28: Stories of AIDS in Africa - Softcover

Why28

I looked at AIDS in Africa for a long time before I understood what I was seeing. That moment came on the shady porch of a small mud-brick house in a village called Nkhotakota in Malawi, early in 2002. The house belonged to Lillian Chandawili. She was thirty-five years old, and I met her through the local AIDS organization. We sat in the softening heat of the late afternoon and she told me how she was raising her five children on her own–her husband was gone. She confided that she was plagued by diarrhea and a racking cough; some days she barely had the strength to lift a hoe, but her little plot of land was the only source of food for her family.

While we talked, Lillian’s children ventured up to sit near us, and neighbours and relatives stopped by, polite and eager to greet a visitor. There were a great many children. Lillian explained that in addition to her five she was raising two of her late sister’s children and two orphaned cousins. She laid one gentle hand on their heads as they crept in close–“This one has it,” she said. “And this one, I think he’s infected.” When the neighbours moved on, she gestured with a lift of her chin at one or another–“She is infected. He is positive. Her husband is dying. He lost his wife.”

And as I listened, I suddenly understood that it wasn’t just Lillian and the dozen people in her support group in Nkhotakota who had AIDS. On paper, it was one in six adults in Malawi. But in this village, it was hundreds of people. If they weren’t sick themselves, they were caring for the sick. They were sheltering their sisters’ orphans, their dead brother’s young wife and baby. One way or another, everyone had the disease. And it meant that they earned less, that they grew less food, that fewer children went to school, that no one had any savings. Lillian talked of all the people who had “passed,” and I had a sense of a community quietly evaporating around me.

A few days later, in the Malawian capital, Lilongwe, I set out early one morning for the main hospital, where the lone doctor in charge had agreed to speak to me about the country’s HIV epidemic. When I got to the hospital, however, no one was quite sure where he was, and people suggested I try one ward or another, check this corridor or that office. I wandered the halls in a state of growing horror. I had by that point seen many basic and overcrowded African hospitals, but never anything like this. There were people everywhere: three to a bed, lying head to foot to head; under the beds, lying on grass mats in the stairwells and in the verandas off the wards. They were bone thin and covered in lesions and abscesses. As I stepped gingerly among them, they shifted their heads slightly to look up at me through eyes grown huge in sunken faces. I could not find the doctor; I did find a nurse–perhaps the only nurse–who was stout and slovenly and clearly drunk, her hairpiece of copper curls askew. Looking around the ward, I couldn’t blame her: it was barely 8 a.m., but I felt in desperate need of a stiff drink myself.

I had realized, long before that day, that AIDS was a unique and savage phenomenon in Africa. Back in 1998, in a rural hospital in Tanzania, the chief medical officer had led me on a tour of the wards. In one, we passed rows of antique but tidy beds lined up under billowy mosquito nets. Then we came to three men off by themselves, lying in a row on a thin mat on the floor. Their legs were like twigs, and their breathing was audible from the other side of the room. I was puzzled at first, and stopped in front of them. Then realized what this must be.

“Do they have AIDS?” I asked.

The doctor and his assistants whipped around. A nurse seized my arm and began to pull me out of the ward.

“Shh, shh, shh,” she scolded. “You can’t just say that word.”

The sight of those men stayed with me. Over the next few years, I kept going back to Africa, drawn to what I began to believe was the biggest story in the world. Not the wars or the refugee crises that occasionally–very occasionally–made the evening news back home, but the slow, almost incalculable devastation that HIV/AIDS was wreaking in country after country I visited.

I know something about what makes news. In the fifteen years I have worked as a journalist, I have reported on some of the biggest stories in the world. I watched Yasser Arafat and the Palestine Liberation Organization move into the West Bank after making peace with Israel in the early 1990s. I saw tentative women venture out of their homes for the first time in five years as the Taliban lost their hold on Afghanistan. I watched Saddam Hussein’s army flee Baghdad in the face of an onslaught of U.S. Marines. There is an undeniable thrill that comes with being in the centre of the big story.

But nothing I was sent to cover anywhere in the world compared to what I saw AIDS doing in sub-Saharan Africa. And yet this story never made the news at all.

In 2003, I persuaded my editors at The Globe and Mail that we were missing something important. They did not yet share my conviction about the urgency of the story, but they were willing to let me try to tell it. I moved to Johannesburg and began what would turn out to be years of travel through the heart of the epidemic: the Swazi villages, the slums outside Durban, the highlands of Lesotho, the urban hospitals of Botswana. I found hundreds and hundreds of communities like Nkhotakota on the verge of disappearing. I knew people in North America who had been living with HIV for years, taking antiretroviral medication that does not cure AIDS but will keep a person with HIV healthy for decades. But no one in Africa had the drugs. No one was even talking about getting them the drugs. AIDS was a fully preventable illness at home. But in Africa, it was a plague, and people like Lillian Chandawili could do little but sit and watch its inexorable progression. And I began to wonder how this could be happening–how we could be letting this happen–almost entirely unremarked.
From the Hardcover edition.