, are living very normal lives – for what accounts for “normal” in Zimbabwe these days! More than 750 of these people have now been alive for more than two years on treatment. Remember, before we started our treatment program, ALL of these 750 would most likely be dead at this time, with countless more orphans in the District as a result. Of the 1800 + clients, 210 are children under the age of 14.

Being involved in the initiation and development of the AIDS treatment program has been one of the most satisfying things I have ever been involved with. You cannot imagine the satisfaction when you see this woman who was at deaths door and weighing only about 65 pounds just a year ago, and now is totally well and weights 130 pounds. As Elise, at Mission Doctors Associations, says: “where else would you find a woman who would be happy about gaining 65 pounds?”

Here is a picture I took of one of the empty male wards: I am proud of it, because when we arrived at St. Theresa’s in 2001, these wards were all full of dying AIDS patients. The overall hospital census has dropped from an average of 130 per day to under 70 per day. There is no other area of medicine where one can have such a huge impact!"

Much of the success of decreasing the incidence of AIDS is because of the treatment of AIDS patients. After being on treatment for six months or more, the viral load decreases to "undetectable" and this means that transmission to another is much, much less likely. Kudos to ALL involved in this work throughout the world, and to the UN Global AIDS and TB program. We must keep the "pressure" on the rich countries of the world to continue to support this work, and even increase the funding so that more and more people can have access to treatment.

Life continues...

I have just returned from my first Board meeting with Mission Doctors Association. It was a two-day “retreat” where we went over all aspects of the organization, including reviewing the Mission Statement, Values, etc. You can get an update on the web site.

During the weekend, I talked with Jessica about my blog and how I had not done much of an update lately, because it does not seem appropriate to write in the blog about my life in Florida! After all, people want to read about “life in the missions.” I do keep up with the life at St. Theresa Hospital, so here is some of that information.

On a monthly basis, the hospital administrator, Ms. Hove, sends me all of the financial information; how much diesel has been used and how much is in the tank for future use; how donor money that I supply has been used during the past month; the complete hospital statistics that are sent to the Ministry of Health; and the Pharmacy inventory statistics. I go over those reports each month, and send back comments and questions to Ms. Hove. About three weeks ago, I also was able to talk with her via Skype on a Sunday morning. We chatted for about 40 minutes, so it was a good time to really get some pertinent information, and also to just hear how things are going.

They are indeed going quite well in spite of all of the difficulties. The staff are still paid a pittance by the government (as are ALL government employees in the country). The top nurses salary is about $180 per month, and the bottom “general hand” salary is $100. It seems like so little (and it is) but it is still better than during the days of hyperinflation, when the Zimbabwe currency would lose half of its’ value within one to two days. Now at least, if one has $20 US today, it is still worth $20 next week or next month or next year!

The financial report for the first six months is quite impressive. Remember, this is to operate a hospital that is averaging about 60 patients per day, plus a very busy out-patient department, a maternity ward that delivers around 90 babies per month, and an extensive AIDS diagnosis and treatment center, with several out-reach centers. The figures exclude most salaries, since those are paid directly by the government. There are a few still having to be paid by the hospital out of “revenue.”

Total revenue for six months: $80,000.
Sources of revenue:
Hospital fees 50%;
Donations: 25%;
Government allocations 20%;
“other” 5%.

Total expenses: $80,000. Medicine purchases is 25%, and the remainder is all of the other items needed to keep the hospital running. Remember, this is for six months! Of course, there are many things that “just do not get done” because there is not the money for it, but still, the main work of the hospital goes on and I feel that it goes on very well. They can all be proud of the good work they are doing under such difficult conditions.

Archbishop Romero Prayer

On this blog is a copy of the “Romero Prayer” (left). People that know me, know that part of that prayer is my mantra: “We cannot do everything, and there is a sense of liberation
 in realizing that. This enables us to do something, 
and to do it very well.” It could well be the mantra for anyone working in the Third World, where many times it seems hopeless. If one reads that prayer frequently and meditates on it, then we can focus on the something we can do, and we can indeed try to do it to the best of our ability. That is all that God asks of us.

I would like to clarify some things about the prayer. I was given a copy of it at a retreat given by Bishop Robert Morneau, Auxiliary Bishop of Green Bay, Wisconsin. In fact, it was given to us on a retreat at beautiful Chambers Island in 2000, and it was at this retreat that we decided that we would be able to return to Zimbabwe for long term work, which eventually ended up being nearly eight years. In any event, the prayer was listed as “A prayer that Romero used at a retreat for priests, shortly before he was martyred in 1980.” It has become know as “The Romero Prayer” even though he never actually claimed to have written it. In fact, it was written by Bishop Ken Untener of Saginaw, Michigan, and was drafted for a homily by Cardinal John Dearden in Nov. 1979 for a celebration of departed priests. It is appropriate that we give credit to Bishop Untener for being the author, and for Archbishop Romero for his martyrdom and example of how we should live our lives.

Maybe we could head this prayer in this manner: “The Romero Prayer”, popularized by Archbishop Romero but written by Bishop Ken Untener in 1979.

Thoughts about my trip...

It is a long trip, and seems to get longer as I get older. It takes me at least a week to “re-adjust” to the time zone so that I sleep at the right times. Still all of the flights went very well and my luggage arrived at the same time as I did, both going and returning.

• It was really good to see so many of our friends: in Harare, at St. Theresa’s, at Driefontein Mission, in Masvingo, and in Gweru.

• Zimbabwe continues to “look normal” even though there are many bad things happening throughout the country. Fortunately, none of those things are happening in the areas where I was visiting.

• All of the stores have quite a good supply of goods to sell, although at a premium price about 10 to 30% above what we would pay in the U.S. Every place now accepts either US dollars or South African Rand, BUT the money is SO terribly dirty. It is amazing to see dollar bills on which you can barely read the denomination or see the picture. This is especially true of the lower denomination bills.

• I did take care of one of the wards for a few weeks, and even did three C-sections and a couple of other small surgical procedures. It was good to be doing some clinical medicine again.

• All of the people working at St. Theresa’s are doing a tremendously good job. It was so rewarding to see everything running so well. The two young Zimbabwe doctors are doing a great job, as are all of the nurses, administration people, and of course, the Dominican Sisters – in fact, ALL of the staff continue to do exemplary work under very difficult conditions and with very low pay. Even though I did some clinical work, they could have gotten by without me doing that. It does mean that in the future, I can go for just two to three weeks and accomplish all that needs to be done.

• The hospital census is averaging about 50 to 60 people per day. That is such a difference from when we first went back to Zimbabwe in 2001, when the average census was over 120 per day, and some days as high as 145 patients. The difference is due to the very large number of people now on Anti-Retroviral drugs for AIDS. More than 1300 people are returning every one to two months to get their drugs, and are completely well! This means that none of those people are being readmitted every month or so for opportunistic infections. Of all that was accomplished while we were there, this is the most significant. It means that these people can live healthy, productive lives and can continue to take care of their children. Of course, some 70 of these patients ARE children, and we are hopeful that the medicines will prove to be lifesaving for them for many, many years to come, and that at some time in the future, there will be a treatment that will truly cure AIDS.

• I made some home-visits with Sr. Andrea, specifically visiting some people that have been on ARV treatment. Here is a man with quite a story, which he was happy to relate to us: Two years ago, he was totally bed-ridden, and unable to get out of bed at all without help. He was started on ARVs, and for one year, he still needed help. He showed us a wheelbarrow which his family put him in to get him to the pit toilet, or to just let him sit outside on a blanket. After a year, he started to slowly improved, and now he is able to walk with the aid of a stick; is able to work in his garden, and has such a smile! Click on the image to view a video clip of this man; he specifically gave me permission to use it “as I wanted to.”
  

• Another place we visited was where a grandmother was looking after three of her grandchildren. Both of the parents had died of AIDS, and one of these children had recently been started on treatment. Even though people are so very, very poor, they still have such nice smiles, and have such good attitudes. We can indeed learn from these very poor.
  

• I left Zimbabwe with a sense of hope; hope that the leaders of the country will be able to find a way to have true democracy so that they will listen to the needs of the people, and will bring peace and prosperity to these very peaceful village people.

I promised to come back...

I promised to come back to St. Theresa Hospital every year for a month. This year it ended up being only nine months since we left. The trip here was too long, as usual: flight from Tampa to Wash. D.C.; easy connection then to the South African flight to Johannesburg. That is an 18 hour flight, with about 1 to 1½ hours on the ground in Dakar in the middle of the night. I never can sleep much on the airplane, so only had about two hours sleep in the 18 hours. I had reserved a place at a B&B in JoBurg; they were there at the airport to pick me up as soon as I had my bags. The place is only about a 5 minute drive from the airport. I was very happy to get a hot shower and get into bed. Of course, I woke at 3:00 and could not get back to sleep, so just read for a few hours. Then had breakfast and they drove me back to the airport in plenty of time for the flight to Harare. I was met there by three of the Dominican Sisters – they were glad to see me and I was glad to see them. I stayed in Harare Sunday night, and then ran around Harare Monday morning with Sr. Andrea, including meeting with a man about drilling a new borehole for the hospital. I also paid for the rest of the year for the internet satellite connection -- $1,400!

We arrived back “home” (really not my home any more, but still sort of feels like it) at 4:00 PM. The tar roads are fairly bad, but the dirt road is really terrible. There had been heavy rains last Saturday which was not good for the road, but good for some of the crops, and for water in our dam. Then again, there was over 3 inches of rain yesterday, so we have plenty of standing water just now.

Since getting back I have not had any patient contact, but will start that tomorrow. I have been busy with administrative “stuff” – especially trying to get the computers to work properly. There was problem with the internet satellite connection, and I was trying to get that sorted out. First with my laptop, then with the hospital laptop. There is a program which “Forces” the modem to lock onto the satellite, but it was not working. Then I connected the hospital laptop directly to the modem rather than trying to connect through the wireless. No luck with that either. So I was putting that laptop away and forgot I had the cord connected, and pulled the modem off the shelf directly onto MY laptop – and it made the screen go blank, and nothing that I do resolves that issue. Obviously will have to have someone look at it when I get back. I am glad that I brought my old laptop and not the new Apple MacBook.

The hospital computers are always having problems with viruses, and most of the anti-virus programs are outdated, so last night I uninstalled the one on the hospital laptop, and purchased a new one that is good for “more than three computers” and for three years. The satellite connections were working alright, and so I downloaded that – it took about two hours at the slow speeds with the satellite connection that we have. After completing everything I then got a message: “An Unauthorized Change was made to Windows” and the computer stopped functioning. The modem was not working at that time, so I had to wait until this morning to get reconnected and try to find out “on line” what the problem was. It seems like the antivirus program has caused a problem and might need to be uninstalled. I have sent an email off the anti-virus company and see what they think I should do. I hope it is going to work out alright.

While at the hospital earlier this morning, the woman in the statistics office called me in to help with that computer. They have a battery to help with short-term power when the main-line electricity goes off, so that the computer does not just go blank because of loss of power. The battery is obviously at the end of its function, because it ceases to function even IF the main-line electricity is on. I have short-circuited the entire system by connecting the computer directly into the wall plug, which means it will go off whenever the electricity does, but at least they can use it when it is on. I wonder how they would handle the problem IF I was not here?

There also was a man here yesterday to try to sort out the solar lighting problems in the Nursing School and Dormitories. That system is quite new, but one entire section was not working, and it is apparently because the batteries are totally dead. The batteries are supposed to last at least three years, and these have been about18 months. We had big problems with the man who installed them, and he has even threatened St. Theresa with a law suit IF anything derogatory is said about him, so I won’t! Seems like a very odd “Business Plan” to me, and not likely to lead to huge success.

Still, all in all, I have to say that things are really running quite smoothly since I left. I am glad to see that. Dr. Maunga has stepped up and become very responsible and helpful in all respects, and apparently a good mentor for the younger doctor. The hospital is very quiet at this time. Only about 45 to 50 patients, which is such a huge difference from 7 to 8 years ago, when we were averaging between 100 and 120 patients, and occasionally as high as 145 – most with HIV related diseases. I am certain it is because of the good AIDS treatment program that we have running. The people no longer are coming back and coming back, ill with one opportunistic infection after another, until they finally die of AIDS. We have about 1400 patients who are returning every one to two months for the medicines, and are very faithful about coming for their appointments and for taking their pills.

Right Now...

We are getting ready to travel to L.A. for the big Charity Event on Feb 6th. Although we will be getting an award, we really feel that there are most likely many others who deserve it just as much or more than we do. Still, we are very grateful for this recognition.

I am busy trying to prepare an appropriate talk -- we will post it on the Blog after the event. I most likely will "again" use part of the "Romero Prayer" (on the left) since it has been my mantra ever since we returned to Zimbabwe in 2001. It helps to provide some stability in a situation where there is so much instability.

I read the news from Zimbabwe nearly every day, and it is only by having something like that prayer to fall back on that one is able to continue to have hope for the very poor of the country. Now we hear that once again the Southern half of Zimbabwe has had essentially no rain since the middle of December, so there will again be very poor (or no) crops this year. It is going to be another extremely difficult year, and deaths from starvation will only be prevented by even more food aid -- the majority of it from the U.S. With the devastation in Haiti and the need for such a large amount of aid "right now", it is going to be difficult for organizations to find the food that will be necessary.