Walking Together, Walking Far: How a U.S. and African Medical School Partnership Is Winning the Fight against HIV/AIDS

5. “We Are Not a Mortuary”

“We Are Not a Mortuary” 67 5 “We Are Not a Mortuary” In mid-2003, the PEPFAR-inspired hope in Washington had not yet reached the wards of Moi Teaching and Referral Hospital. There, a woman named Theresa huddled under a thin and tattered blanket in a bed she shared with another woman whose feet lay by Theresa’s head. She looked up vacantly at the doctors and medical students surrounding her. Theresa was so thin—”wasted” was the term the Kenyan medical student used when reading aloud from his examination notes—that her eyes seemed to bulge out from above her sunken cheeks. The medical student read on: Theresa had had a persistent cough for four years. Her breathing was rapid but shallow. Her mouth and throat were choked with a white fungus that made it seem as though Theresa had been chewing cotton. It was oral thrush, an indicator of AIDS. Theresa’s breathing was so labored because she also had PCP—pneumocystis carinii pneumonia—one of the most common and serious infections for people with HIV. The medical student closed by reciting the social history. Theresa was a twenty-eight-year-old widow with three children at home, the youngest just three years old. The student finished and looked up at Joe Mamlin, who was leading hospital rounds. 68 walking together, walking far 68 walking together, walking far Mamlin shook his head and looked past the students toward a visitor from Indiana. “Unfortunately,” he said, “that is your introduction to Kenya.” Mamlin then led the group on. Women lay two or even three to a bed, flies alighting on their heads. The physicians and students stepped around a woman curled up on the bare floor, clutching herself and moaning. They examined Elizabeth, who had arms the circumference of a broom handle. Janet was in a coma. Beatrice had skin lesions. Alice hadn’t been tested yet, but showed signs of late-stage HIV; she had lost her husband to the disease a few years before. One of the observers leaned over to read her hospital chart and was bumped in the hip by an attendant trying to maneuver a battered aluminum cart down the aisle. On the cart was a small body under a stained blanket. It was clear that, soon enough, all of these women would be on that cart. But the next day, away from the grim Eldoret hospital wards, some signs of hope were beginning to emerge. At the Mosoriot Rural Health Center, twenty-five kilometers west of Eldoret, a young Kenyan woman walked into a closet-size room with concrete walls and pulled from a plastic bag three cardboard boxes, worn at the edges and dusted red by the region’s clay soil. The woman handed the boxes to clinical officer Lillian Boit, who opened each box and counted the pills inside. The young woman was in perfect compliance with that month’s triple therapy antiretroviral drug regimen. She had HIV, but she was healthy. For five hours straight, Joe Mamlin sat next to Boit as patients came in one after another and Boit translated their Swahili or Nandi into English. Although told at first that their services were not needed in this community where no one said “HIV” aloud, the Indiana and Moi doctors had kept coming. For months, they treated other diseases and slowly built trust and relationships with the local residents. Now, twice a week, dozens of patients were openly acknowledging their HIV status by lining up to see Mamlin. Community groups were singing songs about HIV awareness, and a large sign advertising HIV testing was painted on the outside wall of the clinic. “We Are Not a Mortuary” 69 The Mosoriot program was proving that rural Kenyans were quite able to comply with strict antiretroviral therapy, once widely thought to be unsuited to people living in the African countryside . Mamlin gestured to where Boit was explaining the requirements of the therapy to an HIV-positive pregnant woman whose husband had already agreed to get tested as well. “People say you can’t do this in a village in Africa, but just look how intently they are paying attention to Lillian,” he said. “This is life and death, and they know it. There is no doubt you can do this business out here.” Mosoriot’s success as the first rural program for the Indiana– Moi team was due...