The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa - Softcover

Epstein, Helen

Softcover

ISBN 10: 0312427727 ISBN 13: 9780312427726

Publisher: Picador, 2008

Synopsis

A New York Times Notable Book of 2007

The Invisible Cure is an account of Africa's AIDS epidemic from the inside--a revelatory dispatch from the intersection of village life, government intervention, and international aid. Helen Epstein left her job in the US in 1993 to move to Uganda, where she began work on a test vaccine for HIV. Once there, she met patients, doctors, politicians, and aid workers, and began exploring the problem of AIDS in Africa through the lenses of medicine, politics, economics, and sociology. Amid the catastrophic failure to reverse the epidemic, she discovered a village-based solution that could prove more effective than any network of government intervention and international aid, an intuitive response that calls into question many of the fundamental assumptions about the AIDS in Africa.

Written with conviction, knowledge, and insight, The Invisible Cure will change how we think about the worst health crisis of the past century--and indeed about every issue of global public health.

About this title

About the Author:

HELEN EPSTEIN writes frequently on public health for various publications including The New York Review of Books and The New York Times Magazine. She is currently a visiting research scholar at the Center for Health and Wellbeing at Princeton University.

Excerpt. © Reprinted by permission. All rights reserved.:

Chapter One
The Outsiders
APRIL 1993 About two weeks before I was supposed to leave for Uganda, I packed up the materials I would need for the experiment I planned to do there and called Dr. Arthur Murray, whom I would be working with, to confirm the shipping address. “Maybe you shouldn’t send the stuff just yet,” he said. “There’s a problem?” “There may be a problem.” “Is it a bad problem?” “It could be.” “Is it a political problem?” “Well, not the whole country.” “Just the project?” “Yeah, just the project.” A few days later he called and said that everything was OK; the problem had had to do with a truck. “A truck?” “Yeah, a truck.” I knew there had to be more to it than this. I arrived at Entebbe airport in a small propeller-driven plane from Nairobi and walked across the tarmac to a two-story building that had been almost completely gutted. The only light came through the doorway; fragments of electrical wiring and old plumbing fixtures, black with tar and dirt, dangled from the walls and ceiling. A man lounged on an elevated platform; a sign above his head said health. This was the man who checked your immunization papers. Before I left, I had been told that to be allowed past him you needed to show that you’d had injections for yellow fever, cholera, and typhoid. Malaria pills and injections for hepatitis A and B and rabies were recommended. Arthur was there to meet me. During the drive to Kampala, we talked about my materials, which still hadn’t arrived. I’d called the shippers before I left, and they’d told me they thought a project called CHIPS was closing and, thinking that my project was part of CHIPS, they hadn’t sent anything out for me. I told the shippers to send my parcels anyway, but what was CHIPS? When I asked Arthur, he became tense. “Just don’t talk about that,” he said. So I didn’t. It was midday. I had been up all night on the airplane, and my first view of Africa out of the car window seemed like part of a waking dream. Soldiers in baggy green uniforms carrying heavy machine guns shambled by on the road. We drove along the shore of Lake Victoria, which sparkled in the sun. A bright yellow bird ?ew up out of a marsh, and vines cascaded from the crabbed and twisted branches of giant trees. I made myself a promise, which I would soon break, to learn the name of every plant and animal I saw. Within a few miles of the airport, the road gave way to threadbare patches of tarmac and our progress slowed considerably. The air was heavy with diesel fumes, wood smoke, and fine ochre dust. We passed through towns: the road became an open-air market, with kiosks selling furniture, chicken coops, spare parts for cars, machine tools, jerry-built appliances of all kinds. Pale green trucks stood in the middle of the street wheezing black vapors. Their flimsy metal frames were piled high with bananas, foam-rubber mattresses, and chickens crammed in their cages, their feathers raining everywhere. Along the roadside, there were old men in baggy suits; dusty, barefoot workers; children dressed in rags; stray goats; and stout women in colorful wraps selling green bananas and charcoal from lean-tos constructed from stripped tree branches roped together with banana leaves. Everything seemed handmade, makeshift, rough-hewn. Small, colonial-style cement bungalows, their roofs dented and askew, ranged untidily over the hillsides. Without a sterilizing winter, their foundations were riddled with cracks from the intrusions of tree roots, creeping molds, burning sun, and driving rain. Over the coming months and years, I too would have to contend with the forces of nature. There would be power cuts and water shortages and broken toilets and stuck doors and cars that started only when you kicked them. Most of the time, someone would find a way of rigging things to avert disaster. ARTHUR DROPPED ME OFF at the house of his colleague, Dr. Celeste Quinn, on the campus of Makerere University, where I wouldbe staying. Celeste was a gynecologist working with the urban poor in Kampala. She was also the director of CHIPS, the U.S.Agency for International Development–funded project that I was not supposed to talk about. Like most expatriate residences in Kampala at the time, Celeste’s house was a space pod of Western comfort. There were guards, servants, a telephone, a television. Celeste was a large, slightly intimidating woman, with a physician’s scrubbed white hands. When we were introduced, she extended an ivory arm and gave me a brief smile. She was seeing off some friends at the door and seemed distracted, so I sat in a wicker chair on the back porch and played with her cat, which emerged from its cardboard box and slunk over to me. I would be working in a lab at the Uganda Cancer Institute, a compound of weathered one-story concrete buildings on the grounds of Mulago Hospital, the only state-run hospital in Kampala at the time. The lab was next to the dental clinic, and the screams of the children being treated there could be heard all day long.The Cancer Institute had two barn-like open wards that were so dark and overcrowded that most of the patients and their families lounged on the verandahs and gravel yards outside. They bathed their children under an outdoor spigot and prepared maize meal and mashed bananas on open wood fires. On the Cancer Institute grounds I saw people with growths on their necks the size of pineapples, and people without arms or legs. I saw a man without a nose. My lab was a short distance uphill from the Cancer Institute. Arthur took me there the day after I arrived. We walked through the main lab, which was crowded with equipment and Ugandan technicians, and entered a much smaller room, which had no light and was full of empty cardboard boxes and rusty machine parts. When he pushed the door open, plumes of red African dust rose and swirled around us. “We were thinking of putting you here,” Arthur said. It was clear that some other place would have to be found for the boxes and machine parts. A plasterer and painter would have to be hired, and we would have to install a refrigerator, a light, and a table. Some time would pass before I could begin my experiment.A few days later, a contractor was hired, but he quarreled with the institute’s accountant over how much the job would cost. The two men negotiated within five dollars of each other before the contractor lost his temper and left. It took two days to get him to come back and accept his own terms. I grew accustomed to such delays. The materials I had shipped from California were still missing in any case. The American shipping company assured me the boxes had been sent and should have arrived. The airline said the boxes were with customs, customs said they were with the clearing agent, and the clearing agent said they were at the Cancer Institute, where, according to Celeste, who kept track of the shipments that came in, they could not be found. I had come to Kampala to carry out an experiment that I hoped would contribute to the development of a vaccine to protect Ugandans against HIV, the virus that causes AIDS. I became interested in the problem when I was doing postdoctoral work in California. I had been studying the sexual organs of a tiny insect the size of the letter I in ELIZABETH on an English penny, when I realized I was finding it increasingly difficult to concentrate. I had recently heard a lecture given by a scientist named Kathelyn Steimer about the HIV vaccine that her lab at Chiron, a bio technology company near San Francisco, was working on. It had been injected into about two hundred volunteers so far, and the results were encouraging. After the lecture, my mind never seriously returned to the insect world. My research had been bothering me for some time. In my university biology department, and others like it, “frontiers” were the thing. It was unfashionable to study anything for a practical reason. We thought of ourselves as the astronauts of the cell, exploring the logic left behind by evolution’s intricate digressions. Our heroes were the men and women who described the structure of the gene, saw the first microtubule, and found out how ribosomes worked. We were not in the business of developing cures or vaccines. My academic outpost near San Francisco was some distance from the frontier. In the 1920s, a German scientist discovered that if you stained the nucleus of certain insect cells and looked at them under a light microscope, you saw a black dot. He wrote a series of long, detailed articles on the subject suggesting that the black dot was a chromosome, and left it to posterity to figure out what it was for. My boss believed that the black dot was extremely important. He theorized that it determined sex, that it contained a genetic memory bank, that it was some sort of death clock. We spent hours discussing it. The aphid-like bug I was studying was tiny and round and had six legs, each consisting of three segments. It had a pair of short antennae with seven segments and a tiny mandible. Its little body was covered with pores from which it secreted a white goo in which it hid....

About this edition

• Publisher: Picador
• Publication date: 2008
• ISBN 10: 0312427727
• ISBN 13: 9780312427726
• Binding: Paperback
• Edition number: 1
• Number of pages: 324