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'You can't give up on these patients. There are simple things you can do for them.'
ife or death often depends on where you live.
In the United States, no one expects to die from diarrhea, pneumonia, measles, tuberculosis, or even AIDS in many cases. Malaria has been stamped out; the rare case becomes national news.
But even in countries where those diseases often kill, poor people are now surviving -- if sometimes by the luck of an address.
Philip Miyoba is proof. Miyoba has AIDS. He lives in Lusaka, the capital of Zambia. His home is in the Garden Compound, a neighborhood of 50,000 where the roads are washed out, the water unsafe to drink, the homes dark, and the kitchen cupboards mostly bare.
Here, a health system works. A Catholic church and a doctor have pieced together a program that has kept Miyoba alive and is adding years to the lives of many who almost surely would have died if they lived even a few streets away.
Their plan of attack is simple: St. Peter's Parish sends volunteers to visit the sick in their homes and take them medicine and food. A doctor, Waza Kaunda, administers a combination of powerful drugs and a faith that his patients' illnesses can be beaten back. Both find jobs for the sick so that they can feed themselves, keeping them nourished and well.
"This disease has come to kill me," said Miyoba, 53, who weighed just 92 pounds when he was interviewed in November. "But now I think I can restore my body and my health."
In the poorest nations of the world, the often-ignored truth is that successful projects are not hard to find, as the stories in this Globe report make clear: from the clinic that helps Mayans in Guatemala to the relief-group doctors in Cambodia to the Garden Compound project in Zambia. But most of the neighborhood programs save lives only in the neighborhood, their impact sadly circumscribed.
The global challenge today, in the face of the astounding number of needless deaths from disease, is to replicate the successful programs cheaply; to bypass corrupt ministries; to plug these programs into an overall country health care scheme without undercutting the passion and energies of those already working to save lives, one neighborhood at a time.
"The fact is that in every country, even under the most appalling of human circumstance, there are signs of determination and hope," Stephen H. Lewis, the United Nation's special coordinator for AIDS in Africa, said earlier this month.
In Zambia, a landlocked country in southern Africa with more than 9.7 million people, an estimated 20 percent of all adults between the ages of 15 and 49 are HIV-positive. One in 10 children dies before age 5. Life expectancy has fallen to below 40 years. And yet, the Garden Compound project leaders believe their program can not only help those with AIDS and other diseases, but rebuild the nation's health system as well.
In a spartan room next to St. Peter's health clinic, the Rev. Eamonn Hayden, a cheerful native of Ireland, sat behind a desk that was clear but for one book -- a thick registry of the neighborhood dead.
"We are lucky," he said, "because the volunteer concept has stayed so strong."
About a decade ago, his Catholic parish recruited volunteers to provide home-based care. AIDS was killing scores of people in the prime of their lives. The church divided the neighborhood into 27 sectors and the volunteers into 27 groups. They made each area small enough so that team members knew everyone in their area and would hear if someone was failing.
"Obviously this isn't a perfect system, but we have no other option," Hayden said. "To wash people, to clean up a house, to be prepared to be involved at the most basic level, that's hard work. The whole concept is based on the compassion of the Lord and to translate that into the reality of the world today."
As a team of volunteers checked on Mabel Tembo, 13, who had dark rashes on her body, her older cousin appraised their work.
"They are very good at counseling," said Kevin Ngulube, 35. "They also bring food at times, and that helps all of us stay well. We are now coming to a stage where many people are growing desperate. We need help, any kind of help."
They are getting help. Those who live nearby are not.
The next day, a woman named Agnes Komba, 52, died a half-mile away from tuberculosis or AIDS or a combination of both. She had seen private doctors and went to the University Teaching Hospital. Nothing helped.
After she passed away, relatives walked to the world of the dead, to the hospital morgue, and then inside the morgue's Freezer B. It is a place many in Lusaka have seen, and still they gasp.
There, 100 bodies were laid shoulder-to-shoulder in four rows of shelves, wrapped in blankets, most of their faces uncovered. Babies were bundled on the upper left shelf, a nursery of the recently dead, the newborns smaller than loaves of bread.
They found Komba on the lower right shelf, then quickly departed. They brought her in a casket to the United Church of Zambia, wept, prayed that her soul would rise to heaven, and then drove to Chingwere Cemetery, where church women dressed in red shouted her name up to God.
In a long row, they watched men standing chest-deep in nine holes in the earth, swinging pickaxes, wiping sweat from their eyes, softly joking with one another. It was burial on an assembly line, an ordinary day, nine more lives lost this hour. Nine mourning parties, nine choirs, and nine preachers all patiently waited their turn.
But in a country where they cannot bury the dead fast enough, Dr. Kaunda's clinic shows that the pace of death can be slowed. His 20-bed facility, St. Claire's, consists of two concrete one-story buildings separated by a courtyard. One building holds people who can pay a flat $90 fee. Kaunda also gets money from a foundation run by his father, the former president of Zambia, Kenneth Kaunda. The other half of the clinic houses the poor, who pay nothing.
Kaunda, 52, opened a clinic because he saw how Zambia's health system gave up too quickly on patients. Doctors and nurses now must be retrained to deal with AIDS and other diseases, he said.
"I've found that, for instance, you give patients that famous drug of yours in America, cipro, for three days for certain opportunistic infections and they markedly improve," he said, nearly rising out of his seat with excitement. "I've cut back on IV drugs and fluids for patients with chest pneumonia. If I give them normal loads, I could kill them -- the fluids overload their systems. I've even used a rock salt that we have here in Zambia, and I stick a piece of it under the patient's tongue. It works better than oral rehydration given through IV drip!"
Kaunda supplies antiretroviral drugs to 30 patients who can pay a $30 monthly cost; the poor are participating in a drug trial for a new class of medication that may stop the virus from replicating. He isn't sure it will work, but he feels he must try anything with promise.
Using the new drug, Philip Miyoba's CD4 count -- the most accurate measurement of a body's immune system -- rebounded to 140 from 90. He feels strong enough to start work as a $35-a-month night watchman, a job that clinic workers found for him.
Kaunda takes great satisfaction from saving a life. But he feels he must save many more.
"You cannot afford to build hospitals and state-of-the-art labs everywhere, but you can do this," he said. "You can't give up on these patients. There are simple things you can do for them. They don't have to die."