"In Kenya, AIDS Therapy Includes Fresh Vegetables"
By Roger Thurow
Wall Street Journal
Wednesday, 28 March 2007
"ELDORET, Kenya -- Just beyond the morgue of Moi Teaching and Referral Hospital, Dr. Joe Mamlin, a professor of medicine at Indiana University, questions his staff on their latest progress in the war on AIDS.
"How much food are we harvesting today?" he asks. "How many people are we feeding?"
Stretching over two acres of the hospital grounds is a garden of carrots, onions, cabbage, collard greens and fruit trees. A stream meanders by, providing water for drip irrigation. This land and other farms around the city tilled by Dr. Mamlin's team yield four tons of vegetables and fruit each ...."
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To read the rest of the article: ELDORET, Kenya -- Just beyond the morgue of Moi Teaching and Referral Hospital, Dr. Joe Mamlin, a professor of medicine at Indiana University, questions his staff on their latest progress in the war on AIDS.
"How much food are we harvesting today?" he asks. "How many people are we feeding?"
Workers till the fields at the Moi Teaching and Referral Hospital in Eldoret, Kenya. Each week, this patch of land and a few other farms around the city yield four tons of vegetables and fruit that are sent to clinics in the area.
Stretching over two acres of the hospital grounds is a garden of carrots, onions, cabbage, collard greens and fruit trees. A stream meanders by, providing water for drip irrigation. This land and other farms around the city tilled by Dr. Mamlin's team yield four tons of vegetables and fruit each week, year round. Every morning, a truck delivers the freshly picked produce to clinics in western Kenya. When the doctors write out prescriptions for drugs for AIDS patients, they also hand out a ration card for food to those who are malnourished.
"In the U.S., I can sit in my office and write a prescription. But here, amid hunger and such poverty, I can't just write a scrip," says Dr. Mamlin. "There are no calories in the drugs."
Getting affordable drugs to Africa has been the top priority in the fight against AIDS. But the continent with the majority of the world's AIDS cases also has the world's highest rate of hunger. As clinics proliferate and distribution of drugs widens, health workers are finding that hunger and malnutrition sap the therapy's effectiveness, undercutting the multibillion-dollar investments of private organizations and governments.
The standard advice that comes with medicine throughout the developed world -- "take with food" -- is just catching on in Africa. Last year, the United Nations, which estimates one-sixth of the people on antiretroviral treatment also need nutritional support, formally declared that access to food should be part of a comprehensive response to HIV/AIDS. In September, the Bill & Melinda Gates Foundation, which has been at the front of the philanthropic assault on AIDS, opened a new funding thrust: boosting agriculture production in Africa.
NEW PRESCRIPTION
The Issue: Health workers in Africa are finding that hunger and malnutrition sap the effectiveness of AIDS treatment.
The Background: Relief organizations say food should be part of a comprehensive AIDS program.
What It Means: In Kenya, one medical group runs farms and gives patients food rations along with drugs. It also teaches patients farming techniques, so they can grow their own food.
In the highlands of Kenya, Dr. Mamlin has been pioneering a merger of medicine and agriculture. The rangy 71-year-old internist with a crown of white hair studies the life span of passion-fruit vines. He surveys the construction of a tomato greenhouse. He worries about access to fertilizer and seeds. Of the 3,500 chickens under his wing, he says, "Any one that can't lay an egg becomes a contribution to our meat stock."
Dr. Mamlin leads a partnership between Indiana University and Kenya's Moi University School of Medicine. It created the Academic Model for Prevention and Treatment of HIV/AIDS, or Ampath -- one of the first AIDS programs to include a large-scale farming component.
The program treats more than 40,000 Kenyans stricken with HIV, the AIDS virus; about half require antiretroviral drugs. It also feeds more than 30,000 people, including patients and their families. And Ampath -- which has a staff of nearly 900, most of them Kenyans -- teaches modern farming techniques to thousands of recovering patients so they can grow their own food.
"Instead of just focusing on one aspect of the epidemic, Ampath has developed a whole ecosystem of response," says Warren Buckingham, Kenya coordinator for President Bush's international Emergency Plan for AIDS Relief, which provided about $11 million to Ampath last year.
In addition, Ampath received about $2 million from private donors and grant-funded research. The U.N.'s World Food Program also donates grains and cooking oil, to supplement Ampath's fresh vegetables, fruit and eggs. The World Food Program, which has traditionally helped victims of drought and disaster, is expanding its food distribution to needy people with HIV/AIDS and their families in many places.
Foray Into Farming
Dr. Mamlin's foray into farming began five years ago when Salina Rotich, who had wasted away to little more than skin and bones, was carried into his clinic in the rural village of Mosoriot.
Before then, Dr. Mamlin had an academic career and was chief of medicine at Indianapolis's Wishard Memorial Hospital, where he created a neighborhood health-care system for the poor. In 1989, he and other doctors from Indiana formed an exchange program with Moi University in Kenya.
In the early 1990s, he spent two years in Kenya as a visiting professor. In 2000, nearing retirement, Dr. Mamlin went back to Kenya to head the university partnership.
Immediately, he noticed a drastic difference from his previous stint in Kenya: Patients were dying at a much faster rate and at a much younger age. "Indiana University found itself in the middle of maybe history's worst pandemic," he says.
Close to Home
The AIDS explosion struck particularly close to home when Dr. Mamlin, making hospital rounds, spied one of the fifth-year medical students sitting on a bed feeding a patient with a spoon.
"What are you doing?" he remembers asking.
"This is my classmate," the student replied.
The deathly ill patient was one of the Kenyan medical students, Daniel Ochieng. He became the partnership's first patient to be treated with the antiretroviral drugs. "It took six weeks, but we saw Lazarus come back from the dead," recalls Dr. Mamlin. "We thought, if that can be done for Daniel, how many more can we save?"
To remain a purely academic program, he says, "would have been absurd." While the student-exchange continued, the partnership transformed into a practicing health-care network, introducing HIV/AIDS treatment into 19 government clinics.
In April 2002, Ms. Rotich, 34 years old at the time, appeared on Dr. Mamlin's doorstep. She was suffering from pneumonia. The oxygen level in her blood was minimal. Her weight had plummeted to 70 pounds. She was dying of complications of AIDS.
Dr. Mamlin controlled her pneumonia and put her on antiretroviral treatment, expecting improvement. "We waited for something to happen, and it didn't," he says. "That's when I asked her about food. 'What are you eating?' She said, 'Nothing.' "
He reached into his pocket and pulled out some Kenyan shillings to buy eggs, milk and corn meal. Week after week, the doctor gave her money for food. And week by week, she added strength. After six months, she had gained 70 pounds.
"I didn't have any food at home, and I wasn't able to work to buy the food because I was so sick," Ms. Rotich says now. "Once I started eating, I started to get better."
Again, Dr. Mamlin thought: How many more can we save? This time, with food as well as the drugs. "For 80% of people on antiretrovirals here, their health improves up within six to eight weeks," he says. "But 20% don't come up. They're the ones without enough food."
The village high school donated a plot of land and Ampath sowed its first seeds. Dr. Mamlin hired Steve Lewis, who was nurturing community farms in Kenya at a development organization. For Ampath, Mr. Lewis cultivates several farms, providing vegetables, fruit and eggs.
"The doctors need the farmers," Mr. Lewis says. "For the drugs to be as effective as possible, they need what we grow."
By the time Christine Kili, 35, came to the clinic in Mosoriot in 2004, sick and malnourished, the program was handing out prescriptions for AIDS drugs and food at the same time.
"If we were given only drugs, without food, we wouldn't have come this far," said Ms. Kili, pointing to herself and Ms. Rotich. The two had returned to the Mosoriot clinic on a recent day for their monthly checkups and drug prescriptions. "It is only because of drugs with food that we are sitting here."
Most Grateful
She is most grateful that her prescription for food included her two daughters as well -- also a result of the doctor's orders. "You can't say to your children, 'No, this is my food and I'm not sharing,' " she says. "You can't eat an egg while your child has nothing."
One 33-year-old woman, who recently came into an Ampath clinic to fill her first weekly food prescription for herself, her husband and their five children, said they hadn't had an egg in three weeks. She told the nutritionist that she and her husband are too weak to work and can afford one meal a day, usually only corn porridge. They sold most of their corn crop from the previous harvest to care for their 8-month-old baby when he was sick with pneumonia.
Her eyes widened as her bag was filled with milk, eggs, assorted greens and dried grains. "This will really help," she said, straining to lift the sack, which weighed about 20 pounds.
Ampath distributes food to patients for six months while the medicine gets them back on their feet. Then they graduate to Ampath's Family Preservation Initiative, where they learn skills that will help them grow their own food or get a job so they can buy food.
"When a patient first comes to me wasted and dying, the eyes look up and ask for medicine," says Dr. Mamlin. "After two months, when they are a little more powerful, those eyes look up and say, 'I'm hungry.' After six months, those eyes look up and ask, 'How do I get a secure life, be independent?' "
Mr. Ochieng, 30, Ampath's first patient, now heads the program's outreach efforts, checking to make sure patients take their medicine and eat enough. "They will be getting medicine for the rest of their lives," he says, "so they need to be able to provide their own food for the rest of their lives."
That is Ronald Kegoli's ambition. When he first met Dr. Mamlin, he vigorously shook the doctor's hand and said only, "Sept. 17, 2004."
"Do I know you?" Dr. Mamlin asked.
"That's the day I got the courage to go to the clinic," replied Mr. Kegoli, reflecting a common fear of seeking treatment.
He became ill in 2002. After being diagnosed two years later, he was put on the AIDS drugs. With food, he recovered and then enrolled in an Ampath farming class. One day last year, the class visited a passion-fruit farm and the owner explained how she makes about $50 a week from the fruit, an income that is steady throughout the year. When he was growing corn before he fell ill, Mr. Kegoli would make about $300 from the annual harvest; he knew that wouldn't be enough to keep him well-nourished throughout the year.
The 'Moneymaker'
He jumped at the chance to be an Ampath passion-fruit farmer. Now, he tends the vines of 408 seedlings. He has rigged up an irrigation system that pulls water from a well. To bring up the water, he walks on a StairMaster-type pump for several hours a day. "We call it the 'moneymaker,' " he says of the pump.
Under blue skies and a hot sun, Mr. Kegoli surveyed his half-acre field and smiled. "With passion fruit, every week I make money," he says. "Now I am at peace."
The Ampath farmers have banded together in a cooperative they named Amkatwende, which means "Rise up, we go."
That is also Salina Rotich's motto. Back from the dead, she has added 300 passion-fruit seedlings to her two acres of corn. Her five children, who had gone to live with her parents when she was too weak to care for them, are now back with her. She is feeding them all.
"I'm working my farm, I'm carrying the water myself," she says. "We're eating well."
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