Because of the shockingly candid details related below, the author, a physician, has asked that we delete any comments that might reveal his identity. Warning: This account is sobering and distressing.
Sub-Saharan Africa, early 2001—”The main reason I can’t wait to get out of here is that my personality is suddenly altering. They say it’s called ‘becoming a doctor.’[Here] that means your main emotion when a patient dies is relief.
“The AIDS [epidemic] is becoming alarming. Most of our beds are filled with HIVpositive patients. They talk about the ‘package deal’down in the emergency department. An extremely skinny patient comes in, coughing, complaining of tiredness. On examination, they have oral thrush, often so bad that even their lips are covered with a white fungus as it climbs out of their mouths. And immediately you know that they have HIV, TB [tuberculosis] and oral candidiasis [a fungal infection].
“We go through the motions of testing them, but I don’t know why. We admit them, rehydrate them, and all that we succeed in doing is prolonging their death by a week or two. We are now at the point where we refuse to give them any active treatment (antibiotics, antifungals, even blood), which includes resuscitation. It’s quite simple—even with active treatment, the only difference you make is a few weeks. (They always wait until they are terminal before arriving at the hospital.) So why waste money you don’t have to begin with?
“The other day I caught myself saying out loud that we should start refusing to admit HIV-positive patients, since we’re only prolonging the inevitable. We’re turning away patients with asthma and diabetes, patients with controllable diseases who could contribute to the economy, because AIDS patients are taking up all the beds.
“And then it hit me: I’m playing God. If we start doing that, we might as well start denying medical care to old people and premature babies, because they no longer contribute to society. We might as well start turning away patients with other terminal illnesses, like cancer and multiple sclerosis, because we’re only prolonging the inevitable.
“You have no idea what kind of hell it is to do ward rounds in [this city] in the morning. You walk through rooms of skeletons, their chests rattling with each cough … Many of the patients lie in beds [soaked with] their own urine … Their lips are caked with white fungus, their faces mottled with blood-flecked sputum. They watch you from their beds, their eyes often the only body parts they can still move. Some of them still beg with their eyes for help …
“Some are beyond caring. Their eyes are already dead, which is why you check each patient’s pulse before discussing them. We use pseudonyms like ‘retrovirus’or ‘high five’for HIV and ‘Koch’s bacillus’for TB in an effort to maintain privacy. But they all know the telltale wailing following the post-test ‘You have HIV‘speech.
“Not all of the deaths here go unnoticed. One of my patients will always haunt me. As I mentioned, most of the AIDS patients have pretty typical appearances (skinny and coughing).
“Some (especially the children) never reach that stage. This particular young girl (19 years old) didn’t fit the typical profile at all. She was educated, eloquent and still looked very healthy. She had known she was HIV-positive for three years prior to her admission. (Her boyfriend had told her that he was monogamous, and so he was. Unfortunately, his previous girlfriend had not been.) She came after she suddenly started battling to breathe, rather like a severe asthma attack. In well-fed HIVpositive patients in Africa, this normally is due to pneumocystis pneumonia. This was the diagnosis in her case.
“If we could pull her through the pneumocystis pneumonia, she could still have a few good years left. So we put her on oxygen, nebulizations and antibiotics. For two days I had to walk into the ward and watch her struggling to breathe. For two days she couldn’t sleep for fear of forgetting to breathe. The [nurses] were unfortunately ‘forgetting’ to give the full dose of antibiotics. On the morning of the third day, she looked worse than even when I arrived. I can’t describe the feeling of powerlessness when you realize that you can’t give anything to ‘make it go away.’The only option left to us was to give her small doses of opioids to make the struggling for each breath at least seem less painful.
“When we came round later in the day with the consultant, the patient had finally fallen asleep. He was impressed by her improvement and decided to forgo the opioids. As we moved on to the next patient, I suddenly knew that I would never see her alive again. She died that night.
But for the grace of God
“Most of all, you wander between the patients and know that, but for the grace of God and a single needle-stick wound, that could be you.
“I’m beginning to hate medicine [here].
“Diagnostically it’s no challenge, because they all have HIV. Therapeutically it’s no challenge, because we do nothing. Emotionally it takes you to places where you simply don’t care about life anymore. And still we work … [with] the constant danger that the next time you draw blood or put up a drip you could get HIV.
“And the state doesn’t … [care]. They no longer even provide us with free anti-HIV drugs (AZT, etc.) following a needle-stick injury … We can’t afford that.
“And … they wonder why we’re leaving the country.
“I hope [these letters get] people thinking twice, whether it’s about unsafe sex or an awareness of human fragility” (end of letters; emphasis added throughout).
No easy way to say it
There’s no easy way to describe the desperate situation that grips Africa. While this eyewitness account does not describe all hospitals there, it does point out that the epidemic is made all the more disastrous because of i0nadequate infrastructure.
A recent report from one African government revealed that one in every nine of its citizens and nearly 25 percent of pregnant women are HIV-positive. The same report forewarned that, by 2016, the country’s population would begin to shrink, because the number of deaths due to HIV will surpass the number of births. (Regrettably, this country is not alone. In several others overall infection rates are even higher.)
A single faint glimmer of hope appeared in statistics that show a marginal decline in HIV infection rates in regions where there have been sex-education campaigns—no easy task, given centuries-old taboos and traditions.
Promiscuity is the major reason, but not the only one, for the rapid spread of AIDS on the African continent and in other countries around the world. Many diseases that have been largely controlled in the West by advanced medicine are rampant in Africa and other regions. They include malaria, syphilis, gonorrhea, tuberculosis and pneumonia. Such diseases weaken the immune system and apparently ease transmission of the AIDS virus. Diseases that involve open sores and exposure to bodily fluids also boost the proliferation of AIDS.
In December 2000 the United Nations announced its estimate on the African-AIDS condition. It said 24.5 million people in the sub-Saharan region are HIV positive. Contrast that with the total figure worldwide of 36 million infected. Seven out of every 10 cases in the world are in the sub-Saharan countries of this plague-stricken continent.
A race to develop an AIDS vaccine is underway in the international medical community. Billionaire philanthropist Bill Gates has personally donated $100 million to the research, challenging other wealthy people to contribute generously as well. Mr. Gates’ Microsoft Corp. has raised nearly a quarter of a billion dollars for the project so far.
AIDS drugs are notoriously expensive, out of reach for the average African government or private citizen. However, cheaper, generic versions of the patented drugs are available.
No effective anti-AIDS drug has been developed. Even if it were, and could be made available in generic form to the afflicted African nations, could AIDS be stopped?
Between the dead and the dying
Numbers 16:4-48 Numbers 16:4-48 4 And when Moses heard it, he fell on his face:
5 And he spoke to Korah and to all his company, saying, Even to morrow the LORD will show who are his, and who is holy; and will cause him to come near to him: even him whom he has chosen will he cause to come near to him.
6 This do; Take you censers, Korah, and all his company;
7 And put fire therein, and put incense in them before the LORD to morrow: and it shall be that the man whom the LORD does choose, he shall be holy: you take too much on you, you sons of Levi.
8 And Moses said to Korah, Hear, I pray you, you sons of Levi:
9 Seems it but a small thing to you, that the God of Israel has separated you from the congregation of Israel, to bring you near to himself to do the service of the tabernacle of the LORD, and to stand before the congregation to minister to them?
10 And he has brought you near to him, and all your brothers the sons of Levi with you: and seek you the priesthood also?
11 For which cause both you and all your company are gathered together against the LORD: and what is Aaron, that you murmur against him?
12 And Moses sent to call Dathan and Abiram, the sons of Eliab: which said, We will not come up:
13 Is it a small thing that you have brought us up out of a land that flows with milk and honey, to kill us in the wilderness, except you make yourself altogether a prince over us?
14 Moreover you have not brought us into a land that flows with milk and honey, or given us inheritance of fields and vineyards: will you put out the eyes of these men? we will not come up.
15 And Moses was very wroth, and said to the LORD, Respect not you their offering: I have not taken one ass from them, neither have I hurt one of them.
16 And Moses said to Korah, Be you and all your company before the LORD, you, and they, and Aaron, to morrow:
17 And take every man his censer, and put incense in them, and bring you before the LORD every man his censer, two hundred and fifty censers; you also, and Aaron, each of you his censer.
18 And they took every man his censer, and put fire in them, and laid incense thereon, and stood in the door of the tabernacle of the congregation with Moses and Aaron.
19 And Korah gathered all the congregation against them to the door of the tabernacle of the congregation: and the glory of the LORD appeared to all the congregation.
20 And the LORD spoke to Moses and to Aaron, saying,
21 Separate yourselves from among this congregation, that I may consume them in a moment.
22 And they fell on their faces, and said, O God, the God of the spirits of all flesh, shall one man sin, and will you be wroth with all the congregation?
23 And the LORD spoke to Moses, saying,
24 Speak to the congregation, saying, Get you up from about the tabernacle of Korah, Dathan, and Abiram.
25 And Moses rose up and went to Dathan and Abiram; and the elders of Israel followed him.
26 And he spoke to the congregation, saying, Depart, I pray you, from the tents of these wicked men, and touch nothing of their’s, lest you be consumed in all their sins.
27 So they got up from the tabernacle of Korah, Dathan, and Abiram, on every side: and Dathan and Abiram came out, and stood in the door of their tents, and their wives, and their sons, and their little children.
28 And Moses said, Hereby you shall know that the LORD has sent me to do all these works; for I have not done them of my own mind.
29 If these men die the common death of all men, or if they be visited after the visitation of all men; then the LORD has not sent me.
30 But if the LORD make a new thing, and the earth open her mouth, and swallow them up, with all that appertain to them, and they go down quick into the pit; then you shall understand that these men have provoked the LORD.
31 And it came to pass, as he had made an end of speaking all these words, that the ground split asunder that was under them:
32 And the earth opened her mouth, and swallowed them up, and their houses, and all the men that appertained to Korah, and all their goods.
33 They, and all that appertained to them, went down alive into the pit, and the earth closed on them: and they perished from among the congregation.
34 And all Israel that were round about them fled at the cry of them: for they said, Lest the earth swallow us up also.
35 And there came out a fire from the LORD, and consumed the two hundred and fifty men that offered incense.
36 And the LORD spoke to Moses, saying,
37 Speak to Eleazar the son of Aaron the priest, that he take up the censers out of the burning, and scatter you the fire yonder; for they are hallowed.
38 The censers of these sinners against their own souls, let them make them broad plates for a covering of the altar: for they offered them before the LORD, therefore they are hallowed: and they shall be a sign to the children of Israel.
39 And Eleazar the priest took the brazen censers, with which they that were burnt had offered; and they were made broad plates for a covering of the altar:
40 To be a memorial to the children of Israel, that no stranger, which is not of the seed of Aaron, come near to offer incense before the LORD; that he be not as Korah, and as his company: as the LORD said to him by the hand of Moses.
41 But on the morrow all the congregation of the children of Israel murmured against Moses and against Aaron, saying, You have killed the people of the LORD.
42 And it came to pass, when the congregation was gathered against Moses and against Aaron, that they looked toward the tabernacle of the congregation: and, behold, the cloud covered it, and the glory of the LORD appeared.
43 And Moses and Aaron came before the tabernacle of the congregation.
44 And the LORD spoke to Moses, saying,
45 Get you up from among this congregation, that I may consume them as in a moment. And they fell on their faces.
46 And Moses said to Aaron, Take a censer, and put fire therein from off the altar, and put on incense, and go quickly to the congregation, and make an atonement for them: for there is wrath gone out from the LORD; the plague is begun.
47 And Aaron took as Moses commanded, and ran into the middle of the congregation; and, behold, the plague was begun among the people: and he put on incense, and made an atonement for the people.
48 And he stood between the dead and the living; and the plague was stayed.
American King James Version×tells of a plague that struck Israel when Moses and his brother, Aaron, governed it. At Moses’urging, Aaron literally ran between the dead and the dying with the means to stay the plague.
African governments do not work as efficiently.
Michael Ledeen, who spent many years in sub-Saharan Africa and has seen AIDS firsthand, wrote in his March 27 column— titled “Fighting AIDS Is a Losing Proposition”—that distributing medicine through African governments would never work.
“There is no infrastructure capable of delivering medicine to those who need it, nor to ensure that patients take the full course of treatment.”
Unless the West virtually creates and imposes the missing infrastructure, Mr. Ledeen continues, “no matter how generously we donate medicine to Africa, a huge bloc of Africans will never receive it …”
Many African leaders, he warns, would enrich themselves by selling cheap medications at a markup. Further, they would probably use medicine as a political weapon. Those who ally themselves with the leaders would receive medication while those who did not would be frozen out of any supplies. Witness that type of political manipulation in the distribution of food relief in famine-stricken African countries.
“Is it hopeless, then?” Mr. Ledeen asks. His answer: “Most likely, it is, at least in the sense of ‘solving the problem.’”
Hope for the hopeless
We hope that Mr. Ledeen is wrong and that ways will be found to bring relief to the millions suffering from this dread disease. However, our hope doesn’t rest in man’s capabilities.
The example of Aaron mentioned above is, in some ways, a forerunner of the coming Jesus Christ, who will be forced to intervene in a devastated, sin-sick world to prevent the extinction of human life. As He warns us in Matthew 24:22 Matthew 24:22And except those days should be shortened, there should no flesh be saved: but for the elect’s sake those days shall be shortened.
American King James Version×: “If that time of troubles were not cut short, no living thing could survive; but for the sake of God’s chosen it will be cut short” (Revised English Bible).
As Aaron interposed Himself between the dead and the dying, Jesus the Messiah will intervene at His return to bring healing to the nations (Isaiah 35:5-6 Isaiah 35:5-6 5 Then the eyes of the blind shall be opened, and the ears of the deaf shall be unstopped.
6 Then shall the lame man leap as an hart, and the tongue of the dumb sing: for in the wilderness shall waters break out, and streams in the desert.
American King James Version×; Luke 4:17-21 Luke 4:17-21 17 And there was delivered to him the book of the prophet Esaias. And when he had opened the book, he found the place where it was written, 18 The Spirit of the Lord is on me, because he has anointed me to preach the gospel to the poor; he has sent me to heal the brokenhearted, to preach deliverance to the captives, and recovering of sight to the blind, to set at liberty them that are bruised, 19 To preach the acceptable year of the Lord. 20 And he closed the book, and he gave it again to the minister, and sat down. And the eyes of all them that were in the synagogue were fastened on him. 21 And he began to say to them, This day is this scripture fulfilled in your ears.
American King James Version×).
Clearly, our world desperately needs two kinds of healing—an immediate intervention to restore physical health and soundness to the millions who suffer and a spiritual healing of the character of individuals and their governments that have brought on the dark days in which we live.
Therein lies the hope of Africa. God speed the dawning of that day of healing. GN