Ghana’s population of 19 million is being ravaged by HIV/Aids. One reporter spends the day with a doctor there, fighting to get his patients the treatment they need to live.
It is estimated that 200 people become infected each day in this West African nation.
While Canada is about to become the first industrialised country to introduce legislation that will make cheaper HIV/Aids drugs available in developing countries, in Ghana, Dr Fred Abrokwah is already giving his patients a second chance.
On a hot April morning, at 8:30 am, there are 25 people waiting outside Dr Fred Abrokwah’s office in the Fever’s Unit (Aids ward) of the Korle-Bu Teaching Hospital in Accra, Ghana.
One patient sits in a wheelchair, his head tilted, mouth opened and eyes closed. He is too thin and can barely breathe. As the doctor’s door opens, a patient comes out, while three others rush forward, not waiting to be called in.
Thirty-year-old Dr Fred appears at the door, wearing a lime coloured button-down shirt, looking slightly tired. With one gentle motion he pushes the patients aside and calls in the man in the wheelchair and his two young relatives.
It is an “Opportunistic Infections” day at the Fever’s Unit, where Aids patients suffering solely from serious infections are admitted. Dr Fred is the only permanent full-time doctor in this Aids ward where more than 2,000 patients come to be treated.
His office is almost bare: blue and white kente curtains (cloth from Ghana’s powerful Ashanti kingdom) with Danida (Danish International Development Agency) printed on them, a small wooden desk with four chairs and a bed covered with a white sheet where the words "Donated by Miss Universe 2001" can be read.
Speaking in both Twi and English, Dr Fred examines the man in the wheelchair. He pinches the patient’s skin, checking for any sign of dehydration. As Dr Fred touches his stomach, the unconscious man moans quietly. The problem is clear: urinary retention probably caused by an untreated case of gonorrhea.
During the inspection, Matron Laetitia, the head nurse, comes in, standing tall and strong in her white dress. Dr Fred tells her he’s not feeling too well today, probably allergies. Looking upset and worried, she responds: “Why did you come in then? You have seven files on your desk. Hurry up and get lost!”
Dr Fred smiles shyly. For the first time, he looks towards the corner where I’m sitting quietly, and asks me: “Have you noticed there are many less people today than usual? It’s because of the ARV treatment.”
Antiretroviral (ARV) drugs slow down the reproduction of HIV in the body. Although it does not cure the disease, it helps people infected with the virus to prolong their lives drastically. Korle-Bu hospital became one of the first public hospitals in Ghana to offer cheaper ARV treatment to its HIV/Aids patients last December.
In October 2003, the Fever’s Unit counted only 20 patients who privately benefited from antiretroviral drugs. They were paying about 800,000 cedis a month (about CAN$120) for the treatment. Ghana’s average monthly income is of merely 200,000 cedis ($CAN30). Today, the costs for the treatment are of 50,000 cedis (CAN$7.50) per month. Now, less than five months after the program began, more than 400 patients are using the drugs at Korle-Bu. By the end of 2004, it is expected that 1,200 patients will be taking ARV drugs at Korle Bu, at a rate of 100 new users each month.
The drugs being used were manufactured in Thailand, one of Asia’s first countries to produce ARV medication at highly subsidised prices. This is thanks to a US$5m grant from the Global Fund; an independent organisation governed by representatives from governments, nongovernmental organisations (NGOs), the private sector and affected communities. Canadian Prime Minister Paul Martin recently promised that Canada would give CAN$70 million towards the fund, which is also backed by rock band U2’s lead singer, Bono.
Before being able to receive ARV treatment, HIV/Aids patients need to undergo a CD4 count test. CD4 count measures the level of HIV in the blood, to determine the staging and outlook of the disease. Normal CD4 counts range between 500 and 1,500. Any HIV patient with a CD4 count of below 350 should begin receiving treatment.
HIV-infected persons who have CD4 counts below 200 are regarded to have Aids, regardless of whether they are sick or well. However, CD4 count tests are still quite expensive in Ghana, at about 250,000 cedis (CAN$38) per test.
Perpetua is 35 years old and the President of the Wisdom Association, a local association of People Living With HIV/Aids (PLWHA) that has offices in the Fever’s Unit. She has had HIV/Aids for four years. When I met Perpetua last October, she looked ill and scrawny, weighting less than 45kg.
Today, she has gained more than 15kg and looks perfectly healthy thanks to Dr Fred’s ARV treatment. Perpetua says that Dr Fred is “One out of thousands. Just the way he talks to you, always asking how you are. Every patient who comes in asks to see Dr Abrokwah,” she says.
Audrey, a member of Wisdom who is also benefiting from ARV treatment, says that Dr Fred helped her a lot emotionally. “He made me know that I am not going to die, that I will get better,” she explains.
Audrey says Dr Fred has become a personal friend. She remembers one Sunday morning when she was not feeling well; “I called him at home and he came to meet me at the Unit to treat me.” Last October, Audrey’s CD4 count was just 5. Today, it is at about 120. “I’ve grown fat and my body has changed”, she says proudly.
As most PLWHA, Perpetua and Audrey still live in fear of the stigma associated to HIV/Aids. Only Peterpetua’s mother is aware that she is ill. Even now that she looks healthy, she does not want her picture taken or be associated with the disease.
When Audrey is asked how she contracted HIV, she responds it must have been through a pedicure. Most PLWHA in Ghana will deny having contracted HIV through sexual contact. Dr Fred explains that “almost everyone knows about the disease. The knowledge has not yet been transformed into behavioural change.”
According to him, basic HIV knowledge should be included in Ghana’s school curriculum. “We also need a lot more commitment from religious groups,” he says. “People listen to their pastors a lot more than they do to other people. People in Ghana are very religious.”
Dr Fred is always calm and serene and looks much younger than his 30-years. Originally from the Eastern region of Ghana, Dr Fred studied medicine at the University of Ghana at Legon, in Accra. When I ask him why he became a doctor, he remains humble.
“I wouldn’t bore you with those noble things like wanting to help people,” he says, “It’s really because of the interest I had and the support from my family, especially my mother.”
Dr Fred remembers difficult times growing up when his mother struggled to raise her four sons after her husband’s death. As a child, Dr Fred sold soap after school in the streets of his neighbourhood to help his mother make ends meet.
Following his year of internship as a medical student at Korle-Bu, Dr Fred asked to be assigned at the Fever’s Unit. “I chose the Fever’s Unit because it has been completely neglected,” he says. “Nobody was doing much about the Fever’s Unit. There was no definite treatment for the illness. It was a big challenge. And area where you could really be on your own and do something new. You had to build something from scratch.”
When the ARV treatment program finally began, work was overwhelming at the Fever’s Unit. “It was terrible…. We lost a few patients. We lost about two per cent of the people,” says Dr Fred. “The people we lost were probably people who were at too advanced a stage of infection. Half of them started with a CD4 count of 1, so we started when it was too late.”
After examining a woman in her late 60s, Dr Fred opens a big jar of antibiotics manufactured by GlaxoSmithKline, in Kirkland, Québec. Counting the orange and white pills, Dr Fred says: “This is thanks to a donation from the Kay Morris Foundation in Canada. They’re really good drugs that we are using at the unit for people who can’t afford them.”
Although Dr Fred welcomes aid from foreign countries, he condemns Africa’s negative image in the Western world.
“Some officials in the West have said that Africans don’t have a concept of time, so ARV cannot be used in Africa,” he says. “I feel so insulted when I hear such comments.”
Another of Dr Fred’s patients, Emmanuel, is in his late 50s and complains of rashes. Dr Fred asks him if he has done a CD4 count test. “No, I can’t afford it. I’m waiting for my sister to give me money. Every morning I wake up praying to God I can afford it,” Emmanuel responds, looking down at his feet through his large glasses. Dr Fred sighs calmly. “We are trying to get it cheaper”, he reassures him.
Although the ARV treatment has now been made more affordable, there are still many other drugs that Dr Fred’s patients cannot afford, as for meningitis or toxoplasmosis. “You have to give second-rate drugs because they can’t afford the correct drugs. We lose quite a few patients because they can’t buy treatment,” says Dr Fred.
“We lost some patients because they got depressed and just gave up and refused to go along with the treatment because the family support is just not there.”
After almost two years at the unit, Dr Fred still struggles every day when he faces the horrors of HIV/Aids. “I don’t know how I manage. Sometimes it’s really hard for me. I’m becoming callous now,” he says. “I see people with malaria and minor chest infections and they tell me they are suffering. I tell them they don’t know what suffering is, so please shut up… I’ve seen too much suffering… so much so, some people have become like animals.”
One particular case taught him to separate his personal feelings from his work. “One lady became a personal friend… a young lady of about 24. We lost her to cerebral toxoplasmosis. That perhaps was the case that affected me the most,” he says. “People suffer a lot before they give up. The illness really brings you down to your knees. It really humbles you.”
Still, Dr Fred is quite hopeful for the future of his patients. “At a point it will become boring for me, because the challenge will be over,” he says, “they are looking to put many people on treatment. It will not be challenging anymore, and then I will leave.” If Canadian legislators fulfil their promises, perhaps Dr Fred Abrokwah and more doctors like him in Africa will see a shift in their day-to-day work.