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 Clare Taylor is a British doctor who recently returned from a working year in the Democratic Republic of Congo (DRC). It was her first mission with MSF after several years of hospital medicine and training in tropical diseases. I was working in the city of Bukavu, on the shores of Lake Kivu, on the border with Rwanda. It's a beautiful, green, hilly area, still volatile with simmering conflict as DRC tries to emerge from over 10 years of conflict. Occasional bursts of fighting now remind us of the much worse situation of the last decade. For me and the other MSF staff, this meant curfews at times and having to be vigilant to change, but for the most part, it's business as usual. Bukavu is a city of 600,000 people in the South Kivu province of DRC. 90% are unemployed; 5-10% are HIV positive. People live hand to mouth and most struggle to feed their families adequately. Transport is difficult along mostly unsealed roads; hot and dusty in the dry season and ankle-deep in mud in the wet! The town is marked by the presence of UN peacekeepers and many armed Congolese soldiers, some very young. Local children have learned words of many languages from the UN peacekeepers - surprising international vocabulary from Congolese children! It is in this context that MSF started providing free antiretroviral treatment - drugs against the HIV virus which, when taken regularly, every day for life, prolong the lives of HIV positive people and stop the infections that they catch so frequently if untreated. These drugs began to be available in the west in the late 1980s and only in the last few years have the first small successes been seen in Africa in giving treatment to those who could not otherwise afford them. This was initially a pilot project but while I was working in Bukavu we opened a second clinic and were able to reach more and more people with HIV treatments. I was lucky to be part of a great team. Most of my days were spent in the clinic with Congolese medical staff, doing rounds at the hospital and organising changes that were happening with staff and medical treatments while supervising and training our nurses and doctors. HIV is still taboo here. It infers imminent death and shame to those who find out that they are infected - their only hopes are prayer, sorcery or traditional treatments. But now, the people who are treated in the MSF clinics are starting to speak out - they want to tell the city how they have recovered and are strong, how their bodies feel so much better after gaining weight on antiretroviral treatments. It was so encouraging to see two of our patients later employed in the programme as community educators. They are healthy, enthusiastic and have the best and most effective personal stories and prevention messages to tell - not to mention lifting stigma simply by speaking.We had so many volunteers speaking at teaching sessions for nurses about their experiences from being unwell, diagnosed with HIV and then of getting better and “positive living”. On one occasion in mid 2004, the team was forced to leave Bukavu as the town was taken over by a rebel militia group. There were many concerns about the programme and it was a frightening experience for national and international staff but, on returning, the team found that that over 95% of the patients had stuck exactly to their treatment regimes despite the terrible fighting in town. The amazing national staff team had continued to deliver medication to the homes of patients and the patients themselves,well informed about their illness and treatment, knew to use their “security stock” provided by the clinic to avoid breaks in treatment in just this sort of emergency. Our typical patient would be a widow in her thirties who has lost her husband to AIDS,without him having any medical care - I will always remember a mother I treated in the clinic who later died of tuberculosis. Because the mother died, her nine month old daughter had not been receiving her medication and also died. As I left the programme, the mother's older child was winning her battle against tuberculosis under the caring eyes of her grandmother and aunt. These children at least had a loving extended family who took care of them - many are orphaned without any option other than orphanages or the streets. It was not unusual for me to meet a mother who is a widow and has lost, say, 5 out of 7 children to disease,whether diarrhoea,malaria or HIV related disease. It's hard to know - they just die at home. In Africa AIDS is a real family illness affecting ordinary people. Mothers pass it to their children through pregnancy, childbirth and breastfeeding. We don't yet have enough resources - human or financial - to run a replacement feeding programme here; this would mean giving bottle milk to HIV positive mothers for their children to ensure that more children of HIV positive mothers are born without the virus. However we tried to access more and more pregnant women through local clinics to test them for HIV and to work with them to reduce the risk to their children through medication that reduces the chance that the virus is passed from mother to child, and gives that child a long life expectancy and gives the family a lot of hope. Not only does MSF look after HIV positive people - we also helped train local staff to do the same.We ran some really interesting, enjoyable courses on treating people with HIV for local doctors and nurses - it was good to work with them and exchange experiences - and also to dispel myths even amongst health care workers! I feel really proud and lucky to have been involved in the groundbreaking struggle against AIDS that MSF is fighting - to keep a programme of antiretroviral treatment going in a conflict zone is new and exciting and demonstrates to other health workers that such a thing can be done. It is in part due to the campaigning for the reduction of the price of antiretroviral treatment, in which MSF has been very active. The challenge now is to increase the availability of these treatments and prevention activities that really work so that more of the 40 million HIV positive people in the world can be treated . For more information contact www.uk.msf.org  |
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