It is bad enough that people are dying of AIDS, but no one should die of ignorance.Elizabeth Taylor
An old woman is praying.
She sits in the teeming hospital corridor on a broken bench and twiddles a white plastic rosary through her gnarly fingers, muttering an unperceivable mantra. I am reminded that praying is still the most widely used medication, especially in hospitals. ‘There are no atheists in trenches,’ Eisenhower once said. Even doctors believe in God. I think. Or do they?
Then, as I continue to walk down the labyrinthine corridors of the Puerto Plata General Hospital Ricardo Limardo, I catch myself humming the catchy Juan Luis Guerra tune “Niagara en Bicicleta” about Dominican hospitals. I can’t help it. Patients scamper directionless in and out of doors, nurses stride about seemingly aimless. A fat little medico waddles importantly past me like himself a god on his way to stardom someplace else, a gaggle of interns in his wake. There is an air of controlled drama, spiced by the odor of antiseptics. At last I reach a door marked ‘statistics–please knock and enter’ and, although I disapprove of being considered a statistic, I knock and enter.
The kinetic doctor is seated behind her iron desk in the incommodious office and she is elbowing towards me through a swamp of paperwork like a soldier in the trenches. I select a chair older then me, and as we begin our conversation the words ‘fighting’ and ‘struggling’ keep popping up. After a few minutes Dr. Sonia Ramirez has me convinced that, indeed, we are at war, and the enemy is not a flesh-and-blood being with a conscious mind bound on supremacy, but an ultramicroscopic microorganism occupied entirely with its own survival: the human immunodeficiency virus, HIV in short. I’ve come to inquire about the hospital’s HIV battle plan, and Dr. Sonia is prepared to reveal details.
It Starts Before Birth
“We call it the Project of Vertical Transmission,” she says with no lack of conviction.
Around us hospital life unfolds dramatically: a lost patient staggers repeatedly into the statistics office. A nurse complains that there is no more coffee. Somewhere someone is giving birth — or is having some other type of pain.
“Vertical transmission is the transmission of HIV from mother to child during pregnancy. Here at the hospital we are prepared to offer to all pregnant mothers a quick, gratuitous test. Should a test result HIV positive — or rather, as we say here, reactive — then the expecting mother will be introduced to the project, where she will be provided with oral antiretroviral medications several hours prior to birth. The same medication will be administered to the newborn eight hours after birth, in order to reduce the risk of infection to the newborn by 80 to 85 percent.”
I scribble down the numbers; to me it sounds like a good plan, since there are three main ways to be infected with HIV: sexual intercourse, the use of contaminated paraphernalia (needles, blood transfusions, etc), and the third, mother-to-child contagions. The first two can be obviously avoided, while the last involves an innocent third party that can not be blamed for the infection, yet is cursed with it.
If something urgent needs to be done, then it is for the innocent unborn.
The Battle Is On
Sonia is called to a phone. I put down my pen and stare into the austere office she shares with three others. The furniture is secondhand, the walls bare and cracked, an empty coffee machine stands on a chair. But no religious icons, I note. Water pats onto the concrete floor from thin stalactites dangling from a hole in the ceiling. Sonia had been unable to give me numbers as to how bad the infestation is in Puerto Plata, but an estimate shot from the hip puts the number at over 6,000 cases, of which 5,000 are young, working and sexually active individuals. The country’s total is estimated at 2.5% of the nearly 8 million inhabitants, and 80% percent of these are between the ages of 15 and 44. Compared to other nations, that’s not so bad. But it doesn’t mean we can let our guard down. We are still at war.
“80 percent,” I remind her.
“Yes. The idea is to reduce the child’s risk by 80 to 85 percent. However, this is not yet confirmed. We are trying to reduce it by 80 to 85 percent. The project outlines that the mother should not breastfeed the child, but should use special powdered milk instead, and that the child receives a three-monthly check up.” Her gaze turns firm. “Listen,” she says, and I do. “It is important that this is said: before the expectant is tested, she is taken aside and a qualified person–a psychiatrist or such–explains to her the reasons and importance of the following test, as well as the meaning of the results. The results are then presented by the same person, no matter if negative or positive, because negative results are is important to us as the positive.”
I understand why: if the suspicion of an infection is present, it is possible that the infection remained undetected and another test should be performed at a later time. For HIV, or AIDS, as the disease is known, can not be taken for granted. And never has.
It is interesting, if unnerving, to note that the rise of AIDS along the North Coast can partially be blamed on the North Coast’s main economic revenue: tourism. The Puerto Plata area is still one of the nation’s chief tourist center, which translated over the last few years into a pouring migration of men and women from the campos (an expression that refers to the farm lands outside big cities…and a little more then that) seeking work in the numerous resorts.
Looking For A Living
This urban explosion has done nothing but aggravate the expansion of AIDS. According to an AIDS dossier published by Grupo Clara, the interrelations between the campos and the big cities, the unbalanced cultural interchange with foreigners, and the booming sex-market have created new values, new moral standards and novel situations in social and family relations which demand answers that can not be given easily. And it is in this context that the HIV infected find themselves set apart from everyone else by society’s forced alienation.
And on top of all, it is mostly the wretched of the earth that are fertile breeding grounds for the virus — the poor and misfortunate. Certainly the want of health care, hygiene and nutrition contribute, but one of the foremost causes of AIDS is the little background knowledge or complete lack thereof. For example, social ignorance condemns the use of preservatives.
“There are many myths,” explains Sonia. “’It’s not the same, it doesn’t feel right’ and such. It’s because of the little education the people have.”
Then how can these people prevent infections? I ask. The answer is simple only in wording: “the best prevention is education.” She redirects me to a small office boxed away in the ample Health Center of Puerto Plata, where a group of dedicate men and women going under the name Grupo Clara attempt the near impossible: reeducate a nation. They are funded by residue money, equipment and volunteers from UN programs, USAID, the occasional windfall donation from European nations, and a few scattered private and government sources tagged with long knotted initials common to Dominican organizations — CEPROSH, COVICOSIDA, SESPAS — and they have the battle plan clearly outlined. But despite all these helping hands they still lack such fundamentals as medications, food rations and even milk.
For a war can only be fought with supplies.
And education is only the beginning. What the North Coast needs is to establish a working health care system for AIDS/HIV patients both in medical as well as psychological terms. Sonia also dwelled on this point: the deterioration of the immune systems is only part of the damage AIDS causes. The other impairment is psychological: sufferers become automatic social outcasts. Although the AIDS virus is not as easily transmitted as the common cold, people snub a known AIDS carrier more readily than someone who is coughing. Sufferers lose their jobs, friends, even family. This expulsion forces many to live in isolation or to go underground and breaks their spirits faster than the virus can destroy the immune system.
It doesn’t have to be that way. Sonia points out that many carrier live normal lives, their impairment only limiting them to sexual intercourse and the dependency to certain antiretroviral and antibiotic medications. She compares it to diabetes, were a patient is forced to adapt his life to his malady and relinquish a few of life’s pleasures. There is no reason to banish someone because he can’t eat mint candy and drink coffee. People need to realize that AIDS/HIV is not as unspeakable as much assumed, and that sufferers have as much a right to a job, friends and family–in short, a life–as everyone else.
A Future Without AIDS?
When I ask her about the future, Sonia smiles. There are several promising projects the hospital and Grupo Clara are pursuing, and if and when they root, more positive numbers will be reported. But for now there is a dire need for everything from medications and psychologists to money, in order to assist the suffering and, referring to her pet-project of vertical transmission, the yet unborn carriers. But by the time someone else takes her chair, what does she hope the AIDS situation locally, even worldwide, will look like? Will the battle be won?
“By that time,” she replies, “I hope that it will no longer be an issue, that mankind will have won the war and defeated AIDS.”
And then, like an afterthought Dr. Sonia adds, “God willing.”