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Doctor fights odds to ease AIDS epidemic

By Alphonso Van Marsh
CNN
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TAUNG, South Africa (CNN) -- In a country plagued by AIDS, a doctor in this remote industrial area of Taung, South Africa, is quietly providing life-prolonging drugs and hope for people who are HIV-positive.

"I saw too many of our people dying," Dr. Vanga Siwisa said, explaining why he gave up a comfortable life and medical practice in the suburbs of Johannesburg for this small town.

His office in the Taung Public Hospital is far from fancy: A ratty sheet partially covers an examination table, and posters hung with strands of medical tape cling to the wall. An air conditioner groans. (Watch how Siwisa gave up his lifestyle to fight AIDS Video)

But that simple office occupied by Siwisa, who was recently named "Doctor of the Year" by South Africa's Rural Doctors' Association and the South Africa Academy of Family Practice, is a life-giving center.

At this clinic -- which Siwisa started from scratch two years ago -- thousands of people infected with HIV can receive life-prolonging anti-retroviral drugs.

Access to anti-retroviral drugs is a necessary component of effective HIV/AIDS treatment, according to the World Health Organization. When the drugs are given in combination, they stop the HIV virus from replicating within the body, and delay the deterioration of the immune system and onset of AIDS, according to the organization.

Lowering the high mortality rate of AIDS in South Africa -- nearly 1,000 people die of it each day -- largely depends on this treatment, according to a report from the Actuarial Society of South Africa and the Medical Research Council. (Watch an uphill battle to stop AIDS Video)

But as of September, only 213,828 South Africans with HIV are receiving anti-retroviral drugs, says the country's health minister.

That's out of the 5.4 million people who were infected with HIV by the middle of this year, according to estimates by the government and the Society of South Africa and the Medical Research Council.

So when health minister Dr. Manto Tshabalala-Msimang advocated so-called "superfoods," like garlic and lemon, as an alternative to drug treatment for HIV, it caused an international uproar, ridicule and calls for her resignation.

Tshabalala-Msimang was effectively replaced by South Africa's deputy president as spokeswoman for the government's plan to fight HIV/AIDS -- but retains her ministerial post.

Siwisa, 65, is careful not to disparage South African authorities. "For this disease, it is true we started late. We should have started around 1999 or 2000. But I wouldn't say it's too little, too late," he said.

Before his clinic, he said, "Most people were just coming in with AIDS-defining illness and probably dying in the hospital."

'I don't know where else I would go'

Indeed, his clinic, the first in Taung, a town about 300 miles northwest of Johannesburg, has signed up 2,876 critically ill patients for HIV/AIDS treatment for an anti-retroviral drug rollout program. Nearly 2,000 of them are already on anti-retroviral drugs.

"Patients tell me, 'Hey Siwisa, you know when you first came here I was almost dead? Now you can see I am alive,'" he said.

His clinic is a battleground for the fight against HIV/AIDS. The infected line up in the early morning hours. Those healthy enough to work tend to a vegetable garden on hospital property, and reap some of what they sow. It is part of Siwisa's philosophy that nutrition should accompany, but not be an alternative to, anti-retroviral drugs.

Every open space of the clinic seems to have a chair with somebody sitting, waiting. Grandmothers, middle-aged men, a young mother carrying a newborn baby -- all wait to have their blood drawn, their bodies weighed, and ARV drugs dispersed at the makeshift clinic pharmacy.

It's loud and chaotic -- this is a public hospital after all -- but there's a sense of dignity among those who were otherwise shunned by their communities when their HIV-positive status became known.

"I don't know where else I would go. Without Dr. Siwisa and the clinic we'd have nothing, no one to assist us," Miriam Ganabo said. The frail 42-year-old woman learned she was HIV-positive last year, and she's now receiving anti-retroviral drugs and nutritional food parcels from the clinic.

Some patients say the clinic and Siwisa are a godsend, but Taung's anti-retroviral rollout program is far from perfect.

"We are understaffed. We are all suffering from burnout because everybody is a jack-of-all-trades," Siwisa said.

It is difficult for rural public hospitals to recruit talented medics like Siwisa, the province's Department of Health admits. The salaries are low, and a lack of a social life or decent schools for children deter many. Siwisa said the clinic needs social workers, pharmacists and professional nurses.

"The department recognizes and values the huge contribution Dr. Siwisa has done. We need people of Dr. Siwisa's caliber, people who are committed to serve our community with pride, particularly in rural areas," says Nomonde Rasmeni, the Department of Health's top official for the province.

Such recognition may not be enough to keep Siwisa in Taung. He said the struggles of running the clinic and lack of social opportunities have taken their toll.

"I doubt I will stay beyond 2007, unless something drastic happens but I doubt it," Siwisa says. "My social life has been suffering for too long. I have to live again."

But his legacy -- and clinic here in Taung -- will continue.


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Dr. Vanga Siwisa started the HIV/AIDS clinic in Taung, South Africa, two years ago.

HEALTH VIDEO LIBRARY

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