On Me and the Deputy Minster Being BFF

OK, so as most of y’all know, the politics around HIV in South Africa are very complicated. As late as 2003, the SA government not only denied that HIV was a problem in South Africa, but also that HIV caused AIDS (what did cause AIDS no one had a good answer for). Fortunately, due to a lot of pressure from humanitarian organizations and patient advocacy groups (e.g. the Treatment Action Campaign), SA was forced to provide ARVs to prevent mother to child transmission (PMTCT) of the virus in January of 2003. With some more pressure by international groups as well as an injection of capital from the Global Fund and PEPFAR, South Africa is now providing not only PMTCT but full HAART to AIDS patients. The decision to do this was and is still not very popular in Parliament due to the high cost of providing treatment and the fear that the costs of ARVs, both monetary and medical, outweigh the benefits.

If you read the previous rant about the Minister of Health, you can see that government officials have no trepidation about publicly denouncing the value of these lifesaving medications. I’m not sure if the crap they’re spewing out is what they really believe or whether it’s a calculated maneuver to slow down the roll-out and therefore save some dough. In any case, there remains a great deal of dissention within the government between those realizing that the short-term costs of ARV are far surpassed by the long term gains and those who are too myopic to get past the sticker shock of Efavirenz.

Fortunately, the 2^nd in command at the Ministry, Mrs. Nozizwe Madlala-Routlege, is a strong proponent of the national ARV program as well as the work that IHI is doing. One thing you should know about these ministry officials is that they are not at all healthcare trained. They are simply elected officials from the ruling party who are rotated through one of the many government departments. The DM of health was previously DM of Defense, which makes her ideal to deal with stubborn officials reticent to deal with the world’s biggest health crisis. We invited her on one of our visits to the Eastern Cape last month in the hopes of reenergizing the group and generating momentum for the project going forward.

She accepted, and we headed off to the hinterlands for a really great day where Mrs. Madlala-Routlege and her entourage (including a gun-toting badass bodyguard) visited local clinics, shook hands with patients, and met with nurses and counselors. We had kind of a sit-down session where I described the progress so far and expressed what we hoped to do in the future. Some of the people involved in the project gave very moving speeches about how the “young one” (referring to me, not Pierre) made them think critically about the HIV/AIDS program and forced them to change to provide better care. At the end, everyone was pretty excited and we left feeling good about the next few months. The Deputy Minster was scheduled to fly back to Pretoria with her guards, but instead hopped in our car for a quick 5 hour jaunt to Durban.

When I got home, I shot her a quick email thanking her for coming with us to Mhlontlo. She wrote back saying, “No, Nupe, I thank you. I think you are the Paul Farmer of South Africa. The work you are doing in rural areas is an inspiration to us all. Keep up the good work.” Despite the comparison to the most unsustainable person in medicine, I was pretty stoked that she said something so nice. Made me feel like those months spent holed up in the armpit of South Africa (Umtata) were worth it. Now, if only I can get her to hook me up with one of those white BMW’s they drive around in, I’ll be all set.