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.