Editors’ note: During 2006 we will publish coverage of hospital practices in other countries. This and the article on Iraq (p. 28) are the third and fourth articles in that effort.
At the Ontario Hospital Association’s (OHA) CEO Forum in September 2003, Stephen Lewis, the United Nations Secretary General’s Special Envoy for HIV/AIDS in Africa, challenged Ontario’s hospital leaders to take a leadership role in the fight to treat and prevent the spread of HIV/AIDS in sub-Saharan Africa. Lewis’ compelling words evoked an outpouring of interest on the part of Ontario’s healthcare and hospital community, culminating in the launch of the OHAfrica Project in 2004 by the OHA and its affiliated health research foundation, The Change Foundation.
OHAfrica supports a small team of Ontario healthcare professionals working at the first public HIV/AIDS treatment center in the southern African country of Lesotho. The Tsepong “Place of Hope” Clinic is located in the town of Leribe. The Canadian team includes two physicians, one nurse practitioner, one registered nurse, one pharmacist, and one program administrator—all working alongside a small number of local staff.
The landlocked country of Lesotho was chosen at Lewis’ recommendation. The southern African Kingdom of Lesotho was selected as the focus of the OHAfrica project. Close to 30% of all Basotho people between ages 15 and 49 are infected with HIV, and Lesotho has the fourth-highest HIV prevalence rate in the world. More than 100,000 children have been orphaned by HIV/AIDS, and approximately 29,000 people in Lesotho die of AIDS every year.
A young mother, sleeping infant tied on her back, waits patiently in the crowded hallway of the Tsepong Clinic for her turn to see the clinic staff for an assessment and HIV test. New patients are taken on a first-come, first-served basis; many of them walk several hours in the pre-dawn darkness from their homes in rural areas to reach the clinic by the time the doors open at 8 a.m.
Dr. Philip Berger, leader of the first OHAfrica team on the ground in Lesotho, enjoys a joke with a patient who experienced a tremendous improvement in health since starting antiretroviral drug therapy. An experienced HIV physician, Dr. Berger is the chief of the Department of Family and Community Medicine and the medical director of the Inner City Health Program at St. Michael’s Hospital in Toronto, Ontario, Canada. He spent seven months working at the Tsepong Clinic in 2005.
In 2006 all children at the Tsepong Clinic are guaranteed to receive free antiretroviral drugs.
Since OHAfrica was launched on World AIDS Day in December 2004 the project has accomplished a great deal. The Tsepong Clinic has become the largest antiretroviral (ARV) treatment center in the country, and the clinic enrolls more than half of all new patients put on ARVs in Lesotho each month.
Until recently, antiretroviral drugs were beyond the means of most people in Africa, costing between $12,000 and $15,000 per year. With newly available generic drugs, the cost to provide one person in Lesotho with ARV treatment for one year is now approximately $140—less than .40 cents per day.
The ARV drugs available at the Tsepong Clinic are provided to patients free of charge, thanks to an agreement between the government of Lesotho and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In 2006 children on ARVs at Tsepong will benefit from a guaranteed pediatric drug supply for the entire year, thanks to generous support from The Clinton Foundation, created by former President Bill Clinton. The Clinton Foundation was instrumental in negotiating the deal with pharmaceuticals companies to allow for the sale of generic antiretroviral drugs, which in turn allowed third-world countries access to life-saving treatment. The Clinton Foundation has a particular focus on ensuring that children get access to antiretroviral drugs and has been supportive of pediatric drug supply in Lesotho.