We Have Changed

When I first travelled to Zambia three years ago, big money was just beginning to flow in for health care. Still, treatment for HIV/AIDS seemed a pipe dream for many. Infrastructure is not exactly a sexy word, but that seemed to be the secret. And the real story of limits in infrastructure came down to the human element. Not enough doctors or nurses to provide health care: a simple enough problem with no real solution in sight. I didn't know that in 2005 a group of Zambians and researchers from the University of Alabama were finding the solution while I was just beginning to perceive the problem.
The Center for Infectious Disease Research in Zambia (CIDRZ) began as a group of researchers from the University of Alabama Medical School. Dr. Moses Sinkala from Zambia had been studying in Birmingham when he met Dr. Jeffrey Stringer. Both obstetricians with a keen interest in HIV- particularly prevention of mother to child transmission- they struck up a friendship that eventually led to Dr. Stringer's involvement in CIDRZ. In a relatively short time, Dr. Stringer was given the challenge of putting a thousand Zambians on antiretroviral therapy. This seemed an impossible task. A combination of factors came into play, which can serve as an important lesson for scaling up health care in developing countries.
First, the Zambian government did allow a laissez-faire, even entrepreneurial approach, to increasing access to antiretroviral drugs. There were not universal protocols mandated by the Ministry of Health; rather a ground-up approach for the many clinics involved. Second, nonphysician health care providers played a key role: from nurses, to clinical officers, to community health workers. Third, some top-rate logistics and organization allowed a pipe dream to become a reality. Fourth, the money and CIDRZ came together at an opportune time in the history of the AIDS epidemic in Zambia. An openness about HIV was beginning to push back against stigma. So many had been directly or indirectly affected by AIDS that the truth could no longer hide.
Dr. Stringer and CIDRZ published a landmark paper in the Journal of the American Medical Association in the summer of 2006, in which they documented their initial success at rolling out antiretroviral treatment for 16,000 Zambians. What many had thought impossible had been done. Currently, there are over 100,000 on antiretroviral therapy in Zambia.
When I returned to Zambia this year, three years from my first visit to film 'A Year in the Life', much had changed. I think I was somewhat naive in my preconceptions for the film. I didn't want to make a film about outsiders 'saving Africa'; I wanted to tell an African story, about Africans taking charge. I think that is the story we filmed, for the most part. But it is naive to think that the enormity of the problem of HIV and other health care issues is a problem that can't be solved with out multiple partnerships between NGOs (both Zambian and international), governments, and individuals. And the vast majority of the health care for CIDRZ and others in Zambia is provided by Zambians. But maybe the best way to remind ourselves on how to solve these problems is to remember an important step in saving those 100,000 lives. The first step was a friendship struck up between a Zambian doctor and a US doctor in Birmingham, Alabama.