A world away

For Dr Jane Wall and her partner, nurse Sally Simpson, fighting AIDS in the African nation of Lesotho is a confirmation of their work in Toronto.

“I have been privileged to care for many people living with HIV/AIDS over the past 15 years. Many of those people have allowed me to care for them through to their deaths. Each person has touched my heart and has been my teacher,” says Simpson. “It is in honour of each of their lives that I want to share the knowledge that they entrusted me with. And I know that they guide me, and this team, in our work in Lesotho.”

Lesotho is seemingly a pastoral place that time forgot, where many villages can only be reached by horseback and much of the country remains undeveloped.

But the tiny mountain kingdom – which is completely surrounded by the country of South Africa – is also among the countries in the world most affected by HIV/AIDS, with some 30 percent of its adult population infected with the virus.

According to the World Health Organization (WHO), Lesotho not only faces a serious HIV/AIDS problem, but a worsening one.

“One in three people 15 to 49 years old in Lesotho is HIV- positive, among the highest rates in the world,” says the WHO in a recent summary profile of the country. “Not only are the numbers of people dying of AIDS increasing drastically, the number of new HIV infections is very high with no indication that the epidemic is stabilizing.”

And, although the small country is a leader among sub-Saharan African countries in dedicating resources and strategies to fighting HIV, it is also one of the 10 poorest countries in the world.

To help, the Ontario Hospital Association (OHA) has stepped forward with a new project aimed at increasing the capacity of Lesotho to treat and care for those living with HIV/AIDS within its borders.

The OHAfrica Lesotho project is a joint initiative between the OHA and the Change Foundation. It was established in response to a challenge issued by Stephen Lewis, the United Nations’ special envoy on HIV/AIDS in Africa, to help fight the HIV/AIDS pandemic in sub-Saharan Africa.

Working with partners in the health care system, including the Registered Nurses Association Of Ontario, teams of HIV/AIDS professionals will arrive in Lesotho in December and January to assist in training doctors, nurses, pharmacists and laboratory technicians on HIV/AIDS treatment and care.

“We plan to take what has already been learned in similar projects in other African countries, the expertise of health care professionals and care-givers already working with HIV-positive people in Lesotho, and add the experience and expertise of our team to establish a sustainable frontline approach to HIV health care in Lesotho,” says Wall, one of the members of the January team. “Ultimately substantial numbers of HIV-positive people will receive HIV treatment. If all goes well, we hope that others will take the best of our program and use it in future efforts.”

Wall, a Toronto radiologist with a specialized expertise in treating people infected with HIV/AIDS, and her partner Simpson, a registered nurse with the St Michael’s Hospital HIV Team, will be leaving with the January team later this month. They are scheduled to return in July.

“The project is about setting up a clinic that distributes HIV/AIDS medication in one particular location of Lesotho. That, while it is easy to say, has its own host of pretty serious challenges,” says Ottawa-based doctor Robert Birnbaum, a leading travel health physician with extensive experience on the ground in Lesotho as part of the Flying Doctor Service from 1979-1981. “We are there to really figure out for the OHA how can this project unfold and, as soon as we can, basically get it off the ground.”

Birnbaum, and his partner Russell Armstrong, a vice-president at The Ottawa Hospital and former executive director of the Canadian AIDS Society, left late last month as part of December’s advance team and are scheduled to return at the end of January.

Armstrong points out that Lesotho is a supporter of the United Nations “3 by 5” AIDS Initiative on HIV/AIDS in Africa, which seeks to have three million Africans infected with HIV on anti-retroviral treatment by 2005.

For its part, Lesotho hopes to have 28,000 patients in treatment by the end of next year. By assisting in the treatment and care of patients with HIV/AIDS, Armstrong says the OHA project will help Lesotho meet its goal.

Armstrong adds that in addition to language and cultural barriers, there is still a huge amount of stigma and fear across Africa regarding HIV/AIDS.

“And to us it seems extraordinary to have one of the worst situations and yet it is still very difficult for people to accept their HIV status – either privately or publicly – and for the country to really mobilize itself to address the situation,” says Armstrong.

Previously, the largest issue for third-world nations such as Lesotho regarding its HIV/AIDS programs was the cost of the anti-retroviral medications needed to help those infected.

But now, Armstrong says, through the UN’s “3 by 5″ initiative,” that problem is “beginning to get solved.”

“Monies have now been given to countries like Lesotho to purchase the medications for its population, but the challenge is that it has no health infrastructure to distribute these medications – and basically to monitor and care for these people who are on them,” he says.

“And we need to extend ourselves to those who might be too afraid to be tested. As many would attest to here in Canada, being on HIV treatment is by no means easy, and is life-changing. But it is also life-saving,” says Simpson.

But despite the difficulties that will arise as the two teams attempt to set up the clinic, all four say they are ready to help provide the Lesotho people with the right tools to combat the disease that has ravaged their country.