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Among the hundreds of formulas in my textbooks, Silence = Death was the most important equation I learned as a young student in medicine and public health.
I did my PHD training on HIV infection and substance abuse in urban America and subsequently responded to my medical school classmate’s call in 2006, where there was a concentrated HIV epidemic among migrant workers in rural Nepal, in the wake of the civil conflict and long-standing economic, political, and geographic isolation.
Possible’s origin story is a response to this epidemic and the need to solve for the most underserved communities.
Take the case of a 45- year old woman, Sarita*, who has been living with HIV for 10 years. Sarita’s husband was a factory worker in India, where he lived for most of the year until he got sick. He returned home to Far West of Nepal to see a traditional healer, but his illness got worse. Finally, he went to Bayalpata Hospital, and got a blood test that confirmed his diagnosis. Unfortunately he was in the final stages of the disease and died of pneumonia that his immune system could not fight.
Widowed, Sarita experienced a lot of stigma from her neighbors who ostracized her and teased her two children, blaming her for her husband’s death. Sarita went to see a counselor, and eventually developed the strength to not let the discrimination get to her. Through government subsidies for HIV/AIDS treatment, coordinated with staff at Bayalpata Hospital, Sarita has been able to access regular medicines and care to manage her illness.
“My CD4 is 700 now which shows that my immunity power is strong. I educated my children, both who tested negative. My daughter has completed 10th standard and is now going to college,” Sarita says.
The HIV/AIDS epidemic forced us to consider a health systems approach that went beyond vaccination, sanitation or light-touch community healthcare workers, but that was integrated, affordable, accessible, timely, and curative.
In the past decade, incredible progress has been made, locally and globally.
Now Bayalpata Hospital is the largest center for treating HIV in the Far West of Nepal, and one of the first to implement CD4 counting. These efforts, including all medications, are exclusively funded by the Nepal government, and one example where the government has championed both policy and practice. But in addition to the government funding, the linkages and coordination of a strong facility and health system is needed to make the impact truly realized for patients
Policymakers, implementers, and clinicians together are needed to push HIV/AIDS from a death sentence to a chronic disease. It has forced us to confront our race-to-the-bottom obsession with “simple” solutions at the expense of long-term investments in health systems.
Today we mark World AIDS Day, honoring the work of early champions. And we urge philanthropy, bilaterals and governments, to deploy the lessons learned from the AIDS movement as we tackle other conditions. By starting with a health systems approach that is integrated and coordinated, and truly meets the healthcare needs of patients like Sarita, we can move closer to expanding healthcare for all — this is the call to action, for all of us.
Duncan Maru, MD, PhD, is co-founder and CEO of Possible.
*The name and other details of this patient have been amalgamated from various patients to protect identities.
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