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Bringing hope to the forgotten
Karen Palmer, Toronto Star
August 29, 2005

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Zimbabwe treated as a pariah of African nations. But Canadian doctors try to aid at-risk newborns

The ends of the "s" on the tiny sign at the fork in the dusty paths just outside the Howard Hospital in central Zimbabwe swirl in curlicues, a seemingly cheery illustration for such a dark message: "coffins for sale."

In a country where HIV rates are in the double digits and there's no money for life-saving drugs, death is a virtually certain outcome for AIDS patients visiting the local hospital.

Although Zimbabwe is hardly alone among African nations in its struggle against the virus, none has a worse international reputation and fewer offers of help.

Yet, for three weeks this month, infectious disease specialist Dr. Andrew Simor visited the overwhelmed Salvation Army hospital where expectant HIV-infected mothers have learned that early intervention by the Canadian doctor and his team can save their babies from AIDS.

In a country where HIV infection rates hover at about 25 per cent, Simor is using a $280,000 grant from the Canadian International Development Agency to build a new laboratory and offer life-saving anti-retroviral treatment and medications meant to reduce AIDS transmission rates.

"The women are very aware of what the implications are," Simor said.

"HIV in that country — there's still a stigma attached to it," he said. "Women in particular don't want to know their diagnosis because their partners blame them and beat them."

Simor has visited the clinic every year to year and a half since 1998, mostly with the help of the hospital and Ve'ahavta, a Jewish humanitarian group with local and international projects.

Although his specialty is tuberculosis and antibiotic resistance, Simor is better known as the doctor from Sunnybrook & Women's Health Sciences Centre who added clarity to the sensationalism surrounding SARS and West Nile virus.

He first learned of the Howard Hospital, 90 kilometres north of Harare, from Paul Thistle, a Toronto-born and trained obstetrician who presides over its wards as everything from family doctor to anesthesiologist to thoracic surgeon, since he is the hospital's sole physician.

Seven years ago, Thistle was visiting family in Toronto and turned to one of Simor's colleagues for advice on what to do if he got a needle prick from an HIV-infected patient. That led to a partnership aimed at reducing the number of babies infected with HIV during labour and delivery by giving them drugs to fend off the virus as soon as they're born.

Although its pharmacy shelves are frequently bare and its x-ray machines routinely run out of developer, the government hospital treats about 300,000 people, most of them subsistence farmers who live in thatch-covered huts that seem to radiate from the clinic, down dusty roads and rugged pathways where chickens and goats scratch for food and women walk in search of water.

"They, least of all, can afford to deal with HIV/AIDS," Simor said.

Already an ignored corner of the world, Zimbabwe's pariah status makes it just about the worst place to try to stop a virus bent on destroying it, says Simor.

He is harsh in his criticism of President Robert Mugabe's dictatorship, calling it "incompetent" and "corrupt." During these trips, he sees what Mugabe's reforms have done to the local people, how they've grown thinner and sicker and more depressed in a seemingly endless cycle of oppression.

During his visits, Simor says he feels a growing air of hopelessness permeating the hospital.

Zimbabwe was once seen as the bread basket of southern Africa for its rich mining contracts, plentiful mineral deposits and lucrative farming sector — one that not only managed to feed the country but export produce and crops like tobacco.

Today, it's an international pariah.

Land owned and occupied by white farmers has been forcibly redistributed to black workers by Mugabe's order. Aid workers say the result is that the country is suffering from a serious, potentially deadly food shortage. Blistering United Nations reports point to numerous human rights abuses, including rigged elections and harassment of Mugabe's detractors.

The latest condemnation came as Mugabe ordered the slums surrounding the capital city torn down and the squatters forcibly removed.

Almost a quarter of all Zimbabweans are infected with HIV, a staggering rate that means out of the 12 million people who live in the south African country, three million could die of AIDS.

While it's official policy to provide every HIV-infected person with free anti-retroviral drugs, the country rarely has any in stock.

Simor uses a small, five-year-old CIDA grant to pay for a new laboratory at the hospital, one that will be able to provide more accurate testing for things like tuberculosis and HIV. Once that money is gone, Simor says he's unlikely to get further funding from CIDA for Zimbabwe, since the south African country's dictator makes it politically unsavoury to provide foreign aid.

Until then, Simor is heading a study looking at whether transmission rates between infected mothers and their babies can be reduced if the babies are treated with anti-AIDS drugs at birth.

The study includes counselling for the AIDS-infected mothers, which Simor insists helps it succeed.

Another study is looking at whether a shorter course of treatment is effective at reducing infection rates among newborns, while yet another is looking at ways to prevent mother-to-baby transmission through breast milk.

So far, they've convinced a dozen women to face the cultural stigma of giving up breastfeeding after six months to study whether it has any impact.

And they've just enrolled their first 100 non-pregnant patients in a study that gives them life-saving anti-retroviral therapy.

"That's a drop in the bucket when you look at the whole country," Simor said.

"But it's a start."

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