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Kline's plan for dealing with the ongoing emergency in Africa was to create several pediatric centers of excellence for AIDS. (Four have opened--in Botswana, Lesotho, Malawi and Swaziland--and four more are in the planning stages.) Then he set about finding the staff and the money to run them. Since there aren't enough doctors and nurses in most African countries, that meant recruiting young physicians from the U.S. to spend a year or two at the clinics. Most of the funding for the first class of 52 doctors in his Pediatric AIDS Corps comes from Bristol-Myers Squibb (BMS) and Baylor. The clinics were built with money from BMS and Abbott. But the day-to-day operating budgets of the centers are the responsibility of local governments.
You can already see the difference in Lesotho, a tiny mountain kingdom of 2 million people surrounded by its much larger and richer neighbor, South Africa. At least 22,000 Basotho children are HIV positive, but as of two years ago, fewer than 20 were on ARVs, and there were only two doctors in the whole country looking after children with AIDS. In the year since the children's clinic opened on the outskirts of Maseru, 700 kids--including Bokang--have received treatment from 10 pediatricians.
Kline expects that the influx of U.S. doctors will be temporary. The plan is to dramatically increase the ability of local health-care staff to treat children with AIDS. To that end, the children's clinics and their doctors, including the Pediatric AIDS Corps, have provided training in the past six months for about 3,600 health-care workers.
The Americans aren't alone in their efforts. Dr. Edith Mohapi was born in Lesotho and left when she was 17 to pursue advanced studies and medical school. She returned last year to run the clinic in Maseru and was joined earlier this summer by her daughter Dr. Lineo Thahane, also a pediatrician and one of the first Pediatric AIDS Corps members. The nurses, social workers and other staff are also from Lesotho.
Their optimism in the midst of extreme difficulty is contagious. "It's hard to see children that sick," Mohapi says. "But children respond so quickly--that's why I went into pediatrics--and after just a few weeks of us treating them, they come back, and they're smiling, they're running, and they're eating better."
Not everything runs quite as it should yet. While the ARVs are free, getting to the clinic is not. A ride in one of the ubiquitous minivans everyone uses for public transportation can cost $1 or more--an exorbitant sum when you're living on $1 or less a day. Because the government's telecommunications agency wants more money than Mohapi's budget allows to set up high-speed Internet access, the clinic still depends on a sluggish dial-up connection. Meanwhile, the center has become a de facto emergency room for the neighborhood--further evidence of the fragile state of basic health care in the region.