Monday, June 30, 2008

Next Stop: Nairobi



I'm packing now for Kenya. The next phase of the trip will take me to places a lot less familiar.

In East Africa, malaria is the bug to beat. The following is from the WHO site info on malaria:

About 40% of the world’s population, mostly those living in the poorest countries, are at risk of malaria. Of these 2.5 billion people at risk, more than 500 million become severely ill with malaria every year and more than 1 million die from the effects of the disease.

Malaria is especially a serious problem in Africa, where one in every five (20%) childhood deaths is due to the effects of the disease. An African child has on average between 1.6 and 5.4 episodes of malaria fever each year. And every 30 seconds a child dies from malaria.

The ravages of this disease --- heralded by little more than the buzz of a mosquito -- have become one of the new foci of global health. U.S. President George W. Bush's malaria initiative pledges to increase U.S. malaria funding by more than $1.2 billion over five years to reduce deaths due to malaria by 50 percent in 15 African countries, making malaria one of the "hot" diseases for global health workers and funders.

I'm going to be looking at efforts to prepare the ground in coastal Kenya for clinical trials of the RTS,S vaccine protoype, developed by GlaxoSmithKline.

There's a, perhaps Western, science-based, hope that vaccines are the answer to problems like HIV and malaria. The work going on in Africa will tell us if that is the truth.

I'm expecting to have less reliable Internet connectivity over the next few weeks but will post as I can. Don't forget about me!

Farwell to Baragwanath



I finished the first stage of the project today, wrapping up a couple of last interviews with AIDS vaccine trial participants at Baragwanath Hospital.

Noluvuyo Mncini was my final interview. A 20-year-old from the vast Orange Farm shantytown outside of Johannesburg, Noluvuyo was not letting the world get her down: she showed up in high heels, a smartly cut jacket and long beautiful braids.

Like so many of the participants I talked to at Bara, she seemed both very young and very determined. She lives with eight siblings and her parents in a small house in Orange Farm. Her father was recently laid off, and the whole family is making do with his minimal unemployment insurance -- and, presumably, the periodic payments Noluvyo gets for coming in to the Phambili clinic.

Places like Orange Farm are where South Africa's AIDS epidemic is hitting hardest. People are afraid to get tested, medical services are minimal, and the heavy stigma that surrounds HIV can make people reluctant to access free antiretroviral drug treatment.

Noluvuyo said she sees it all around her: last Saturday she spent at the funeral of a friend, dead at the age of 23.

"I am afraid of HIV. I don't want to die of HIV," she said.

Of course, the money she gets for participating may be important too. Each participant is paid 150 rand (about $20) to come in for their clinic check-ups. The money is reimbursement for transport, but in extremely impoverished households like Noluvoyo's it can make a difference, if only for a couple of days.

She said she thought most of the Phambili participants were in it for the money. Few others that I talked to agreed with her. But teasing out the motivations of people who are part of the AIDS vaccine enterprise is tricky: most sincerely seem to want to be part of the solution, however far off. But most are also very young and very poor -- an ethical conundrum for researchers.

The picture above is not mine, but shows one of the murals painted on the walls of the hospital complex. I've come away with lots of notes and lots of questions. I'm planning to be come back in August to do some follow-up, and also (I hope) to set up a TV version of the story with colleagues at Reuters Television.

Friday, June 27, 2008

Africa Time


I'm remembering why -- for the impatient or the uninitiated -- "Africa time" can be so frustrating! The way that appointments slip and slide, people commit and uncommit..for a reporter it can be daunting trying to figure out what is really going to happen when (or if it will happen at all!)



In my case, today, it didn't. Spent several hours waiting at Bara Hospital for two of the Phambili trial participants who said they would take me visit an AIDS hospice in Soweto. I had hoped that this would give a good view of how the disease is hitting the community, as well as a window into the motivation of the (by and large very young) South Africans who opted to take part in HIV vaccine research trials.

But the wait was fruitless -- despite several phone calls and updates, they never came. I guess I'm not surprised: it is asking a lot of someone to guide around a nosy foreign reporter. And it is Friday afternoon! Still it's too bad. The hard part about this project will be breaking out of the confines of clinics and offices to see how people really live. I'm not there yet.

On the upside, I had a great, 1-1/2 hour interview with Glenda Gray, the principal investigator on the Phambili trial. "Prof. Glenda", as she is almost universally known by the Phambili crew, is certainly an effective advocate for the AIDS vaccine enterprise, and despite the disappointing results so far she seems ready to carry on. One interesting element that was underlined during the interview was the tension between researchers and government health officials. Most top-ranking HIV clincians and researchers in South Africa are white, so inevitably the argument over who decides where to go with clinical trials (done mostly on black citizens) takes on a racial tinge.

But that's the way it is with almost everything in the "Rainbow Nation" -- a country publicly and sometimes angrily wrestling with the race questions that bedevil so much of the world.

Wednesday, June 25, 2008

Journalist, Don't Distort Me



Yesterday I had a long talk with Gloria Malindi, a 60-something Soweto grandmother and retired nurse who also serves as chairperson for the Community Advisory Board at the hospital's vaccine trial site.

Gloria has the cuddly look of a South African "go-go" (granny), but she's no slouch when it comes to self expression or the right to protect herself from misinterpretation.

"Journalist, don't distort me!" she warned, before giving me her two cellphone numbers.

The Community Advisory Board (CAB) is an important part of a vaccine clinical trial, serving as the main conduit between the scientific researchers and the community upon whom the research is being conducted. The Soweto CAB includes nurses, teachers, religious leaders and a hefty helping of HIV/AIDS NGO workers, who are then tasked with "going back to the community" with information about the trial.

Gloria's more at home than I am in discussing the specifics of the Phambili vaccine, and obviously has logged plenty of time in the dismal world of international health meetings, where words like "paradigm shift" and "relevant stakeholder" are tossed around like confetti.

Like most of the people I've talked to, she's got nothing but good things to say about Phambili and how it was conducted (the caveat being, of course, that like most of the people I've talked to, she was INVOLVED in how Phambili was conducted!). Nevertheless it seems like the system worked: participants felt adequately informed, rights were protected.

As a person this is gratifying -- even if, as a reporter, I'd like a little more controversy! Perhaps that will come as I get deeper into the story -- but perhaps not.

A WORD ABOUT SECURITY

It has been funny getting reacquainted with South Africa's security obsession. Everything is triple locked, gates slam shut, guards issue passes...moving through parts of this country can be like moving through a medium security prison. Today when I went for an interview in downtown Johannesburg, I had to have my car registered at the garage, then sign OUT of the garage as a pedestrian, walk down a short street under the view of security cameras, then sign IN to the building where I was going, get a security pass, and go through turnstiles. It's all done with good humor though and I guess in a country with crime rates as high as South Africa's it is to be expected, but it can make even the bravest person a little phobic!

Monday, June 23, 2008

Trapped in an Elevator!

So today it came to pass that I was trapped in an elevator in Soweto's Chris Hani Baragwanath Hospital with one of the principal investigators of South Africa's Phambili AIDS vaccine trial...

Sadly, we were released after only a few minutes so I was denied every reporter's dream of the in-depth, five hour interview with a subject who cannot escape. And, despite the lost interview opportunity with Dr. Glenda Gray, I was just as glad we didn't end up like this. Glenda says she'll give me an interview later in the week.

The rickety elevator leading up 12 floors to the offices of the Perinatal HIV Research Unit (PHRU) is emblematic of the weird world of "Bara", the main public hospital serving Soweto's more than one million residents. A sprawling medical city, Bara resembles a sort of broken down military encampment. Patients, some in pyjamas and others on crutches, hobble to and fro among the low slung brick buildings, many looking as lost as I felt. I saw one security guard go whizzing past on a bright canary yellow quad bike, looking as though he was headed for the beach.

The PHRU, which is probably South Africa's most famous HIV/AIDS research institute, is housed in Bara's only 'skyscraper' -- a 60's building that is still used mainly as housing for trainee nurses, hence the nickname "Nurses' Home". The top floor administrative offices have the hush carpeted feel of a downtown law firm, but at the action level on the ground floor there is the low-level chaos that seems to mark much of Bara. Mothers, many with their babies tied African-style across their backs with warm winter blankets, queued for transport chits while the main infirmary was jammed with people waiting appointments to discuss ARV medication with clinic staff.

Dr. Guy de Bruyn, a young South African MD who did his training in Houston and Seattle, kindly gave me the tour, ranging from the PHRU's first outpost as a site dedicated to fighting mother-to-child transmission of HIV, to its more recent additions including a shiny lab and research offices working on everything from couples' counseling to outreach into South Africa's gay and bisexual community along with investigations of new medicines and other interventions.

The impact of the U.S. Pepfar program on AIDS funding is clear in the PHRU, but one wonders how much of the largesse trickles into other parts of the huge hospital complex (clearly it doesn't go for elevator maintenance: de Bruyn told me all the elevators were out for four months (!) last year meaning that people had to hoof it up 12 floors to do everything from hold a meeting to deliver toilet paper).

I have made a base with the kind people at the office running the Soweto site for Phambili, which continues to collect information on study participants despite being forced to stop new injections of the AIDS vaccine candidate last year. I'll have more on them, and interviews with the formidable women who serve as clinical trial recruiters, as the week continues.

Friday, June 20, 2008

Dateline:Klerksdorp (?)


I was scratching my head too, but Klerksdorp is where I found myself on Wednesday as I began two days of interviews at the Aurum Institute's AIDS vaccine trial site.

While the STEP AIDS vaccine trial and its South African counterpart Phambili were both stopped last year, work is still going in places like Klerksdorp to try to make sense of what happened and where the vaccine enterprise is going from here.

One of the old South African towns built on the gold that made the country rich, Klerksdorp is still surrounded by mine complexes run by major miners such as AngoGold Ashanti, which established Aurum in 1998. The institute is now a public non-profit, however, and is one of the major HIV research groups in South Africa.

It was an interesting couple of days -- I met my first few AIDS vaccine trial volunteers, and sat in on a meeting of the trial's Community Advisory Board which included in its number both a Christian minister and a traditional healer or sangoma ( "He's a witchdoctor!" one of the other board members whispered to me with a smile.)

People were very open about their hopes and disappointment over Phambili, and where they see the vaccine project going. Most said they believe work has to continue. "Many people are dying. My people are dying" one of the trial volunteers said to me.

For the rest of it, Klerksdorp looks alot like Riverside County, California -- a small old downtown surrounded by a vast wasteland of car dealerships and strip malls, eventually flattening into bushveld and mine dumps. The city's small museum is mostly under renovation but did feature a weird exhibit of different cells once used to house blacks and whites, complete with black and white plaster figures.

I'm still going over what I got from Klerksdorp and experimenting with my new digital recorder. Its great to download interview files to the laptop, but listening to them has really made me aware of how cold and clinical my interview style is -- I'm no Oprah, but I guess that's no surprise. I have to work on it though.

I've had patchy Internet connectivity this week but I hope it smoothes out now. I'm still just fooling with this blog but let me know what you think.

Friday, June 13, 2008

"Dr. No" under fire after ruling....


South Africa's health minister Manto Tshabalala-Msimang -- known as 'Dr. No' for her long opposition to anti-retroviral drugs -- gets whacked again after the Cape Town court ruling...

This woman has the heart of a misguided lioness -- she will never give up. If only she'd been fighting for the right side

S.Africa Court: Down with the Quacks!

This is great!

Matthias Rath et al have been poisoning the S.African AIDS discussion for years, giving false credence to the denialists and generally muddying the already muddy waters. In a country where there is already so much fear and misunderstanding, these guys tried to increase both. The court said no and I say VIVA!

Thursday, June 12, 2008

useful: weird world sockets



With all of my electrical adaptors strewn around the room, I just re-ran across one of my old favorite companies: Adaptelec.
They can tell you exactly what kind of elecrical outlet to expect when plugging in your hairdryer in Kiribati or your laptop in Lithuania....

Wednesday, June 11, 2008

Countdown for Africa Reporting Project


I'm due to leave on Sunday to begin my three month Africa reporting project. I'm looking forward to it, but also a little nervous -- I hope I can do justice to all the time and effort people have put into this!

Here's a summary of the project:

FOOTSOLDIERS IN THE GLOBAL AIDS BATTLE

Nieman Global Health Fellowship 2008 Fieldwork Proposal
Andrew Quinn

GOAL: To illustrate the search for an AIDS vaccine by telling the stories of African volunteers who put their bodies on the line in clinical trials – a process which for participants involves both some of the greatest promises and sharpest risks of scientific globalization.

SUMMARY

Developing an AIDS vaccine has long been a major objective for the global health community, spawning an industry of advocates, researchers, bureaucrats and program directors all pushing toward the goal of immunizing people against HIV.

But while the media often depicts the vaccine hunt as taking place chiefly in high-tech research labs, it is in reality an increasingly global project and relies heavily on volunteers in both in developed and developing countries to test potential vaccine candidates.

The research has thus far produced little but disappointment, including the failure of a promising candidate vaccine last year which has slammed the brakes on most active trials around the world. But the hunt goes on, both in laboratories and in follow-up among participants in trials already under way.

My reporting project aims to examine this process, focusing on clinical trial projects in Africa.

The project will center on volunteers, and particularly on how they were recruited for the vaccine drive and what motivated them to participate. It will also look at what impact the string of vaccine failures has had on morale – a potentially significant factor for researchers contemplating future trials.

The role the Gates Foundation, the U.S. government and Western pharmaceutical firms will also come in for scrutiny, as will Community Advisory Boards and local governments which have facilitated interaction between local communities and the global AIDS establishment.

I envision a package of health features for the Reuters newswire, which could provide an effective worldwide showcase for the story. I also propose writing a longer, in-depth piece to explore more fully the promises and pitfalls of globalization in the AIDS vaccine campaign.

Since the original proposal I've also added a segment looking at malaria vaccine research -- particularly the RTS,S vaccine candidate being promoted by the Path Malaria Organization. They are gearing up for what will be the largest clinical trial ever undertaken in Africa, and should be an interesting counterpoint to the gloom surrounding the HIV vaccine campaign.

I'll be blogging here and there during the trip, which is going to last about three months and take me to South Africa, Kenya and Tanzania.

Peter Piot leaving UNAIDS

The U.N. system is losing a good one: Peter Piot says he leaving UNAIDS.

Piot has been a tireless and savvy fighter on the AIDS front for years, putting the squeeze on both Western governments to come up with the $$$ to fight the disease as well as developing country leaders to get serious about confronting the challenge at home.

I've seen Piot in action in Africa, China and the United States and he never failed to impress with his good humor despite some pretty dreary circumstances. UNAIDS is always going to be political, and always going to be controversial, but Piot was a model leader for such a crucial organization.

No word on a successor, but here's a suggestion: South Africa's Nozizwe Madlala-Routledge

Monday, June 9, 2008

WHO backtracks on hetero AIDS threat



The UK's INDEPENDENT newspaper has following story, quoting senior WHO official as saying world now unlikely to see heterosexual AIDS pandemic. Seems pretty obvious if you look at the numbers, but will still be interesting to see how this plays at the AIDS Conference in Mexico City this summer.....

A 25-year health campaign was misplaced outside the continent of Africa. But the disease still kills more than all wars and conflicts