Review: Vivien Horler
One Life at a Time – a doctor’s memoir of AIDS in Botswana (Picador Africa)
The night before Dr Daniel Baxter, medical director of a downtown community health centre in Manhattan, left for Botswana in 2002, he had dinner with a famous American cardiothoracic surgeon.
The surgeon was interested in Baxter’s decision to work for Botswana’s newly launched HIV/AIDS Treatment Programme and asked him why he was doing it.
For years Baxter had wanted to work in a developing country and help people less fortunate than he was. A little stung that the surgeon wasn’t impressed by his selfless plans, he stuttered that the people of Botswana had the same hopes and fears as Americans, and he wanted to experience the universitality of these feelings.
The surgeon replied: “I’m not so sure about that.”
Baxter says he went off believing the benefit of his time in Botswana would be a one-way affair – he would help the poor Batswana – but he returned to New York after a total of eight years a humbler and wiser doctor.
Baxter was never the sort of American doctor who used his position to make a fortune. He cared – and still does – for the down and out, the drug users, the criminals, the mentally ill and the drug-resistant TV sufferers; people who seemed to have little hope.
In 2000 he attended the International AIDS Conference in Durban, where former president Thabo Mbeki told delegates that HIV did not cause AIDS. Baxter quotes studies showing that Mbeki’s “wilful ignorance and intellectual conceit” probably cost the lives of at least 300 000 South Africans.
Two years later he was back in Southern Africa, arriving in Gaborone to work for the African Comprehensive HIV/AIDS Partnership, a collaboration between the government of Botswana, the Bill and Melinda Gates Foundation and Merck Pharmaceuticals, which provided the country with ARVs free of charge.
Baxter would retire to his bungalow veranda to watch the sunset, listen to Bach and Mozart, and think about his contempt for whining American patients and the purity of his mission in Africa. He felt he had nothing to learn – “nothing, that is, until I crashed into the harsh realities of AIDS in Africa”.
By 2002, while no one in the US was being cured, people were being treated and enabled to live normal lives. It wasn’t like that in Botswana. Yes, they had the ARVs, most of the time, but often there were no hospital beds, there were frequent “stock-outs” of other vital drugs, patients did not want to be tested for HIV because of the stigma and therefore could not be treated, various clinical tests could not be conducted because the ECG machines were broken or there was no film for the Xray machines or no reagents available to test for blood chemical levels.
Baxter became involved in a programme known as Kitso to train health care workers, a three-day course that all clinic workers around the country had to do.
The trainees did not have to be convinced that ARVs worked – they could see ample evidence of that for themselves. They knew, unlike people in South Africa, that the treatment programme wasn’t a scam concocted by the drug companies to confuse Africans. Baxter said then Botswana President Festus Mogae should have been awarded a Nobel prize for being brave enough to launch Africa’s first AIDS treatment programme.
While the programme has been a success, the individual consultations and surgeries Baxter conducted were often depressing beyond belief. Lack of facilities, equipment and transport led to endless suffering. He recounts many stories of individuals, one of the saddest being that of Dolly, who was raped by her pastor at the age of 13, became a prostitute, and died of AIDS in hospital 10 years later.
Baxter found the ABC message to the Batswana – abstain, be faithful, use a condom – ridiculous. He believed sex should be seen as a life force and that people should be taught not to abstain from sex but how to have sex safely. This did not go down well with his employers or the Botswana government.
Later, Baxter spent two years teaching medical students at the Princess Marina hospital in Gaborone. He told them the challenge of medicine was, above all, to care about the patient. Some medical knowledge was useful, he would quip, but what was critical was the awareness of the patient as someone’s spouse, parent, or child. “Remember, the only life you can save is your own. All we do for our patients is give them precious extra time to save themselves.”
And he found that when he returned to New York he had absorbed this message himself. No longer did he despise American patients; he now accepted the universality of suffering.
Reading One Life at a Time, I sometimes wanted a little more of the personal – Baxter tells you little of his own life. But this is a worthwhile and frequently saddening read. I am sure that much of what he experienced in Botswana happens all the time in public South African hospitals, particularly country ones. And that is not good enough.
- This review appears in Weekend Argus on Sunday September 10