An Impatient Optimist

Dec 01 2011

An Impatient Optimist's View of HIV
by SENATOR WILLIAM H FRIST MD

Impatient Optimists: The Bill and Melinda Gates Foundation
 
In 1981, I was a surgeon in training at Massachusetts General Hospital in Boston. I still remember the day we learned about a strange, new, deadly infection that presented on the West Coast. A little over a year later, we learned it was caused by a virus transmitted in the blood, a vital fact for a doctor performing surgery every day.

As I watched the epidemic grow from a handful of cases to a few hundred to several million, I also witnessed the cases grow in biblical proportions in less developed nations, namely across Africa. While I served in the Senate, I volunteered on annual mission trips to do surgery in villages ravaged by civil war. In these forgotten corners of the world, I witnessed how HIV was hollowing out societies.

Drawing on these firsthand experiences, as the Senate Majority Leader I encouraged and supported both the PEPFAR program and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Global Fund, a multilateral institution with the U.S. as the leading contributor, leverages $2 for every single dollar given, all to combat this trilogy of diseases that disproportionately attack children and young adults in the poorest nations on the planet.

The remarkable news is that millions of lives have been saved by these investments. Thanks to the Global Fund, over 3.2 million people living with HIV are on lifesaving treatment.

I am proud to have been part of a government whose leadership, acting on behalf of the American people, has led the world and literally saved the lives of millions of people globally.  

In 2008, I co-chaired the ONE Campaign’s ONE Vote ’08 Campaign. We brought a delegation of Republicans and Democrats to Rwanda to see firsthand the good work being done by the funding of the Global Fund, PEPFAR, and the President’s Malaria Initiative.

In Eastern Rwanda we visited the inspiring Rwinkwavu Clinic, run by Dr. Paul Farmer’s Partners in Health. With 110 beds and eight health centers, this clinic provides essential medicines, supplies, and equipment and recruits, trains, and retains staff to ensure a sustainable infrastructure for the future.

But without Global Fund funding, the Rwinkwavu Clinic could not provide health care services to the people of Rwanda. This is true for so many organizations and clinics worldwide.

And it’s unfortunate that even though we see investments pay off, lives saved, and economies grow, the Global Fund was forced to cancel its round 11 funding. This means clinics like Rwinkawvu will only be able to support those currently on HIV treatment and not add any new patients. This is alarming because in low-income countries half of people living with HIV are not receiving treatment.

At a time when our own economy is faltering, and our national debt is growing unacceptably, we have to tighten our belts. To do so, we need to decide where we make smart investments and where we do not.

The fact is that the American people spend less than one-quarter of 1% of our federal budget on global health and fighting global epidemics like HIV, tuberculosis, and malaria. With this little sliver of the pie, the Global Fund’s return on investment means more sustainable economies, less global instability, and healthier families. For less than a penny to the dollar spent on all foreign aid, we are investing in the lives of children, mothers, and our own national security.

On the horizon is excellent news for HIV. New evidence suggests male circumcision, microbicides, and quicker AIDS treatment will markedly decrease the disease. Combined with known prevention methods like condoms and nevirapine, we are on the right track to substantially halt the growth of HIV/AIDS.

I’m an optimist, an impatient optimist. We will win the war on HIV, tuberculosis, and malaria.  Our investments have worked. The end is in sight. We just have to be smart enough to continue to invest wisely, using health as a currency for peace around the world.
By BONO
New York Times

I’LL tell you the worst part about it, for me.

It was the look in their eyes when the nurses gave them the diagnosis — H.I.V.-positive — then said there was no treatment. I saw no anger in their expression. No protest. If anything, just a sort of acquiescence.

The anger came from the nurses, who knew there really was a treatment — just not for poor people in poor countries. They saw the absurdity in the fact that an accident of geography would deny their patients the two little pills a day that could save their lives.

This was less than a decade ago. And all of us who witnessed these dedicated African workers issuing death sentence after death sentence still feel fury and shame. AIDS set off an almost existential crisis in the West. It forced us to ask ourselves the big, uncomfortable questions, like whether capitalism, which invented the global village and kept it well stocked with stuff, could also create global solutions. Whether we were interested in charity... or justice.

The wanton loss of so many lives in Africa offended the very idea of America: the idea that everyone is created equal and that your destiny is your own to make. By the late 1990s, AIDS campaigners in the United States and around the world teamed up with scientists and doctors to insist that someone — anyone — put the fire out. The odds against this were as extreme as the numbers: in 2002, two million people were dying of AIDS and more than three million were newly infected with H.I.V. Around 50,000 people in the sub-Saharan region had access to treatment.

Yet today, here we are, talking seriously about the “end” of this global epidemic. There are now 6.6 million people on life-saving AIDS medicine. But still too many are being infected. New research proves that early antiretroviral treatment, especially for pregnant women, in combination with male circumcision, will slash the rate of new H.I.V. cases by up to 60 percent. This is the tipping point we have been campaigning for. We’re nearly there.

How did we get here? America led. I mean really led.

The United States performed the greatest act of heroism since it jumped into World War II. When the history books are written, they will show that millions of people owe their lives to the Yankee tax dollar, to just a fraction of an aid budget that is itself less than 1 percent of the federal budget.

For me, a fan and a pest of America, it’s a tale of strange bedfellows: the gay community, evangelicals and scruffy student activists in a weird sort of harmony; military men calling AIDS in Africa a national security issue; the likes of Nancy Pelosi, Barbara Lee and John Kerry in lock step with Bill Frist and Rick Santorum; Jesse Helms, teary-eyed, arriving by walker to pledge support from the right; the big man, Patrick Leahy, offering to punch out a cranky Congressional appropriator; Jeffrey Sachs, George Soros and Bill Gates, backing the Global Fund to Fight AIDS, Tuberculosis and Malaria; Rupert Murdoch (yes, him) offering the covers of the News Corporation.

Also: a conservative president, George W. Bush, leading the largest ever response to the pandemic; the same Mr. Bush banging his desk when I complained that the drugs weren’t getting there fast enough, me apologizing to Mr. Bush when they did; Bill Clinton, arm-twisting drug companies to drop their prices; Hillary Rodham Clinton, making it policy to eradicate the transmission of H.I.V. from mother to child; President Obama, who is expected to make a game changing announcement this World AIDS Day to finish what his predecessors started — the beginning of the end of AIDS.

And then there were the everyday, every-stripe Americans. Like a tattooed trucker I met off I-80 in Iowa who, when he heard how many African truck drivers were infected with H.I.V., told me he’d go and drive the pills there himself.

Thanks to them, America led. Really led.

This was smart power. Genius, really. In 2007, 8 out of the 10 countries in the world that viewed the United States most fondly were African. And it can’t be a bad thing for America to have friends on a continent that is close to half Muslim and that, by 2025, will surpass China in population.

Activists are a funny lot. When the world suddenly starts marching in step with us, we just point out with (self-)righteous indignation all that remains to be done. But on this World AIDS Day I would like you to stop and consider what America has achieved in this war to defend lives lived far away and sacred principles held closer to home.

The moonshot, I know, is a tired metaphor; I’ve exhausted it myself. But America’s boldest leap of faith is worth recalling. And the thing is, as I see it, the Eagle hasn’t landed yet. Budget cuts ... partisan divisions ... these put the outcome in jeopardy just as the science falls into place. To get this far and not plant your flag would be one of the greatest accidental evils of this recession.

Bono is the lead singer of the band U2 and a founder of the advocacy group ONE and the (Product)RED campaign.

Matt Landman
Resident
Kijabe, Kenya
Vanderbilt International Surgery

matt landman kijabe 1

(Photo: Matt Landman at left)

It’s now been one full week since my arrival in Kijabe, Kenya.  Simply speaking, to understand everything I’ve seen and experienced in the past week will take months of careful thought and reflection.   I’ve seen the shackling consequences of poverty, the natural history of surgical disease more advanced than I’d ever seen before, a lack of medical resources, and the list goes on; but, overshadowing all of this, I’ve seen the good several committed people can do at one place in time to positively affect patients and their families for a lifetime. 

My first full day in the hospital was spent in the general surgery clinic.  I use the description “general surgery” but in reality, if forced to label it back at my home institution in the U.S. it would be better described as the general surgery - urologic surgery- otolaryngology -surgical oncology -endocrine surgery -thoracic surgery –vascular surgery-wound care-palliative care clinic. 

I never imagined a more unique conglomeration of surgical diseases coming through the door in a single day.  While the pathology was interesting (and inspiring to hit the books to expand my surgical knowledge) I was most struck by what each procedure meant for the patient—particularly the financial toll.  Instead of flashing an insurance card and putting down a small copayment, each patient (and many times their family) was required to produce a down payment for the recommended procedure.  If they required a cholecystectomy it would be x-amount of Kenyan shillings.  If they required a colonoscopy it would be y-shillings.  Quite foreign to me (and most in the US) was the readily available price tag, if you will, for each procedure (I should note that the payment system was different for emergency cases).  That price tag allowed me to clearly see the financial sacrifice, relatively extreme in some cases, made by patients and their families to improve (or simply maintain) their health. 

I often wonder what would happen to Americans if we were put in a similar situation.  Would we still spend most of our healthcare dollars at the end of life?  Would we be doing radical resections with small chances of cure?  Would emergency rooms still be overcrowded?  What would I give up in order to pay for me or my family’s medical care?  While I’m not sure of the answers, I know that many Americans, as I’ve seen these Kenyans do countless times this week, would step back and evaluate their priorities and healthcare need. 

The knowledge of these costs has another effect.  Physicians are forced to understand their healthcare consumption.   I certainly have been more cognizant here of what each laboratory test, imaging procedure or recommended operation would mean for my patients and have tapered my practice and recommendations to be cost-conscious while maintaining medical effectiveness.   Seeing the results of our operations and care here, I’m confronted with excellent results that don’t necessarily correspond to the amount spent on each case. 

It’s been a week and I’ve learned quite a bit, both medically and professionally.  I look forward to the coming weeks for more experiences in which I can look back and evaluate my role in this place and in surgery as a whole globally and in the U.S.

 

The Tennessean

by Bill Frist

Russian-U.S. relations are complicated and, at times, trying. But since we share a commitment to improve the health of our citizens, there is much we can learn through dialogue and collaboration. And there is no better place to do so than Tennessee, the heart of health-service delivery innovation.

Even at the height of the Cold War, U.S. and Russian scientists collaborated closely to eradicate polio and smallpox. Similar collaboration can lead to mutual benefit for today’s shared challenges, chronic disease and obesity, with a byproduct of improved diplomacy. Collaborations on health-service delivery in Tennessee between Russian and U.S. doctors are a powerful example of health diplomacy and a valuable currency for trust and understanding.

Russia has more doctors, health-care workers and hospitals than most countries, but standards remain variable. Prime Minister Vladimir Putin has committed $16 billion over two years to bolster working conditions, training, and national electronic health records with a promise to trim bureaucracy.

The Washington-based Open World Leadership Center invited 30 health professionals from Kirov State, Russia, to come to the U. S., specifically to Tennessee, to study and explore financing, organization and delivery of health infrastructure and services.

The Russian delegation spent a day in Washington to better understand how health policy is formulated at the federal level and to visit the National Institutes of Health. They then came to Tennessee for a week, spending time in Memphis, focusing on research, and in Knoxville, focusing on rural health delivery.

The visit culminated in Nashville, where they observed firsthand our $70 billion global health-care industry. Hosts Nashville Health Care Council and Hope Through Healing Hands welcomed the travelers to the “Silicon Valley” of health care.

Industry leaders citywide opened their doors with sessions on medical simulation at Vanderbilt and HIV research by Meharry. The group also received an inside look at the public health sector’s progress on making communities healthier from state Health Commissioner Dr. John Dreyzehner, Nashville Mayor Karl Dean and Metro Public Health Director Dr. Bill Paul. The day concluded with global disease-management leader Healthways, and focused on the company’s work to improve well-being through prevention.

Most valuable, however, was the opportunity to hear what the delegates found most applicable to their home. Among them were the development of IT for unified e-records, logistics for emergency services, and the great benefit of community volunteerism.

As the U.S. and Russia attempt to address growing health demands, we have much to learn from each other. Collaboration, using health as a currency for peace, will mean healthier societies, better diplomacy and improved bilateral relationships between our nations.

Sen. William H. Frist is a nationally recognized heart and lung transplant surgeon and former majority leader in the U.S. Senate.

Nashville Business Journal
by Chris Silva, Staff Reporter

Former Tennessee Sen. Bill Frist was at the Hermitage Hotel this morning with about 30 Russian physicians and a cadre of Nashville’s health care and business leaders to promote global unity and attempt to solve public health and behavioral issues that lead to chronic diseases.

Frist said Russia faces many of the same health care dilemmas as Middle Tennessee.

“We do have the best health service infrastructure here in Middle Tennessee, so why not share it with the global community – a oneness of mankind?” said Frist, who prompted Sen. Lamar Alexander to send a request to Open World Leadership Center to host the health exchange. “Out of our commitment to global health, democracy, being the best in the health service delivery and using health as a currency for peace, we had the conference today. It will be a foundation for future exchanges.”

The Russian visitors started out with a tour of Vanderbilt University Medical Center this morning and listened to a presentation from an expert from Meharry Medical College on HIV/AIDS research.

Ralph Schulz, president of the Nashville Area Chamber of Commerce, was on hand, as was Mayor Karl Dean.

“I am concerned most about this issue of obesity,” Dean said. “It’s going to be a battle that will be won or lost in the Southeast.”

Today’s events were hosted by the Nashville Health Care Council and Hope Through Healing Hands.

by Allison Greening

Vanderbilt International Anesthesia

Kibaje, Kenya

anesthesia

I arrived in Kijabe, Kenya with two other senior anesthesia residents from Vanderbilt midday Sat Oct 29th, after departing Nashville Thursday Oct 27th, flying overnight to London, and then all day to Nairobi. We spent the night in the Mennonite Guest House in Nairobi, where we met several missionaries coming and going to and from various parts of east Africa, and then were driven up to Kijabe the next morning.

We had been scheduled to travel Monday Oct 24th, but were delayed with security concerns due to the Kenyan army invading Somalia in response to recent kidnappings in northern Kenya, and threats of Al-Shabaab retaliation in Nairobi for a few days. Effectively this means we’ve missed a week, but three weeks are better than none! One of the first things we noticed about the place is its utopian feel. Justin, one of the other residents, referred to it as a “summer camp” feel.  It seems funny to think of any sort of terror attack happening here, in an idyllic small town mostly made up of missionaries who either work at the hospital or international school, but evidently someone has thought of it, as it’s surprisingly secure.

We spent the weekend getting settled in, and then started in the operating rooms on Monday. I have an interest in pediatric anesthesia, so have been running the pediatric room, though my compadres have been doing lots of regional anesthesia with the new ultrasound donated to the hospital recently from Vanderbilt and Dr. Randy Malchow. (1st photo) We’ve also been involved in a couple of airway cases, using the brand new glidescope, all of which has drawn quite an audience! (2nd photo below) I’ve done some amazing pediatric cases; the two that stand out the most were an open thoracotomy to repair a patent ductus arteriosus (PDA) in a 15 kg, 7 year old boy who was an achondroplastic dwarf, and a debridement of a severe, 48 hour old burn to the face of a 3year old boy. 

jace perkerson

The first case was a pretty big deal, basically minor heart surgery in a third world country, and I was the experienced one in the room, with both a Kenyan nurse anesthetist and a Kenyan nurse anesthetist student helping. A few aspects of the case amazed me, especially how well we did with so much less than we do in the states, and even more so, how well the boy did after having such a major, and painful, surgery. Kenyans are tough!

The burn case was very memorable as well, and also good teaching for the nurse anesthetist and student. The boy also happened to have muscular dystrophy, which presented its own anesthetic challenges, on top of those unique to burns, such as not being able to use certain drugs, and potentially having trouble breathing for the patient after putting him to sleep. The burn patient, like the PDA patient, looked great the next day. There’s even quite a lot to be learned from a fairly basic case like we did today, when just a few minor speed bumps along the way became important teaching points! I should be clear though, that I am not the only one doing the teaching!! I have learned quite a bit, and already in the first week had experiences that will rival any that I’ll get during my pediatric anesthesia fellowship next year!

 

TASO sets another milestone: Launches a House of Hope for persons affected by HIV and AIDS in Uganda.  

house of hope

As 2011 draws to an end, The AIDS Support Organisation (TASO) is elated to record yet another milestone in restoring hope to people affected by HIV and AIDs pandemic in Uganda.  The organization, with support from her development partners and friends, has completed the construction of a multi-million complex, named House of Hope.

The attractive building, located at Plot 10 Windsor Loop, Kampala, was officially opened on 16th of September 2011 in a grand ceremony presided by Hon. Princess Kabakumba Masiko, Minister of Presidency, who represented H.E Yoweri Kaguta Museveni, President of the Republic of Uganda.  

The colorful event was attended by over 400 guests including members of the diplomatic community, representatives of development partners, Ministry of Health, Uganda AIDS Commission, leaders of various local and international AIDs Support Organisations and other civil society organizations, TASO governance bodies, TASO founder members, management and staff and above all, the gallant clients living with HIV.

In her remarks to launch the House of Hope, Hon. Masiko appreciated TASO for the innovativeness in the fight against the AIDS pandemic and for standing tall in the country and the world over in providing hope to people living with HIV. She pledged continued support to TASO and other stakeholders from the Government of Uganda.

The vision of the House of Hope was conceived as one of those strategies of sustaining provision and quality of HIV prevention, care support and treatment services to the TASO clients. Faced with the challenge of a growing number of clients seeking services especially following the initiation of ART programme, the available physical space and related resources at the Mulago Service Centre, which also housed the TASO Headquarters, were increasingly becoming inadequate. Therefore a need to decongest the facility at Mulago became more apparent and had to be addressed.

The management of TASO, with the approval of the Board of Trustees (BOT) then decided to construct a building to house the TASO Headquarters with additional space for generating resources for continued innovations and work in the provision of services to the clients and HIV prevention interventions.

The construction of the building commenced in November 2005 with the laying of the foundation stone in a ceremony officiated by Dr. Sam Okware, a prominent HIV activists and then a Director at the Ministry of Health.

The initial funding for the House of Hope project was provided by the World of Hope Foundation, USA. This funding followed a visit to TASO by a US Senator Bill Frist in 2005. During that visit, Senator Frist, a medical doctor, was taken around and briefed about TASOs work by the then TASO Executive Director(ED), Dr. Alex Coutinho and Dr. Matovu, then BOT Chairperson and Member of Parliament. Senator Frist was deeply touched by the great work TASO was doing in preventing HIV infection, restoring hope and improving the quality of life of individuals, families and communities affected by HIV infection and disease.

On going back to the US, Senator Bill Frist, M.D. nominated TASO to The World of Hope Foundation to be considered as one of the recipients of funds left over from former US President Bush’s election campaign. His nomination of TASO was accepted and gratefully, a generous contribution of US $500,000 was given to TASO, out of which about US $ 350,000 went into the House of Hope project.

The House of Hope project is one of the biggest projects that the current ED, Mr. Robert Ochai inherited when he assumed office. Together with his team, he raised additional funding from TASO friends from near and far, including the Board of Trustees, Staff, Subscriber Members and Clients, to complete this dream of a symbol of hope for TASO clients and friends. TASO pays great tribute to all the friends who contributed to make this big dream a reality.

Speaking at the opening ceremony, Mr. Micheal A Strong, the PEPFAR Coordinator, US Mission Kampala, Uganda, noted that the House of Hope is an investment for people living with HIV and will generate revenue for TASO for years to come to sustain the excellent work on HIV and AIDS prevention, care and support. He urged all organizations to emulate TASOs example of looking outside our narrow boxes to find creative ways to fund and sustain the efforts to improve the health of all Ugandans.  On their part, the ED, Mr. Robert Ochai and the Immediate former ED, Dr Alex Coutinho, noted that TASO‘s commitment to preventing HIV infection, restoring hope and improving the quality of life of persons, families and communities affected by HIV infection and disease, has resulted into the organization taking up a pioneering pace setter role in the fight against HIV and AIDS in the country and the region.  From the enviable milestones recorded over the years, the name TASO has now come to be synonymous with any initiatives in HIV prevention, care, support and treatment in Uganda.

The House of Hope is a modern facility, complete with a 400 seater conference facility/board room and a parking yard of over 30 vehicles. The facility also has a wall of memory of over 100,000 departed TASO clients. TASO is pleased to posses this facility on behalf of everybody involved in the fight against the HIV pandemic and especially the gallant clients who have given HIV a face. There is hope and together we shall fight on to defeat HIV so we can, one day, reach our vision of “A world without HIV”.

by Jenny Eaton Dyer, Ph.D.

Both Friend Force of Knoxville and Friend Force of Memphis are hosting the Russian delegates this week, including today. 

The Russian delegates in Knoxville will be meeting with governmental officials Mayor Daniel Brown as well as Judge Tom Varlan today. They will be briefed on the bluegrass music of Appalachia at the Knoxville Visitor's Center, and their afternoon will be spent visiting with Cherokee Health Systems. This evening, the North Rotary Club of Knoxville will host the Russian delegates for dinner.

In Memphis, the delegates will meet with the Memphis Medical Society as well as with the University of Memphis. At the University, there will be round table discussions regarding healthcare delivery in Russia and the United States among other presentations.

by Jenny Eaton Dyer, Ph.D.

In following the meetings and events of the Russian delegation learning from Tennessee's wealth of health care corporations, universities, and institutions, we will share their schedule throughout the week.

Today, Tuesday, November 1, the delegates visiting Knoxville have spent the morning at Pellissippi State Community College touring the Nursing Department. This afternoon, they toured the UT Hospital and had a quick photo at the Rachmaninoff statue in World’s Fair Park. Afterwards, they will visit the Knoxville Museum of Art and learn about their Mobile Meals program for the elderly.

In Memphis, the other delegates met this morning at the Christ Community Health Services. This organization is a faith-based network of medical and dental clinics supplemented by a range of community outreach activities.  CCHS serves a primarily low-income minority population that does not have the resources to obtain care elsewhere. For lunch, they visited the Caritas Village. And, this afternoon, they visited the Assisi Foundation of Memphis for a presentation and discussion on current health care reform initiatives and then the Hope and Healing Center to learn about their wellness and fitness program for a low-income population.

by Walter Schratt
Vanderbilt Department of Surgery
Kijabe, Kenya

I arrived at the beginning of September for my first time in Africa. I really did not know what to expect but after 2 weeks I am really deeply impressed. Kijabe hospital is a medical center in Kenya where people get medical treatment at a high level for a reasonable price. The doctors are well trained – mostly in America and Australia, the residents, house and medical officers are highly motivated, have abundant basic medical knowledge, and, on top of that, they receive a detailed and profound training in their specialties that will prepare them for their challenges in the smaller community hospitals. Politics just has to make sure that they stay here in Africa to serve their countries and their people after they are finished with their training.

Same for the nursing staff. The nurses are competent, helpful, motivated.  A substantial number of nurses who are trained here are hired at the big and prestigious hospitals in Nairobi – unfortunately for the Kijabe hospital but also an expression of the quality of training they receive at Kijabe hospital.

The African people are friendly, open and very patient and generally happy.  Imagine 100 people in surgical clinic, first come  first serve, waiting from 9 am to be seen at 3 pm – no complaints, still happy to be seen after a 6 h wait. Those people deserve our help despite political uncertainties. The fellow doctors who work here full time on their missionary dedication deserve our full recognition and support. I am lucky to be here. I am looking forward to the rest of my stay and hopefully I will be back some time.

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