Aids in Africa: ‘It is the staff who really inspire you’

source: www.timesonline.co.uk

UN reports show the number of people dying from Aids is falling. Model Erin O’Connor went to Ghana to see the changes for herself.

If ever I have seen people ‘Keep Calm and Carry On’, it’s in Ghana,” says the model Erin O’Connor, settling down with a bowl porridge in her local Camberwell café. “The scale of what I saw there was incredible. You can talk about poverty all you like. You can describe the poor conditions in which people live, but when you see it yourself it is overwhelming. And once you’ve seen it, I don’t think you can turn your back ever again.”

The 6ft 1in model, best known for her handsome face and elegant frame, on which couturiers hang their dresses, was not in Africa on a Vogue fashion shoot. “I was approached by RED [an initiative that engages businesses and consumer-power to help to eliminate Aids in Africa] to be an ambassador,” she explains, “and, while I never want to be just a token face for a charity, which isn’t satisfying to anyone, I did feel that Aids is a global issue none of us is exempt from, so I wanted to try to understand the issues.”

“Even before I went to Ghana,” says O’Connor, “the figures staggered me. For instance, of the 33 million people who have Aids around the world, 22 million of those live in Africa. That’s two thirds — which is not an easy one to get your head around. And 12 million orphans . . .”

The number of affected people that she saw in hospitals in Ghana was even more overwhelming. The capital, Accra’s main hospital St Martin, a single-storey building in a dusty part of the city, was “surrounded by people, waiting to be seen. They were hanging out of the building — literally. I was sidestepping and clambering over them.”

Although many patients would have travelled for hours, if not days, to get to the hospital, O’Connor discovered, many would not have been seen that day at all. “There just aren’t enough doctors or nurses or rooms.”

Facilities were basic, too. One room she was shown had two new, donated computers to fill in patients’ details, beside a decade of paper records lying on top of each other: “Piles and piles of organised chaos. But the staff were incredible. They seem to run on overdrive — working day and night.”

Compared with the rest of Africa, Ghana has been relatively fortunate in evading a full Aids pandemic. Life expectancy is 56 in women and 58 in men, and only 1.9 per cent of it 22.5 million people are thought to be HIV-positive. In Swaziland about a quarter of the population is HIV-positive and life expectancy is 40.

Since the Global Fund — the international governmental and private-sector Aids, TB and malaria organisation into which RED has so far channelled $140 million (£84 million) — started working in Ghana in 2006, 24,000 HIV-positive people have been provided with antiretroviral drugs and more than 646,000 people have been tested and counselled. In one area that O’Connor visited, about an hour and a half’s drive from Accra, Aids prevalence has fallen from 18 per cent in 1992 to 9 per cent.

Although O’Connor witnessed the difference that funding has made to hospitals, it was the staff, she says, who really inspired her : “When you see the conditions, which are very basic, and the need, which is enormous, you can’t help but be overwhelmed by their commitment.” In particular, there was a man in his twenties called Doctor Ernest, who had just got married and yet seemed to spend all day and part of the night in the hospital, tending to about 160 of the hospital’s 10,000 registered HIV patients. “The good thing is that he says conditions have improved. Before they had funding, he would leave at the end of the day, knowing that when he came back in the morning, several of his patients would be dead. Now he says that, with the drugs, he comes back knowing that, not only might they be better, but also able to leave and live a full life. And that keeps him going.”

Unlike ten years ago, when most drugs were too expensive for the majority of Africans to buy, antiretrovirals (ARVs) have now become widely available and inexpensive: about 20p a day. The problems are getting the medicine to infected patients regularly and persuading the population to be tested.

O’Connor was told that in Ghanaian culture men don’t like hospitals. “They see them as places for the very ill,” she says. “And there’s a stigma attached to going to one. Men believe that if they go, they will lose pride.” This is why, with the aid of the Ministry of Health in Ghana, the Global Fund set up a number of travelling units, so that men could be tested and counselled away from hospitals: near their homes or in their workplaces.

O’Connor accompanied one unit to a timber mill, where she saw 250 men gather for HIV testing, education and counselling. “And let me tell you, when those matrons arrived — they’re pretty formidable women — there wasn’t a sound to be heard. They could silence the men just with a look.”

As well as being given a diagnosis within 20 minutes of their test, the men were offered counselling from a trained HIV-positive man who could identify with their concerns, and sex education lessons, such as how to use a condom. “I felt uneasy enough about being with 250 men who were about to find out whether they were HIV-positive, without that. But there was humour, which helped, and also a lot of condoms to take away — so no one could get away from self-protection. And the stigma was reduced.”

The strength of that stigma became particularly clear in a maternity ward that O’Connor visited. “I thought that the women would be the most friendly of the patients that I would meet,” she says. “So, when we walked in and there was real volatility in the ward, I couldn’t understand it. But these were women who had been rejected by everyone: their partners, their villages, society. And they had a real fear of exposing themselves and their status and, completely understandably, had a lack of self-esteem. Even if there were joyful moments — two women discovered that their babies were negative — they still had nowhere to go or anywhere to live. They were angry.”

It is these women and children, she says, whom she would really like to help. “It’s difficult enough for these women to manage and be independent, anyway, without being treated in that way and having to carry on.”

The positive energy of the nurses who provided counselling to these women was, she says, “incredibly powerful. They were full of life. In fact, quite hysterical. They never stopped laughing”.

To find out more about the RED project and receive updates on its work, visit www.joinred.com

Case study: ‘I want to be a bank manager’

Vida, above, couldn’t start school until she was 9, because of Aids and other infections. Since the Global Fund started its work in Ghana in 2006, offering antiretroviral (ARV) drugs to those infected with HIV, Vida has had access to drugs and counselling. Now aged 12, she lives the life of a normal schoolgirl, and says that she loves school. Her favourite subjects are “maths, art, English and natural sciences,” she says shyly.

Vida’s mother, also HIV-positive and paralysed by a stroke several years ago, lives many hours away in a village, where she is cared for by her extended family. Vida is taken care of by her father in Accra, where he works in construction to earn money to support his family.

Her doctor at the Tema General Hospital HIV clinic in Accra, Dr Patricia Nkansah Asamoah, says she is very happy with the way Vida has been responding to treatment.

“I first saw Vida about two years ago. She was ill. She was coughing and couldn’t go to school. So as soon as we saw her, we started her on AVR. She has been doing great.

She goes to school. She takes her meditation monthly.” Dr Nkansah Asamoah has worked in HIV care and prevention at the hospital since 2003 and was the doctor responsible for introducing the prevention of Mother to Child Transmission treatment at the hospital. This has meant that hundreds of HIV-positive women have been able to give birth in the past six years to healthy HIV-negative babies.

Dr Asamoah sees an average of 70 patients a day and may oversee as many as 20 births a day — as well as seeing dozens of children.

The fact that ARV drugs are now available to patients has completely changed outlooks and lives, she says. “You see a lot of people moving from what we call stage four — very ill, moribund, unable to work and bed-ridden — to people who are able to do anything, functional human beings, about six months to one year after ARV. That’s a really big change.”

Vida’s father, Raphael, is overwhelmed by his daughter’s recovery and, at the hospital, the two of them take time out to walk in the garden and play on the swings. He says he hopes that his daughter will continue to do well in school and that one day he might be able to send her to university. Even though she is still very thin for her age, the 12-year-old says that she has bigger hopes than just university. “I want to be a bank manager with the Bank of Ghana,” she says. “So that I can buy a car!”

Lisa Grainger