David Gately

Archive for the ‘Africa’ Category

President-elect Trump on global health and HIV

In Africa, AIDS, David Gately, Health, HIV, PEPFAR, President Trump, Worlds AIDS Day 2016 on December 1, 2016 at 4:54 pm

Secretary of State John Kerry hosts a high-level meeting on global AIDS with PEPFAR partners at the United Nations General Assembly in 2013.

Today is World AIDS Day. A new Republican administration convenes in January. So it’s a good time to look at what the next four years means for American-led global-health programs, particularly efforts to combat the HIV crisis. The U.S. and the world are watching.

Will President-elect Trump make changes to PEPFAR, the President’s Emergency Plan for AIDS Relief? The U.S. initiative is a multilateral global commitment to saving lives and achieving an AIDS-free future. The prospect of Trump making cuts to the program has many health experts fearful.

In a November 9 Council on Foreign Relations online letter, Laurie Garrett, senior fellow for global health, noted that the British journal Lancet created a website tracking the U.S. elections and its impact on global health.

“Terrific detail can be found there,” said Garret, about the website. “Though in fairness to Republicans it is clear the Lancet folks were not enamored” with Trump.

The signs are worrisome, according to Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, a New York-based organization founded in 1995 by nine HIV treatment activists.

“During the U.S. election campaign, plenty was said about emails and sexual harassment,” said Warren, in a November 25 article on (DW), the German broadcaster Deutsche Welle’s website. “But there was little or no talk on global health or HIV.”

President George W. Bush signed PEPFAR into law in 2003, with strong bipartisan support from the U.S. Congress.

“HIV/AIDS is one of the greatest medical challenges of our time, said President Bush, when signing the PEPFAR bill. “The legislation launches an emergency effort that will provide $15 billion over the next five years to fight AIDS abroad.”

Thirteen years later and many experts consider PEPFAR a success. However, there have been challenges. A studypublished in the May 2016 issue of Health Affairs found that abstinence programs in Sub-Saharan Africa have failed.

Despite roadblocks, PEPFAR’s achievements since 2003 have been dramatic, with more than:

  • 68.2 million people receiving HIV testing and counseling, including 14.7 million pregnant women,
  • 1 million babies born HIV-free,
  • 9.5 million men, women and children receiving life-saving antiretroviral treatment,
  • 8.9 million men receiving voluntary medical circumcision, and
  • 5.5 million orphans and vulnerable children receiving care and support.

Today, PEPFAR is a generous $57 billion global-health juggernaut. (Add the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act, and total funding exceeds $72 billion.)

“Thanks to a spate of scientific advances, this decade could be the beginning of the end of the HIV/AIDS epidemic,” reported STAT News in July.

President Obama marks World AIDS Day in 2011 by announcing plans to boost U.S. efforts to fight AIDS at home and aboard.

President Obama continued to support PEPFAR, and, despite eight tough years of partisan wrangling on Capitol Hill, his administration pushed through many advances in global health and development. The Pentagon led an international military mobilization against Ebola, and the Obama administration strengthened the Global Health Security Initiative and launched the Global Health Security Agenda, which coordinates the global effort to standardize disease surveillance and response spelled out in the International Health Regulations.

For 2017, PEPFAR’s budget request is $5.2 billion. Will a President Trump, bolstered by renewed conservative GOP armor in both houses of Congress, maintain the initiative’s staggering momentum? It’s vital that he does, not only for the benefit of its recipients overseas, but for American workers as well.

Though estimates are scarce, PEPFAR employs–either directly or indirectly, in both the public and private sector–tens of thousands Americans.

The State Department implements the program. Key agency coordinators include the U.S. Agency for International Development, the Department of Health and Human Services, the Center for Disease Control and Prevention, the departments of defense, commerce, and labor, and the Peace Corps.

Add to that list the National Institutes of Health, the Health Resources and Services Administration, the Food and Drug Administration, and the Substance Abuse and Mental Health Services Administration–and decreases to PEPFAR’s labor requirements by Trump could impact scores of American workers.

However, some health experts choose to focus on small nuggets of hope in Trump and his Vice President-elect Mike Pence, the deeply conservative and devotedly religious Indiana governor.

“Politics is cyclical,” said Naomi Seiler, an associate research professor at George Washington University, at a World AIDS Day 2016 panel at GW’s Milken Institute School of Public Health.

Democrat or Republican, its normal for policies to be renegotiated, realigned and reaffirmed with every new presidential administration, said Seiler.

HIV/AIDS care delivery and awareness was an exception to the rule in the 1980s and early 90s, said panelist Dr. W. David Hardy, senior director at the Whitman Walker Clinic. But today, said Hardy, the American public is more accepting of the public health model championed by HIV/AIDS that’s shown that effective funding and resources can beget worthy results.

One panelist even finds optimism in Pence.

In 2015, when an HIV outbreak sprung seemingly out the blue among intravenous drug addicts in small, rural and poor Scott County, Indiana, Governor Pence, said Dr. Richard J. Wolitski, director of the Office of HIV/AIDS and Infectious Disease Policy, (eventually) responded admirably.

Pence’s first reaction to the endemic was to pray, according to an August 2016 article in the New York Times. But in short order, Pence approved a needle exchange program, along with drug therapy and aggressive outreach, slowing “the flood of new HIV cases to a trickle.”

But as the AIDS Vaccine Advocacy Coalition’s Warren indicated about the 2016 presidential campaign, there is little indication of what Trump will do about global health or HIV.

However, at an October 2015 press briefing in New Hampshire, when a college student asked Trump whether he would support PEPFAR, he seemed to suggest he wouldn’t make changes. The student, whose name was not revealed, began his question to Trump by saying how successful PEPFAR has been.

“Would you commit to doubling the number of people on treatment to 30 million by the year 2020?” asked the student.

Though candidate Trump did not particularly reference PEPFAR in his response, he mentioned AIDS and seemed to commit to PEPFAR in a general way. “Well, I like committing to all those things. Those are great things–Alzheimer and AIDS–but the answer is yes. I believe so strongly in that. And we are going to lead the way.

A clinic on the outskirts of Kampala, Uganda, that receives money from the United States through PEPFAR for AIDS prevention. (Photo: Rodney Muhumuza, Associated Press)

One year later, will President-elect Trump stick to his word?

Even as Trump’s views rotate toward conservative GOP ideology the closer we get to inauguration day, he has altered his positions on domestic healthcare a number of times, both pre- and post-election. In April, the Washington Postreported that Trump changed his position on abortion five times in just three days.

And what of the Affordable Care Act, or Obamacare, the health reform law that Republicans have demonized ever since it was enacted in 2010? Trump and his fellow 2016 GOP presidential candidates, together with Republicans in Congress, have made it clear that repealing the law will be one of their first initiatives in 2017. Now Trump is not so sure.

“Either Obamacare will be amended, or repealed and replaced,” he told CNNfour days after the November 8 election, acknowledging that it was Obama, who met with Trump in the Oval Office for 90 minutes, who encouraged him to reconsider. “I told him I will look at his suggestions, and out of respect, I will do that.”

If ACA is repealed, an estimated 22 million people, many of them poor and older, will lose their health insurance, according to a November 28 New York Times editorial. After his meeting with President Obama, Trump seems open to compromise. The key word is “seems.”

And if Trump so easily flips-flops on domestic healthcare policies like abortion and ACA, what can be expected on the global HIV crisis? Which brings us back to World AIDS Day.

Absent a crystal ball into Trump’s HIV/AIDS global plans, today is a day for action. Whether partnering with the ONE initiative to empower women to take action, or working with the International Medical Corps to relieve suffering, or volunteering with the CDC to rally a domestic response, World AIDS Day inspires small and large acts of hope every December 1, and throughout the year, for achieving an AIDS-free future.



Xi and Me: Tales from the Kalahari

In Africa, Botswana, Peace Corps on February 6, 2011 at 6:10 pm

In the movie The Gods Must Be Crazy, the protagonist, Xi, a Bushman from Botswana, finds a Coca-Cola bottle in the Kalahari Desert. The bottle, dropped from a plane, is unknown to Xi [pronounced zee] and his people. As the story unfolds the mystery and significance of this “gift from God” turns Xi’s uncomplicated world upside down. Separate characters appear and plotlines evolve – most affecting emotions and encounters Xi had never before – but the central theme is that the bottle’s discovery is a life-changing revelation for Xi.

My epiphany begins in the Kalahari, too, but as a Peace Corps volunteer on the eastern edge of the desert in Serowe, an almost movie-set-ready traditional African village. A tad southeast of the Okavango Delta, Serowe is midpoint on the paved road between Gaborone, the capital, and Harare, Zimbabwe. When it rains, which seldom happens on the arid, grassland savannah, the mud walls and thatched roofs of rondavel homes turn deep coffee-brown and burnt-red. After it dries and sun blues the open sky, the well-watered, fertile land of low sagebrush ripens to a rich, rustic olive-green and yellow-gold.

Before Botswana, my life, like Xi’s preceding the bottle, is remarkably ordinary. Born and raised outside Boston, I grew up in the blissful, if not humdrum, suburban existence of the 1960s and 70s, in a split-level ranch with a hard-working father, a stay-at-home mother and three siblings. There were the typical cast of characters and subplots; plenty of friends rolled in an out of my life with whom I endured early love and heartache. I didn’t travel much; never left the States.

By my teens I was an American with a pedestrian sense of society, tradition and culture. Self-assured? Yes. Stubborn? A little bit. But I was eager to learn about a life beyond anything I had ever called home. I dreamt of somehow pushing the limits of my sense of self and my relationship to the world around me. I cobbled together a mental album of memories and anecdotes, secretly hoping that my oh-so-boring life adds up to a life-that-matters saga where, like Xi, a seemingly celestial transformation might one day change my reality.

Growing up Irish-Catholic in Massachusetts I was drawn to the idealism of President Kennedy and the thought of one day working overseas with the public-service agency he created, the Peace Corps. So I inquired, applied, interviewed and, to my delight, was accepted. I joined for reasons similar to other volunteers: altruism and adventure.

When I arrived in Botswana I lived with a host family and trained at St. Gabriel’s mission with my newly arrived fellow volunteers. Carl was one of them. His host family lived halfway between my host family and the mission. Each morning I’d stop by Carl’s and we’d continue on to St. Gabriel’s.

One morning, waiting for Carl in the middle of his family’s compound, I came upon a wooden barrel. Inside was a shiny, milky brown-grey liquid. Nosy and curious, I stuck my head deep down inside the dank container and inhale its contents. My reflection, a fuzzy distortion, echoed back like a fun-house mirror. I quickly realized the liquid was chibuku – southernAfrica’s moniker for indigenous beer – fermenting in the barrel. I had heard about the notorious homemade brew, popular among expats for its high-alcohol content, from our Botswana Peace Corps trainers.

Dumela” (the standard Botswana greeting), I shouted to no one in particular when my head popped up. “Is this chibuku?”

The compound – awhirl with adults, children, a goat, several chickens and a stray dog seconds before – was now still. All eyes were fixated on me. No one moved. Not the mother pounding millet. Not the teenage boy brushing his teeth by the bushes. Even the father, hung-over and thrashing about, eyes cherry-red from drinking too much chibuku the night before, was frozen.

As an American I had learned to smell my food and drink. A whiff of pleasant aroma traveling up my nasal cavity and my brain said eat, drink and enjoy. But it occurred to me that I had done something wrong.

Carl joined me hovering over the barrel. Oblivious to his family’s sudden displeasure he said, “Yes its chibuku. They’ve  been brewing it all night. See you later,” he yelled to the family as we head off to St. Gabriel’s. “We’ll try the chibuku when we get back tonight.”

But the chibuku was gone when Carl and I returned. That morning we learned it is taboo to smell food or drink in Botswana. It’s considered unhygienic to stick one’s nose near either, our trainers warned. Carl’s family had discarded the beer once they saw my honker sniffing around; it was deemed contaminated, unfit to drink or sell. I was mortified by the thought that I had deprived Carl’s family of potential income and humiliated that I had caused him shame.

When we completed the two-month Peace Corps training in Serowe, I moved 200 kilometers south to teach journalism at the Ministry of Agricultur in Gaborone. Gabs, as it is endearingly referred to, was by all accounts a bustling developing-country metropolis. On weekends the city’s vibrant commercial mall buzzed with shoppers gawking to and fro and sellers hawking curios meticulously arranged on multihued African fabrics. Malachite carvings and jewelry glistened. Teak and mahogany chessboards enticed. Exquisite sawgrass-weave baskets – embroideryBotswanais world famous for – seduced prospective buyers. There was also the mall bank where I cashed my Peace Corps stipend and the post office where, like a kid at Christmas, I gleefully snapped up care packages sent stateside family and friends.

My first visit to the post office and I saw chaos all around. Customers were jam-packed; haphazard everywhere. I staked a position in a long zigzag line and waited my turn at the counter. I surveyed the disorder and waited but the line didn’t move. If only I could jump behind the counter, I imagined, I could fix this mess. I’ve done my time bagging groceries and processing purchase orders in corporateAmerica, I thought. I know good customer service. My patience quickly ran thin. Frustrated, I left the post office without my package to try another day. To my surprise the post-office waiting line – or the bank waiting line – seldom improved. Henceforth I was never in a line in Botswana again without a good book. I got lots of reading done.

One of my first assignments at the Ministry was to travel with my Botswanacolleagues to Ghanzi, a preposterously isolated village deep in the Kalahari, to cover an agricultural show. It was brutal three-day drive through unforgiving desert sand. Eight- to 10-hours each day of trashing up and down in the backseat. My hand muscles atrophied from gripping handrails so long. My head throbbed and my back ached.

The drive challenged sense of adventure. I missed smooth paved roads and quick commutes. I felt a long way from civilization. I went from imaging the truck breaking down, to a frying death under a cruel sun, to being eaten by vultures. So I tried to recall what brought me to the Kalahari. I breathed deep and focused on meditation. I looked around and daydreamed it was Xi country. I kept an eye out for Coke bottles. I saw none but one day the driver threw a soda can out the window and I followed it in the rearview mirror until it disappeared, swallowed in the hazy, mercilessly bleak but stunningly beautiful wilderness where I knew it would remain long after I left Botswana. The thought haunted me.

To assuage my anxiety during those three days, I incessantly chatted up my Botswanacolleagues or nervously flipped through a strangely forlorn copy of an American Ladies Home Journal. One day Nyelle, one of my colleagues, pulls out a bag of what looked like charred, hairy caterpillars. They’re mopane worms, he informs me. He starts popping them one-by-one in his mouth like popcorn. The worms, once moths, he says, are found on mopane trees, vegetation that grows only in sub-Saharan Africa and is an important source of protein for indigenous people. Preparation involves squeezing the guts out, Nyelle extols, a bit of oil, a lot of salt, and a toss in the oven. He offers me one.

My face grimaces at the notion of eating worms. I decline the offer. I’m American, I enlighten Nyelle, and I don’t eat insects, especially caterpillar-like worms that were once moths on trees. I show him a picture of lobster in Ladies Home Journal.

“Lobster is a delicacy in my country,” I announce.

His face cringes. “Mopane worm is a delicacy here,” he says, “and lobster is just a disgusting, bottom-feeding big ocean insect.”

I snicker and roll my eyes. Then I concede and extend my hand, reluctantly, for a mopane worm. Just as I had thought it tasted like cardboard.

In the final scene of The Gods Must Be Crazy, in order to restore peace in his world, Xi takes the bottle to the “end of earth” and throws it back to the gods. He returns to his village a hero and embraces a new life infused with the insight that the world is at once good and bad, happy and sad, right and wrong. It’s all in the perspective, an engaging tale.

My tale is by no means complete. In the chapters since Peace Corps I am an American seeded by epiphany unearthed in the Kalahari. There is no hero to my story, certainly no bottle from the gods, but there is a gift. A beautiful transformative irony; the glorious revelation that sometimes it’s taboo for me to smell food, that patience is a mutable state of mind and that I’ll try anything once, generally speaking, even wolfing a few worms, gutted and baked of course.

By David R. Gately