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U.S.-Backed HIV Services Help Boost Rwandan Health Care System

November 7, 2007 at 6:25 PM EDT
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JIM LEHRER: Now, the second of two stories on AIDS in the African nation of Rwanda. Tonight, health correspondent Susan Dentzer reports on how AIDS funding is also improving the country’s larger health care system. Our Health Unit is a partnership with the Robert Wood Johnson Foundation.

SUSAN DENTZER, NewsHour Health Correspondent: Dr. Diane Gashumba (ph) works long days, and no wonder. She’s one of just 400 doctors in all of Rwanda, a country of roughly nine million people.

Gashumba directs Kibagabaga Hospital in Rwanda’s capital, Kigali. When we visited there recently, she met with a 7-year-old boy being tested for HIV. His older brother told Dr. Gashumba he was worried that the boy had AIDS.

PATIENT’S OLDER BROTHER (through translator): The reason why I brought him here is because he’s been sick for a while.

DR. DIANE GASHUMBA (ph), Rwandan Medical Expert: What was the problem? What were the symptoms?

PATIENT’S OLDER BROTHER (through translator): He was swollen. His belly was swollen. His legs were swollen.

SUSAN DENTZER: The younger boy got a blood test, which fortunately turned out to be negative for HIV. Later, Dr. Gashumba told the older brother that the boy’s swelling was probably due to malnutrition.

Even as the U.S. Global AIDS Initiative makes inroads into fighting AIDS worldwide, it faces huge challenges. One is supporting people like Dr. Gashumba and improving impoverished health care systems that are struggling to cope.

Jessica Price directs the program in Rwanda for Family Health International, a U.S.-based nonprofit.

JESSICA PRICE, Family Health International: The bottleneck now to scaling up HIV services are human resources, physicians trained to take care of the number of patients that actually are out there.

A global AIDS initiative

SUSAN DENTZER: So that's become a key goal of the program sometimes called PEPFAR, the U.S. President's Emergency Plan for AIDS Relief.

Ambassador Mark Dybul is the U.S. global AIDS coordinator overseeing the program.

MARK DYBUL, U.S. Global AIDS Coordinator: Our piece is to build that capacity, to train doctors, nurses, health care workers, to build facilities that will work, to have ongoing training in those facilities, to build laboratories, and to build that hope in the communities that they can tackle their problems.

SUSAN DENTZER: Rwanda isn't alone in lacking enough trained personnel to take care of the millions already infected with HIV, let alone millions more who may become infected in the future. In fact, there's an estimated shortage of four million health care workers worldwide, much of it concentrated in the countries hardest hit by HIV.

So here in Kivumu Health Center in Kigali, Family Health International is helping to train Rwandese nurses to take on some of the tasks normally reserved for physicians. That includes things like prescribing antiretroviral drugs.

Here, nurse Damien Mugesera spoke with a patient with HIV, Chantalle Nyriandorimana. Two weeks earlier, she'd been prescribed antiretroviral drugs for the first time. Mugesera was now getting ready to increase her dose.

As part of Mugesera's training session, Dr. Innocent Turate examined the patient. He concluded she had a typical opportunistic skin infection, of the sort that frequently plagues people with HIV.

DR. INNOCENT TURATE, Doctor (through translator): The skin infection will recede as she continues taking the drugs. With the treatment we're going to prescribe, it doesn't look like it's something that's a long-term threat.

SUSAN DENTZER: So-called "task shifting" like this -- transferring jobs performed by doctors to other personnel -- is a key strategy for gearing up poor health systems to battle HIV-AIDS.

JESSICA PRICE: It's clear that the nurses have the capacity, the competency to provide high-quality care. That being the case, we think that there's an ethical obligation to try and scale this initiative up.

Research in Rwanda

SUSAN DENTZER: Another need the U.S. program is helping to meet is equipping health facilities with the tools needed to care for those with HIV. This lab testing system is used to determine how well a person's immune system is working to fight an HIV infection. It measures how much of a certain type of immune cell is found in the blood.

This type of measurement system is critical. It can determine when an HIV-infected person should go on antiretroviral drugs or move to a higher dose. But this system we saw here, at Kabgayi Hospital in Kigali, is one of only 14 such machines in all of Rwanda.

The good news is that, as staffing gears up and health facilities become better equipped, more improves than just care for patients with HIV. Dr. Agnes Binagwaho heads the Rwandan National AIDS Control Commission.

DR. AGNES BINAGWAHO, Rwandan National AIDS Control Commission: When we equip a lab with a microscope, we don't use the microscope only for HIV-AIDS. The microscope is there for all the lab issues. So that means the knowledge you give is not vertically dedicated to HIV-AIDS. It's horizontally distributed in all the health area.

SUSAN DENTZER: And in fact, a study that Family Health International did in Rwanda suggests that improving services for people with HIV actually drew even more people to use other services, as well.

JESSICA PRICE: When it came to key reproductive health services, in particular the utilization of antenatal care, prenatal care for women, utilization of family planning, seemed to be related -- increases seemed to be related to the introduction of HIV care.

Funding AIDS assistance

SUSAN DENTZER: In a recent report on the U.S. Global AIDS Program, a panel of the U.S. Institute of Medicine said Congress should appropriate more dollars to expand the health workforce in AIDS-affected countries. And back at Kibagabaga Hospital, it's clear that Rwanda still needs far more health personnel like Dr. Gashumba.

One of her last tasks of the day was to tell the mother of a 9-month-old baby that the child had tested positive for HIV.

DR. DIANE GASHUMBA: When he eats, he vomits immediately.

SUSAN DENTZER: The doctor told the mother that the child would be monitored to see when it would be appropriate to start antiretroviral drugs. For this overworked doctor, it meant there was one more patient with HIV she'd probably be caring for, for years to come.

JIM LEHRER: A correction to last night's story: We used the wrong numbers to describe the scope of the U.S. Global AIDS Initiative. The program's goal is to get two million people on antiretroviral drugs by 2008. The U.S. government also hopes to prevent seven million new infections and provide care for 10 million people affected by HIV.

In her next story, this time from Tanzania, Susan will report on the challenges of preventing HIV and AIDS. You can ask questions of two experts on AIDS in Africa in our Insider Forum on our Web site at PBS.org.