GWEN IFILL: Next tonight: providing health care in one of the world’s poorest countries. Ray Suarez has just returned from Mozambique, where he’s been reporting for our Global Health Unit. Welcome back, Ray.
RAY SUAREZ: Good to be back.
GWEN IFILL: What were you doing in Mozambique?
RAY SUAREZ: Well, Mozambique provides a very compelling portrait of what the poorest countries in the world are trying to do to save their people both from preventable disease, from disease that can be treated cheaply with the right kind of responses, and to the particular challenge of HIV and AIDS.
GWEN IFILL: HIV and AIDS was really what you were focused on. What did you see, what kinds of clinics? What kind of stresses are on the health system in Mozambique?
RAY SUAREZ: Well, Mozambique, as a country, can afford to spend only a little bit on its public health infrastructure and on providing drugs to its HIV suffers. So there is heavy dependence on the United States and its PEPFAR program and heavy dependence on the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Well, Mozambique has responded to the challenge, really ramped up the number of people diagnosed with their status known who can go on antiretroviral drugs to save their lives. But there are pipeline problems and also future supply problems that are anticipated because the number of infections is rising every year.
GWEN IFILL: When you say pipeline problems, you talk to the people, the patients. You talk to the caregivers. There are people who actually can’t get their hands on the antiretrovirals, or people who just can’t distribute it?
RAY SUAREZ: Until this month, if you presented yourself at a clinic and you were diagnosed and going on antiretrovirals, you would get a month’s worth of the drug and be told to come back in a month to get your next month of medicine.
The day we were at the largest clinic in the Mozambique capital, Maputo, the patients were told they could only get a week’s supply of medication, which means they would have to come to the hospital, lose a half-a-day or a day of work, wait on hours of lines, and come back four times as often.
And doctors are worried that that will mean they will take their drugs less faithfully and the drugs will be less effective.
GWEN IFILL: How much is the United States responsible? You mentioned PEPFAR, which is the U.S.-backed program, but how much are other countries contributing and how much is the U.S. contributing?
RAY SUAREZ: The Global Fund to Fight AIDS, Tuberculosis and Malaria set out a goal for the 2011-2013 funding cycle, and then, just now, just in the recent past days, had a donors conference and fell billions of dollars short in pledges for replenishing the Global Fund.
That means, right now, we know there won’t be enough money to provide all the drugs necessary for all the drug — for all the people who want to go on antiretroviral therapy. Right now, the United States taxpayer is keeping alive half of all the poor people in the world who take antiretroviral drugs.
The United States is saying the rest of the world needs to put up more, so the United States isn’t bearing that much of the burden on its own.
GWEN IFILL: And the U.S. burden is — this was a program that was begun by President Bush, and it’s continuing unabated under President Obama?
RAY SUAREZ: What the Obama administration has decided to do is level off the funding for antiretroviral drugs and put more emphasis on creating more capacity and more expertise in national health systems, and concentrating on women and their young children, pointing out that you get a lot of payback for investing in the medical care of women and children.
And right now, a lot of AIDS activists are saying, yes, we understand why you want to do that, but we’re really frightened that, if you do, the world won’t step up. And, eventually, we will have to tell people who are HIV-positive, sorry, there are no drugs for you.
GWEN IFILL: And, finally, Ray, is there a war at all for these resources between hunger and AIDS, or malaria, tuberculosis? It’s all the same pool of money.
RAY SUAREZ: And, you know, when you visit a country like Mozambique, you realize how much these are interrelated. I tried to ask that question of a young medical director, one of two doctors in a district where he was caring for 200,000 people.
And he says: “I can’t pull out one disease and say it’s more important than this other disease. My people don’t have clean water.”
That contributed to diarrheal diseases, which weakens them when they try to fight off diseases like tuberculosis and malaria and other things that are endemic in that part of the world. It’s very heavily interconnected, and it’s hard to just pick out one and say…
GWEN IFILL: Yes.
RAY SUAREZ: … if we get this one licked, we’re really on the right road.
GWEN IFILL: I just can’t wait to see your reports, Ray. Thanks for doing it and that 33-hour trip home.
RAY SUAREZ: Thanks a lot, Gwen.