|
Haiti Video Transcript
AIDS HAS BEEN UNIQUELY PAINFUL IN HAITI. EARLY ON SCIENTISTS THOUGHT
THE U.S. EPIDEMIC CAME FROM HERE. ALL HAITIANS WERE PUT ON A WATCHLIST
OF FOUR HIGH-RISK “Hs”: WITH HEROIN USERS, HEMOPHILIACS AND
HOMOSEXUALS. FIRST LADY MILDRED ARISTIDE LIVED IN NEW YORK AND RECALLED
THE HUMILIATION
Mildred Aristide
"I remember, I was a college student in 83 or so and we were going
to do a blood drive. And that was one of the questions asked by the
Red Cross that was collecting the blood, whether I had been to Haiti
or was of Haitian origin and so that has made it a special issue because
there had been an attempt to label Haitians as being the cause of the
disease."
ALTHOUGH UNFAIRLY STIGMATIZED, HAITI DOES HAVE A SERIOUS AIDS PROBLEM.
IT CLAIMED 30,000 LIVES LAST YEAR. TEN TIMES THAT NUMBER ARE HIV POSITIVE.
PREVALENCE IS ABOUT FIVE PERCENT ALL TOLD, 10% IN URBAN AREAS. IT IS HIGHEST
IN THE HEMISPHERE BUT IT SHOULD BE MUCH HIGHER
Dr. William Pape
"We have all the factors that would predispose this country to
have rates as high as 40, 50%. Especially, the disease started here
early, it spread very fast in the heterosexual population. We have the
highest rate of sexually transmitted disease. We have also; we’re
the poorest country with a very high rate of commercial sex workers
who are HIV infected If you put all this together this is the best recipe
for an explosion of the HIV epidemic. Yet this has not occurred…"
ONE REASON IT HASN’T OCCURRED IS THE WORK OF TWO WORLD-RENOWNED
PUBLIC HEALTH FACILITIES. THEY’VE DEVELOPED LOW COST APPROACHES
TO PREVENTION AND CARE. DR. JEAN WILLIAM PAPE’S GHESKIO CENTER…
STARTED 20 YEARS AGO IN PORT AU PRINCE…IS ONE
Sound-up: This is the workload for 2002. We did almost 30,000 HIV tests.
There were more than 23,000 ELISA tests and almost 6000 rapid tests.
And then we did over 18,000 tests for syphilis including a more sophisticated
test for syphilis, about 1500. And we also do rapid tests for tuberculosis
as well, in the year 2000, we did almost 10,000 stains for…tuberculosis.
Sound-up: rural, Cange…
IN THE REMOTE CENTRAL PLATEAU IS HAITI’S OTHER WELL-KNOWN HEALTH
CENTER: ZANMI LASANTE, OR PARTNERS IN HEALTH. FOUNDER PAUL FARMER SPLITS
HIS TIME BETWEEN HERE AND HARVARD MEDICAL CENTER BUT HIS MOTTO IS ONE
STANDARD OF CARE…
Dr. Paul Farmer
"We said we want to have a standard of care for our HIV patients
that is, that might be the same as you’d see in Boston or some
other place. In the six years that we’ve tried to launch it we’ve
never really been able to do it. The great limiting factor has always
been money. It’s always been medications. And now for the first
time with the global fund money comes through our great limiting factor
will be we won’t have enough time, we won’t have enough
staff, we won’t, it’ll be something completely different
but it won’t be money for the first time. So it’s really
exciting…"
HAITI IS THE FIRST DEVELOPING NATION WHERE ANTI-RETROVIRAL DRUGS WILL
BE SOMEWHAT WIDELY DISTRIBUTED. THESE SO-CALLED “COCKTAIL”
DRUGS HAVE ALLOWED AIDS PATIENTS IN RICHER COUNTRIES TO LEAD ALMOST NORMAL
LIVES. BUT THEY’VE LONG BEEN CONSIDERED TOO EXPENSIVE AND NOT FEASIBLE
IN POOR COUNTRIES.
Dr. Paul Farmer
"One of the biggest set of myths we’re dealing with are
about therapy for HIV. HIV, it can’t be done in a placed like
this. You know, people don’t have other rights, they don’t
have a concept of time, they don’t have wristwatches, the medications
have to be refrigerated. It’s not cost effective. You know, it’s
not anything you would ever initiate in a really poor country."
ON A SHOESTRING, DR FARMER INITIATED ANTI RETROVIRAL THERAPY IN THE LATE
90S TO A LIMITED NUMBER OF PATIENTS. ADELINE MERSON WAS ONE.
Sound-up: Adeline weighs in, talks to Farmer…
Dr. Paul Farmer
Farmer over video of Adeline exam: "You see that she weighs 117
lbs. And look here, this is when she started therapy: 79 lbs. So we
are a little bit… what’s the word? As the patients would
say, militant about these drugs because we keep seeing these startling
responses to therapy. For people like them it’s either anti retrovirals,
or, you know, as she’d probably tell you, or a coffin. In fact
that was a discussion with her father who was saying he needed to borrow
money to buy her a coffin… this was while she was still alive.
And I said, “Well, we got one last trick up our sleeves.”
she’s starting her fourth year of therapy. No complications."
ADELINE IS NOW EMPLOYED BY PARTNERS IN HEALTH AS AN OUTREACH WORKER
Adeline: (Creole, trans): "I just pray to god to keep me alive
so I can see my children’s future, and that I can continue to
have these medications so we have a future, and continue to work in
this institution, which brought me back to life...like Lazarus".
ONE BENEFIT OF BRINGING ANTIRETROVIRAL THERAPY TO RURAL HAITI IS THAT
MANY MORE PEOPLE ARE COMING INTO CLINICS TO BE TESTED FOR THE AIDS VIRUS.
FOR THE FIRST TIME, DOCTORS SAY, PEOPLE HAVE BEEN ABLE TO WITNESS AIDS
PATIENTS GET BETTER…
Dr. Paul Farmer
"Suddenly you have treatment and a lot more people want to be
screened. You’re going to get a lot more people who are negative,
who are sero-negative, that is, they don’t have HIV and that’s
when you can start making interventions to keep them from getting HIV."
FOR THOSE WHO TEST POSITIVE, IT HELPS TO KNOW EARLY, TO TREAT THE OPPORTUNISTIC
INFECTIONS THAT KILL THOUSANDS OF AIDS PATIENTS IN POOR COUNTRIES. FOR
EXAMPLE, TUBERCULOSIS, IS RAMPANT HERE, YET IT’S EASILY TREATABLE
FOR JUST A FEW CENTS PER PATIENT
Sound-up: Bonjour Ketya…
19-YEAR OLD KETYA, WHO IS HIV POSITIVE, LOST HER MOTHER AND TWO SIBLINGS
TO TUBERCULOSIS. SHE NOW LIVES WITH HER FATHER. BOTH HAVE BEEN TREATED
FOR TB
Sound-up: from check up
MEDICINES MUST BE TAKEN AS DIRECTED, SO THEY WORK AND TO PREVENT THE
VIRUS FROM DEVELOPING RESISTANCE. VOLUNTEERS ARE RECRUITED…AS ACCOMPANIATEURS
Dr. Paul Farmer
"And the accompaniateur is the person who sees the patient every
day, go and get the med, and then they deliver them to the patient.
So this is a way to protect our stock and make sure that we can follow
and track the medications and see where they’re going."
SOMETIMES, NOT IN THIS CASE, THE VISITNG HEALTH WORKERS THEMSELVES ARE
HIV POSITIVE…
Dr. Paul Farmer
(over Ketya home visit video): "Our prevention efforts rely on
people living with HIV. And we have a partner project in Boston where
again we, the peer outreach workers are mostly people living with HIV.
They’re the ones doing the prevention work. And it’s not
just because they can say, “look, I’ve got HIV and this
is how you can protect yourself,” it’s also because they’re
doing secondary prevention too. They’re actually, you know, it
has…their own engagement with this has an impact on their own
comportment. So and I think that’s a message that needs to be
our there is that a serious prevention project has a care component."
Sound-up: Ketya check up
SOMETIMES A DOCTOR GOES ALONG, LIKE DAVID WALTON, A RECENT HARVARD MEDICAL
SCHOOL GRADUATE…FOR NOW, WALTON FINDS KETYA’S PROBLEMS ARE
NOT MEDICAL BUT FINANCIAL…
Dr. David Walton
"Today, I learned…and I didn’t know…that she’s
not in school. She’s 19, she has been in school but doesn’t
have enough money to pay for school33:16: The other big issue is the
house. This house is not…her father does not own this house, they
rent this house and they say they don’t have any money to pay
rent. They pay rent every six months. We also can help her do this.
These types of things are what I consider, what we as an institution
consider social crises. Part of our job is not only to treat diseases
but to alleviate…in some small way which we can…this crushing
poverty."
USING MOSTLY DONATIONS, PARTNERS IN HEALTH WILL SUPPLEMENT THE MEAGRE
INCOME FROM THIS FAMILY’S TRIES TO EXTRACT FROM THIS STINGY PLOT
OF LAND
Dr. David Walton
" If she didn’t find money to pay for the house, if she
didn’t go back to school, she’d have to do something to
put food on the table and help her father and that may entail maybe
going to Port Au Prince or choosing a partner who can give her some
kind of financial assistance. Q: Prostitution, in essence? DW: In a
way, you can view it as such. Q: Paul Farmer called it survival sex,
yesterday. DW: That’s perfect. Survival sex. She’d have
to have sex with this person to survive and this person would likely
have other partners and she’d be exposed again. And then, if he
wasn’t sick, she’d be exposing him. So, I mean, this is
the way we can epidemiologically kind of step in and stop the progression
and spread of disease.
BUT MISERABLE ECONOMIC CONDITIONS MAKE IT HARDER TO SUSTAIN PUBLIC HEALTH
GAINS
Sound-up: Farmer greet in ward: Bonjour, Isaac…
ALMOST EVERY WEEK, DR FARMER SAYS, THERE ARE CASES LIKE ISAAC, SUFFERING
FROM TYPHOID, A DISEASE FROM CONTAMINATED WATER
Sound-up: I don’t think he’s going to make it
INDEED THREE DAYS AFTER OUR VISIT, ISAAC DIED…AT AGE 10.
DR FARMER SAYS HAITI DESPERATELY NEEDS ROADS, WATER TREATMENT PLANTS
AND NEW ECONOMIC DEVELOPMENT.
Dr. Paul Farmer
"How can we do a good job taking care of our patients and making
sure they have, you know, good outcomes…you know that they do
well when they have these medications…if we can’t get them
clean water or get their kids in school or hope for safe transportation.
We just had a guy die in a car accident, a guy with HIV. Didn’t
die of HIV, died of, you know, in a car accident. The roads are terrible."
WHILE DR FARMER IS OUTSPOKEN, PARTICULARLY IN CRITICIZING U.S. FOREIGN
POLICY TOWARD HAITI, HIS URBAN COUNTERPART, DR. PAPE, TAKES A MORE RESIGNED
VIEW OF THE SOCIOECONOMIC PROBLEMS.
Dr. William Pape
"We will not be able to change the conditions of the country;
the socio economic conditions are things that we have no power over.
We found very early that even though the socio-economic conditions are
not the best or are worse that you have specific interventions that
you can do to reduce the impact to both the morbidity and the mortality
of terrible diseases such as diarrhea, HIVAIDS, tuberculosis…"
Sound-up: This is the counseling unit where we see about 500 people
a day, people coming for pretest and post-test counseling
THE HALLMARK OF DR PAPE’S APPROACH IS CLOSE SURVEILLANCE AND EARLY
INTERVENTION…
Dr. William Pape
"Once they are enrolled, we do tests for HIV, syphilis, tuberculosis.
So if they have syphilis or sexually transmitted diseases, we take care
of it the same day. And if it’s a pregnant woman, we do rapid
tests and then we have them back in 7-10 days to do post test counseling.
Then they are referred to the various clinics, HIV clinic, STD clinic,
TB clinic and we also provide nutritional support…"
Sound-up: clinic activity
Dr. William Pape
"We started testing here in 1985. In 1985 almost 100% of people
were very sick. They would come in with AIDS, practically. I would say
now we would have only 10-20% of people who are symptomatic and among
those maybe half would have AIDS. The majority of people come in asymptomatic.
If somebody feels that they’ve had a risky behavior, that person
will tend to come and be tested. Q: That’s a huge public health
gain, is it not? DP: Yes, definitely, we see them very early. I think
this is why voluntary counseling and testing centers offer the opportunity
to do prevention and offer care as well."
ANTI RETROVIRALS OR ARV DRUGS HAVE BEEN SCARCE HERE…RATIONED TO
A HANDFUL OF CHILDREN…NOT EVEN TO THEIR MOTHERS…SAYS PEDIATRICIAN
DR FRANCINE NOEL
Dr. Francine Noel
"One of the mother told me that if she could take some of the
drugs of her child… herself. Q: She wanted to take them? DN: Yes,
She wanted to break a piece and take it herself and we had to explain
to her and make sure that she was not taking the drug of …her
child."
GLOBAL FUND DOLLARS WILL PROVIDE MANY MOTHERS WITH ARV DRUGS. DR PAPE
HOPES TO NEGOTIATE THEIR COST DOWN TO ABOUT $500 A YEAR…A THIRD
OF THE CURRENT DISCOUNTED PRICE OFFERED BY DRUG MAKERS
Dr. William Pape
"And we have determined national guidelines for this. The right
time to do that (is) before there is a wide massive use of ARV drugs.
So we know exactly the type of regimen that we want to give and the
reason we want to give them first line, second line drugs. So this is
very, very important. So once the drugs come in to the global fund program,
we’ll be able to use them in a very rational manner."
GLOBAL FUND DOLLARS WILL PROVIDE ANTIVIRAL DRUGS FOR SOME BUT NOT ALL
PATIENTS. THE DRUGS ARE ONLY PART OF THE OVERALL STRATEGY. MOST OF THE
NEW MONEY WILL BE USED TO OPEN 25 NEW TESTING AND COUNSELING CENTERS ACROSS
THE COUNTRY. FIRST LADY ARISTIDE SAYS MANY MORE PEOPLE WILL GET HIV TESTS,
AND THAT WILL GREATLY HELP IN PREVENTION…
Mildred Aristide
"I think the most important tool the global fund project brings
is this capacity, because then Haitians and women specifically…because
the women in my estimation have been the most vocal in wanting to know
their status…can be active agents of prevention, information,
education, passing it on to their children what they need to do. And
right now we don’t have the capacity for folks to be able to be
tested."
HER BIGGEST WORRY? PEOPLE’S RISING EXPECTATIONS…
Mildred Aristide
"If we achieve, you know, for instance, having being able to increase
the percentage of the population that can be tested, okay, now what?
What do you provide these women? And the obligation in terms of health
care, in terms of nutritional care and all the other social services
which they must have access to. That becomes an obligation to continue…"
MRS ARISTIDE HEADS THE GOVERNMENT’S AIDS EFFORT AND SHE’S
WON WIDESPREAD PRAISE. SOLID GOVERNMENT SUPPORT WAS ONE FACTOR THAT WON
HAITI ITS GLOBAL FUND AWARD. DESPITE TWO DECADES OF POLITICAL TURMOIL,
SUCCESSIVE GOVERNMENTS HAVE ALWAYS SUPPORTED THE ANTI AIDS EFFORT…WITH
BUILDINGS, LOGISTICS, COORDINATION AND, DOCTORS SAY, ACCOUNTABILITY…
Dr. William Pape
"To us it is a matter of national pride because you know we were
linked with, unjustly, with the HIV epidemic from day one. And for us
it is very important to get this disease under control."
DR PAPE HOPES THE NUMBER OF HAITIANS LIVING WITH THE AIDS VIRUS CAN BE
CUT BY A HALF. THAT WILL CONTROL, IF NOT ELIMINATE, THE EPIDEMIC…UNTIL
A VACCINE PROVIDES THE ANSWER. JUST DOWN THE HALL FROM HIM, 40 PEOPLE
ARE ENROLLED IN ONE SUCH VACCINE TRIAL…
Dr. William Pape
"We used to say that only the optimist people have stayed in Haiti.
You are talking to an optimist person…"
|
