Death Stalks A Continent

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The child in crib No. 17 has had TB, oral thrush, chronic diarrhea, malnutrition, severe vomiting. The vial of blood reveals her real ailment, AIDS, but the disease is not listed on her chart, and her mother says she has no idea why her child is so ill. She breast-fed her for two years, but once the little girl was weaned, she could not keep solid food down. For a long time, her mother thought something was wrong with the food. Now the child is afflicted with so many symptoms that her mother had to bring her to the hospital, from which sick babies rarely return.

She hopes, she prays her child will get better, and like all the mothers who stay with their children at the hospital, she tends her lovingly, constantly changing filthy diapers, smoothing sheets, pressing a little nourishment between listless lips, trying to tease a smile from the vacant, staring face. Her husband works in Johannesburg, where he lives in a men's squatter camp. He comes home twice a year. She is 25. She has heard of AIDS but does not know it is transmitted by sex, does not know if she or her husband has it. She is afraid this child will die soon, and she is afraid to have more babies. But she is afraid too to raise the subject with her husband. "He would not agree to that," she says shyly. "He would never agree to have no more babies."

Dr. Annick DeBaets, 32, is a volunteer from Belgium. In the two years she has spent here in Tugela Ferry, she has learned all about how hard it is to break the cycle of HIV transmission from mother to infant. The door to this 48-cot ward is literally a revolving one: sick babies come in, receive doses of rudimentary antibiotics, vitamins, food; go home for a week or a month; then come back as ill as ever. Most, she says, die in the first or second year. If she could just follow up with really intensive care, believes Dr. DeBaets, many of the wizened infants crowding three to a crib could live longer, healthier lives. "But it's very discouraging. We simply don't have the time, money or facilities for anything but minimal care."

Much has been written about what South African Judge Edwin Cameron, himself HIV positive, calls his country's "grievous ineptitude" in the face of the burgeoning epidemic. Nowhere has that been more evident than in the government's failure to provide drugs that could prevent pregnant women from passing HIV to their babies. The government has said it can't afford the 300-rand-per-dose, 28-dose regimen of azt that neighboring nations like Botswana dole out, using funds and drugs from foreign donors. The late South African presidential spokesman Parks Mankahlana even suggested publicly that it was not cost effective to save these children when their mothers were already doomed to die: "We don't want a generation of orphans."

Yet these children--70,000 are born HIV positive in South Africa alone every year--could be protected from the disease for about $4 each with another simple, cheap drug called nevirapine. Until last month, the South African government steadfastly refused to license or finance the use of nevirapine despite the manufacturer's promise to donate the drug for five years, claiming that its "toxic" side effects are not yet known. This spring, however, the drug will finally be distributed to leading public hospitals in the country, though only on a limited basis at first.

The mother at crib No. 17 is not concerned with potential side effects. She sits on the floor cradling her daughter, crooning over and over, "Get well, my child, get well." The baby stares back without blinking. "It's sad, so sad, so sad," the mother says. The child died three days later.

The children who are left when parents die only add another complex dimension to Africa's epidemic. At 17, Tsepho Phale has been head of an indigent household of three young boys in the dusty township of Monarch, outside Francistown, for two years. He never met his father, his mother died of AIDS, and the grieving children possess only a raw concrete shell of a house. The doorways have no doors; the window frames no glass. There is not a stick of furniture. The boys sleep on piled-up blankets, their few clothes dangling from nails. In the room that passes for a kitchen, two paraffin burners sit on the dirt floor alongside the month's food: four cabbages, a bag of oranges and one of potatoes, three sacks of flour, some yeast, two jars of oil and two cartons of milk. Next to a dirty stack of plastic pans lies the mealy meal and rice that will provide their main sustenance for the month. A couple of bars of soap and two rolls of toilet paper also have to last the month. Tsepho has just brought these rations home from the social-service center where the "orphan grants" are doled out.

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