The Rwanda Cure

Western do-gooders are pouring billions of dollars into controlling malaria, AIDS and other killers ravaging the world's poorest continent. Now comes the hard part. Mayange, Rwanda is one of the poorest towns in one of the poorest countries on earth. This dusty settlement of 25,000 farmers in the center of Africa has no running water or electricity. It got its first paved road this summer. Much of the population was wiped out during Rwanda's 1994 genocide, and many current residents resettled here from elsewhere after the war. Some people here don't see as much as $50 in cash in a whole year.

Until a year ago it was not uncommon in a single week to have the funerals of three young kids. Many of them died in their homes because their parents couldn't afford the town's 18-bed clinic, which was often out of drugs anyway. "I am used to the idea of death," says 82-year-old Rosalia Kabera, who has lived in the town her whole life. "I have seen women die, young girls die and babies die during delivery." Her 1-year-old grandson, Daniel, died of malaria in 2006. His parents, who live in a nearby town, didn't seek treatment until it was too late because they couldn't afford a 30-cent co-payment.

But this year is different. Only 28 children under the age of 5 have died, down from over 100. The difference is that the village now has a functioning health center. It is staffed by nurses, not doctors, and has little high-tech equipment other than a few microscopes. But it provides basic services like generic antibiotics, rehydration fluids for diarrhea, malaria medicines, insecticide-treated bed nets and, beginning soon, AIDS drugs. A little over a year ago the clinic was seeing 5 to 10 patients a day. Now it sees 200, and the biggest problem is overcrowding.

The changes are possible because of a Columbia University program that has pumped $145,000 into the health center, money used to hire and train more nurses and install an order system so drugs don't run out. The program is run by Joshua Ruxin, a Columbia professor of public health. "We are trying to take health systems that have declined and bring them into the 21st century," says Ruxin, who hopes to bring similar improvements to 32 other clinics in Rwanda. "In 15 years people are going to say stuff happened here. It wasn't impossible."

Of the 9.7 million annual deaths worldwide of kids under 5, at least 6 million could be averted with existing technologies, a 2003 study found. The million malaria deaths could be dramatically reduced with $5 bed nets. Oral rehydration fluids, at 25 cents per treatment, can prevent many of another 1.6 million deaths from severe diarrhea. And $1 generic antibiotics can cure the 1.8 million who die every year from bacterial pneumonia. Measles still kills 390,000 a year; the vaccine to stop that was invented in 1963.

Some of what sub-Saharan Africa needs is new technology, like a malaria vaccine. But what's needed most, particularly in Africa, is better logistics. Much of Africa's population lives in rural villages and farms miles from the nearest clinic. Many countries have one doctor or less for every 10,000 residents. It's not uncommon for rural folks to die at home without ever seeing a doctor or nurse.

"The hardest truth for people to come to terms with is that the practical solutions are already out there, but they are not being applied," says Ruxin, who leads the effort in Mayange. (It is part of a larger Columbia University/United Nations undertaking called Millennium Villages, which focuses on making broad improvements in 12 clusters of poor villages across Africa.) Adds Fred N. Binka, a public health expert at the University of Ghana: "Donors always want to do something new. The simple things aren't so glamorous."

Economists debate whether the $600 billion (in today's dollars) spent on foreign aid to Africa in the last 46 years has done any good. But health spending has delivered visible results. Smallpox was eliminated in 1980 after a 20-year effort. Merck (nyse: MRK - news - people )'s 20-year-program to donate its antiparasitic ivermectin has helped treat 530 million cases of onchocerciasis (river blindness), spread by black flies in some parts of Africa; it has prevented 40,000 cases of blindness per year. Cases of Guinea worm, a parasite that slowly burns through the skin, are down from 3.5 million in 1986 to 25,000 last year, thanks to efforts of the Carter Center and others.

Yet, until the last few years, the industrialized world neglected many developing-world diseases, even as malaria and aids spiraled out of control in Africa. "When I went to medical school, global health was almost a nontopic," recalls Tadataka Yamada, 62, the former GlaxoSmithkline executive who now leads the Gates Foundation health efforts. Rich countries spent $100 million on malaria control in 2000, according to one study--20 cents per case. They spent $69 million annually on AIDS in Africa, according to a 2001 Lancet study.

The pessimists said it was simply impractical to bring complicated drug regimens into poor regions with little infrastructure. A Bush Administration aid official told the Boston Globe in June 2001 that bringing more AIDS drugs to Africa wouldn't work because many residents "don't know what Western time is."

One of the first to prove otherwise was Harvard Medical School physician Paul Farmer. In 1985 he started a clinic in one of the most godforsaken parts of Haiti, among the poorest countries in the Western Hemisphere; it soon expanded into a hospital. For years skeptics told him his programs were too complex or expensive to work in dirt-poor settings. But by 2003 the centers had treated 1,050 patients with AIDS drugs. The Haitian patients turned out to be more reliable than low-income patients in Boston at adhering to their regimens.

Celebrity economist Jeffrey Sachs, then at Harvard and now director of Columbia University's Earth Institute, started thinking about health care after a business trip to Zambia in 1995. "I had never seen people dying before my eyes. It was the most shocking thing," he says. "I had no idea that people died of the most extreme lack of access to the most simple things."

Sachs at first presumed that rich countries must be helping as much as they could, but the more he looked the more he realized how little was being done despite the rhetoric. He began exposing the meager response of the developed world. He also examined the relationship between malaria and poverty, concluding that a severe malaria problem reduced a country's economic growth by 1.3 percentage points a year, even after other factors such as geography and governance were taken into account. You didn't need a humanitarian motive to stop malaria. It made economic sense.

In 2000 Sachs started pushing in speeches and journal articles for a worldwide fund for treating poor-country plagues. Instead of having to negotiate with dozens of donors, African countries could set their own plans and apply for grants to buy AIDS or malaria treatments. The grants would be evaluated on technical merit, just like medical grants at the National Institutes of Health.

In 2002 the Group of Eight countries and others created the Global Fund to Fight AIDS, Tuberculosis and Malaria, much along the lines Sachs had advocated. It has distributed $8.6 billion so far, half to Africa; it includes two-thirds of all worldwide funding for malaria and tuberculosis. It tries to hold countries accountable by using accounting firms to audit results. Out of 450 grants, only 9 have been canceled so far for poor performance; another 3 have been suspended for corruption.

Africa, 50 years after colonialism, 600 BILLION in aid, and it's still the most miserable place on earth.

Until Africans develop values like honesty, rule of law, and cooperation, they'll continue to be a basket case.

Owl_Eagle

If what I just wrote made you sad or angry,
it was probably just a joke.

Much of the population was wiped out during Rwanda's 1994 genocide,,

what?

genocide?

what genocide?

Ask Clinton. He and his partners in crime emphatically told us at the time : "There is NO genocide going on in Rwanda!" And he sent HalfBright to the UN to repeat it.

Meanwhile 800,000 men, women & children were hacked, shot and burned to death...

Then there's Darfur - nothing to see there. Jimmy Carter says so.

The only genocide to be concerned about is one that happened 90 years ago...and may give the RAts, headed by Pelosi, what they want: sabotage everything our troops have fought and died for - and cut off their food, water, equipment supply route - which could cost them lives.

None dare call it treason.

Oh wait! I call 'em...

Why aren't we shouting them down 0 why aren't we demanding the republicans in Washington write a "Reid" letter, condemning them and bring up a resolution so condemning them?

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