Johannesburg, South Africa -- After decades of neglect, billions of dollars (much of it from U.S. taxpayers) are now flowing into Africa for economic development, poverty reduction, education, and the fight against HIV/AIDS and other devastating diseases. On a weeklong trip to South Africa, the continent's most prosperous country, I saw first-hand how some of these funds are being put to work. I saw what 'foreign aid' in the form of money, manpower and scientific expertise can do. I saw the ways in which public, private, and global partnerships can work to make a difference in the lives of the world's poorest people. I saw what progress had been made in a few short years of work. And I saw how critical it is that we do more.
My visit coincided with a steady stream of news about aid to Africa. Interspersed with coverage of Paris Hilton (yes, as unbelievable as it sounds, she was big news overseas, too!) were stories about President Bush doubling the U.S commitment to battle the global AIDS crisis, Bono's surprise appearance at the TEDGlobal conference in Arusha, Tanzania to debate the question, "Is foreign aid doing Africa more harm than good?," the G-8's pledge of aid to Africa and the avalanche of criticism from 'development campaigners' insisting that this was an insulting re-hash of an old commitment.
Against this backdrop, I spent a day visiting sites supported by the Elizabeth Glaser Pediatric Aids Foundation, the only private organization that focuses exclusively on children and HIV/AIDS. We began our morning at the stark, rundown 'Alex' clinic that serves the teeming Alexandra Township (population: 400,000) where roughly 35% of pregnant women are HIV positive. It's so gray and colorless that, at first glance, it appears bleak. But when you look more closely, you see it is spare but immaculate, and home to a team of highly skilled nurses and midwives. (Nurses provide most of the medical services at this clinic and others through-out the country.)
The 'Alex' clinic offers free primary health care along with HIV/AIDS counseling, testing, prevention and treatment to all women coming in for ante-natal care. The nurses there see 40 patients a day and are fully booked for months. Scores of pregnant women, many of them 16 and 17 years old, line up in eerie silence. They stand on a scale in the center of the room for 'weigh ins' as part of their checkup, carrying instructions and urine samples. No one says a word, at least while we are in the room. I wonder what they think of us...our party of 6 people from Los Angeles, taking a tour of a place that is clearly not on any tourist map.
The nurses proudly tell us that virtually all of the women who receive counseling (the first step in their ante-natal care) agree to take an HIV test. It wasn't very long ago that women were reluctant to be tested, fearing the stigma of the disease and the certain death that followed. A small victory, in an almost overwhelming battle.....
In a tightly packed, worn, yet spotless labor and delivery ward, we pass by women in labor, and again it's quiet. One ultrasound machine is the only visible piece of new technology. It's not unusual for one nurse to handle ten deliveries in one night. The clinic averages 350 births each month. Keeping those babies free of the HIV virus is one of the most important things they do here. At 'Alex', HIV positive mothers are given a single dose of nevirapine (the common form of prevention of mother to child transmission of the AIDS virus in the developing world). Their babies will also be given a dose. The inexpensive and simple treatment, while not the complex regimen of care that has virtually eradicated pediatric AIDS in the U.S., cuts the transmission rate in half. The clinic is supported by the South African government but the funding doesn't cover all the services they provide. The Pediatric Aids Foundation fills in the gaps. Without that aid, the clinic would not be able to offer this kind of care to mothers and babies in the township.
At Chris Hani Baragwanath Hospital in Soweto, a former military barracks turned public hospital, 'foreign aid' looks like a sophisticated global partnership. The governments of South Africa and the United States work with private foundations to fund much of the HIV/AIDS efforts here. Bara is an imposing maze of buildings, almost overwhelming in size, serving the 4 million people of Soweto and others from nearby nations who cross South Africa's border to get free care.
At its Perinatal HIV Research unit, nearly twenty thousand women a year use its ante-natal care and delivery services. The waiting room is packed with women and children. In this big city hospital, some moms have babies strapped to their backs as they do in rural areas. You can't help but wonder as you step around impossibly cute toddlers waddling around the room how many of them might be infected with HIV. A nurse proudly points to the two or three men in this sea of women. For them it's a powerful sign of change. Not very long ago, the presence of a man in a women and children's AIDS clinic in Africa would have been unheard of.
Among the services Bara Hospital provides are couples counseling, a community based focus on men and prevention, and treatment for the entire family. In the counseling rooms, the staff notes some state of the art features that easily could have gone unnoticed by me: a 2 seater couch, a low table, and a third chair. The low table eliminates the distance and formality of a counselor positioned behind a desk, but the couch means a couple can sit together and receive HIV counseling. Getting a man and a woman together on a couch for HIV counseling, getting a male partner involved at all, is a massive triumph in a country where the hideous burden of this disease rests on the shoulders of its women.
As we leave the sprawling facility nestled in the vast Soweto Township, we pass by their wall of fame with pictures of some of their famous visitors: Brad Pitt, Bono, Elton John, and Prince Charles. Clearly Bara is a 'must-see' in Soweto, an important frontline in the battle against HIV/AIDS and a reminder that foreign support is imperative.
Not far from Bara, also in Soweto, at the African Children's Feeding Scheme, a hundred or so children line up in a dirt and grass yard, adjacent to a few one story structures....not quite shacks, but not quite sturdy buildings either. A few jostle each other gently, but they are shockingly well behaved and polite. They are lined up in an orderly fashion for a thin smear of peanut butter between two slices of bread and a small plastic cup of milk. This looks like a decent and fairly typical child's lunch until you realize that it is probably their only food for the day.
Women who come here learn to raise vegetables in tiny urban garden patches or metal tubs. And today is supplemental food day. Lined up in small piles on the ground are a bag of rice, 2 cans of vegetables, and a small bag of beans to provide protein rich nutrition. Again, it appears healthy and substantial, until someone points out that this pile which would fill a quarter of the shopping cart I'd fill up on a weekly shopping trip for my family is meant to last a month.
The African Children's Feeding Scheme feeds 18,000 children a day, many of them AIDS orphans or heads of households at 20 small centers like this one across Johannesburg. Sister Rejoice Nkuna, who has been here since the 1970s, told us that she'd requested funds from 'Pepfar', the president's emergency AIDS relief fund years ago, but was turned down. Now that there is a better understanding of the importance or proper nutrition to AIDS care, she'll apply again. To me it's clear 'foreign aid' should be directed to places like this where enterprising locals are caring for their own community.
Part II: Aid to Africa Done as Only Oprah Can