AIDS in Africa, a field experience in Tanzania

A field experience in Tanzania

By Dr. Marc Deru

John, Etienne de Harven, Philippe Krynen & Mark Griffiths. Cannes (Fr) 2001

The time is 1981. Philippe Krynen, a pilot, bids farewell to aviation. He and his wife have decided to change the direction of their lives and, henceforth, to care for orphan children, said to be so numerous in Africa. They join the Austrian association, SOS Kinderdorf Int., and, for three years, run childrens’ villages in Senegal, Ivory Coast and Rwanda. In 1984, they spend some time with Third World children in Bangladesh and in India (in the Kerala district).

This three-year experience enables them to realize what it is they really want to do, ie help orphans get off to a good start in life - without removing them from their environment - and to set up their own aid structure. In preparation for this, they undergo nursing training at Sélestat (France). Three years thus go by.

Travel

In 1988, with diplomas in hand, they decide to do an on-site exploration. They choose Tanzania. For two months, they backpack up and down the country until they are informed of the dramatic plight of thousands of children in the Kagera, a region bounded by Rwanda, Uganda and Lake Victoria.

“Ten years later, I can remember our arrival in Bukoba. I can see once again the grey dawn after a long, uncomfortable night aboard an overcrowded boat, the mud puddles by the quayside. It has just stopped raining.

Dense mist from the lake drowns the countryside between the harbour and the hotel. The mist hums: it’s made up of tiny flies. Billions of them. Their predator, a featherweight spider with outlandishly long legs, weaves its web on facades, trees and hedges. The webs are tattered by the wind; the town is falling to pieces. Observations made on the three following days of the visit are likewise: impassable roads, broken bridges, empty stores, rationed petrol (gasoline), no running water, no electricity. The hotel makes us pay in advance so as to be able to purchase meal ingredients. We are the only customers.

What kind of a war was it that caused the capital of a region with a million and a half inhabitants to be in this state? “Things have gotten better”, I am told, “five years ago, you couldn’t even find a box of matches. Soap came in from Uganda by contraband.”

It’s worse in the villages. The banana plantations are declining, the livestock is sick, the huts have been eaten away by termites and the people are in rags. Samsom Musheba, the Lutheran bishop, drives us 40 km to the North, to the Uganda border, to visit Kashenye. I remember the four hours of track under driving rain, the ghostly silhouettes of chilled, half-naked children huddling together as the Land Rover went by.

While on foot in Kashenye, I see the same silhouettes up close during an interminable door-to-door visit behind the mayor and the pastor, who point out to us the houses that are the most affected by “this disease”, the name of which is never mentioned.”

With these unsettling impressions in mind, they return to Europe and get in touch with the European Economic Community (EEC), which promises funds. They stimulate public awareness and draw the media’s attention to the drama that is unfolding in the Great Lakes Region, which soon becomes labelled as the epicentre of AIDS in Africa.

Things could have ended there, with the publishing of an upsetting news report on a dramatic situation. But this is merely the beginning of the story, since, as opposed to the reporters, researchers, media representatives and experts of every kind who have been visiting “AIDS-plagued” Subsaharan Africa for the past 10 to 15 years, Philippe and Evelyne Krynen return to the region to get their project off the ground. They are backed up by promises of funds from the EEC as well as by four thousand child sponsorship pledges from families in France.

Partage** Tanzania

In December 1989, following eight months of specialization at the Institute of Tropical Medicine (IMTA), in Antwerp, they are back in Bukoba. It is in that location that the NGO, Partage Tanzania, is created, with a view to setting up a global health and development programme covering an area of 50 x 50 km (31 x 31 miles) and encompassing some 30-odd villages and 70,000 inhabitants.

It is also there that, in the following years, Philippe makes observations which, little by little, cause him to reconsider the conclusions he had drawn during his first trip in 1988. These had led him to declare that the Kagera region was the victim of a new and deadly disease, a terrible epidemic.

Of course, he doesn’t question his initial observations: the area around Bukoba is indeed in the direst misery, and the immunity of its inhabitants to disease has totally collapsed; the acquired immunodeficiency syndrome (AIDS) appears to be an obvious reality. However, he wonders about the origin of this social distress and widespread breakdown of immunity. He seeks an answer, he asks questions.

Kagera

At the beginning of the Twentieth Century, the region was considered a little paradise, thanks to its favourable climate (1,200m (4,000’) altitude), regular rainfall throughout the year, banana trees with bean plots - ensuring an abundant food supply - growing in their shade around every house, with fisheries products to complete the diet. The development of the coffee trade brings in cash. Children are schooled on the spot or are sent to Uganda for their secondary education.

However, from the First World War on, a series of events brought about a complete reversal of this idyllic situation. East Coast Fever decimated the cattle. Banana trees thus deprived of their natural fertilizer – dung - slowly withered away, to the point of falling prey to a fungus disease several decades later, ultimately bringing about a brutal decline in their productivity. In addition, coffee prices collapsed. Nationalisation schemes, begun in 1967, resulted in the dismantling of the economic system. Then came the ultimate catastrophe: the devastation of the region brought about by Idi Amin Dada’s war against Tanzania in 1979. Serious malnutrition became a lasting feature. Basic commodities were in short supply. The children who managed to survive malnutrition reached adulthood with weakened immune systems, and mortality (from tuberculosis and other respiratory diseases, intestinal infections and massive infestation with parasites) in these young, chronic malaria-ridden adults was high. The disastrous sanitary and agricultural situations forced the survivors to leave and try their luck in the large East African cities.

The Partage Tanzania Programme

This is the picture Philippe Krynen has before his eyes when he begins his work in the Kagera region. He now understands the causes of this catastrophic situation. He discovers that half of the “orphans” are actually wards of the extended family, that is, children left in the village in the care of their often resourceless grandparents by their own parents who have gone off to the city in search of means of survival. He thus begins his programme with the aim of supporting each orphan child till adulthood, while maintaining the child in his/her family environment.

In former times, a fatherless or motherless child would have been taken in charge by the clan. A tutor responsible for raising the child and protecting his/her inheritance would have been appointed. The elders would have seen to it that the child’s rights were respected. Nowadays, with the overly large number of orphans, this traditional system no longer functions. It is now the grandparents who take in the children, without the support of the community, which itself has fewer and fewer assets at its disposal. It is now up to elderly people lacking in resources to feed, send off to school and educate swarms of grandchildren. In certain villages of the North, one family in three is thus composed of very young alongside very old people. These unbalanced families are in great need of support.

Partage Tanzania thus took it upon itself to create an overarching health care structure: day-care centres in each village, where children are looked after by day and return to their families in the evening; a health care centre in Bukoba, in which about twenty children can be fed, observed and looked after until the improvement in their state of health allows them to return to their families; a dispensary in each village to ensure follow-up, and a malaria prevention programme (malaria being the prime cause of mortality among children in the Kagera), based on educating people as to the benefits of using mosquito netting. In addition, kindergartens, primary schools and manual skills workshops were gradually set up in all of the villages. A programme for the rehabilitation of agricultural land was instituted (for growing bananas, coffee and beans); houses were rebuilt, sources of spring water were managed to ensure the widespread use of really safe drinking water.

Unorthodox observations

For two years, in line with what he had learnt at the IMTA [Antwerp Institute of Tropical Medicine], Philippe continues to look upon the health situation as the consequence of an epidemic attributable to a new virus – HIV – and he decides to do some testing.

What he first notices is that the children, whether HIV-positive or negative, have exactly equal chances of being restored to health, provided they receive proper nourishment and care. What he also notices is that HIV-positive subjects, when tested following a bout of malaria, for instance, can be HIV-negative six months later.

On the occasion of the eight international congress on AIDS in Amsterdam, in July 1992, he makes mention of an unexpected observation: tests carried out on his own staff of 149 persons revealed that only 5.4 % were HIV-positive! His statement is rejected. This survey is valuleless because the group tested is not considered as being representative of the general population. So it must be, undoubtedly. Philippe returns to Tanzania and, in order to clear up the matter once and for all, goes about testing all of the inhabitants (some 842 persons) of a village. Result: 13.8% are HIV-positive, whereas the WHO states that in the Great Lakes Region, some 40 to 50% are “contaminated by HIV”.

During the Yaoundé congress on AIDS in December 1992, he gives a press conference in which he presents the results of this survey and expresses his doubts as to the viral origin of the “epidemic”. His statement is very unfavourably received by participants at the congress. Philippe Krynen suddenly loses all credibility; whereas he had been the darling of such congresses in the past - for so long as he carried the torch of the viral theory of AIDS - he has now become the heretic to be rejected and avoided.

An interview with Neville Hodgkinson in 1993, published in the Sunday Times [UK] under the provocative title of “AIDS, the Plague that Never Was” finally discredits him totally. Funds promised by the EEC never arrive. The Tanzanian government threatens to expel him, but quickly goes back on its decision, after taking note of the effectiveness and disinterested nature of his work in the Kagera region.

Since then, Philippe Krynen has retired from the “public life” of congresses and relations with the major press media. He goes about implementing his health programme quietly and efficiently by applying and disseminating elementary common-sense measures. All that is necessary, as well as indispensable, to be in good health and to overcome immunodeficiency resulting from miserable living conditions is to eat properly, drink unpolluted water and take the appropriate measures to prevent and treat the endemic, familiar diseases that have been around for a long time. Moreover, in order to ensure that the health of the population will not become dependent on outside intervention, education must be promoted; the young and not-so-young should be made aware of the causes of declining health.

In the meantime, he makes another observation: young HIV-positive children who are vaccinated in accordance with Western practices and treated with Bactrim and Nizoral to prevent the onset of opportunistic diseases continue to have very fragile immune systems and all too frequently die. The effects of these long-term immune system-depressing medications clearly outweigh the anticipated benefits. Thus, from 1994-1995 onwards, these “preventive” measures are also set aside, resulting in a very noticeable drop in infantile mortality. From this point on, no more mention is made of the theory of virally induced acquired immunodeficiency.

Results

What makes Philippe Krynen’s experience in Tanzania particulary interesting derives from the timespan it covers and that the results obtained can now be evaluated with 12 years of hindsight.

In 1989, he set himself up in the region considered to be the very epicentre of the AIDS epidemic, in the midst of a population declared by the WHO and the big media to be doomed to rapid decimation, unless drastic measures were taken to halt the spread of a new and deadly sexually transmitted virus called HIV.

It so happens that since that time, no one in this area was treated with antiviral drugs (cellular poisons with very serious side-effects, especially in young cells and bodies), no condoms were distributed, no consideration was given to the notion that the immune system breakdown and the high mortality rate in the population were attributable to infection by a new virus, and HIV tests revealed themselves to be of no practical use whatsoever.

Medical follow-up of thousands of orphans and abandoned children was based on ensuring an adequate and balanced diet, consumption of safe drinking water and providing a safe and secure family-type environment. Prevention consisted essentially in educating the population in basic hygiene as well as in the use of mosquito netting. Medical care per se was limited to the classical treatment of endemic diseases (malaria, borreliosis, tuberculosis, parasitic ailments) and of two types of acute diseases which are a frequent cause of mortality: respiratory infections, on the one hand, and intestinal conditions (of parasitic, bacterial or mycotic [fungal] origin) with serious diarrhea and dehydration, on the other.

In the space of only a few years, these basic sanitation measures led to a spectacular decline in morbidity and mortality, as well as to the disappearance of this immunodeficiency epidemic which had placed the region at the epicentre of AIDS. Instead, it is now the epicentre of a health and social recovery process!

In the area covered by Partage Tanzania, the infant mortality rate (ie for that part of the population under 18 years of age) is now, according to statistics, equivalent to a third of the national rate for that same age group, and to a quarter of the rate for the Kagera region as a whole. Those figures speak for themselves.

The Partage Tanzania Programme is now approved, supported and often cited by the Tanzanian authorities as an example to follow in the development field.

It must be noted that, over the last twelve years, the situation outside the area covered by Partage Tanzania, ie for the whole of the Kagera region, has also significantly improved. A ghost town in 1988, Bukoba is now a lively and busy place. The spectre of a deadly epidemic has receded and Kagera is no longer referred to as the “epicentre of AIDS in Africa”. The epidemic of misery has abated and the region has regained a certain equilibrium thanks to social and sanitation measures applied by the Tanzanian government.

Of what value are all the scientific studies and discussions on “HIV”, the statistical estimates and the catastrophic predictions, in the face of these irrefutable facts and results? Why insist at all costs on administering highly toxic products to HIV-positive pregnant women who are essentially suffering from dietary deficiencies, malaria and parasitic ailments, when we know that the children they will bear will be in excellent health, provided they are simply given food supplements during their pregnancy (as demonstrated in a 1998 study)?

What conclusions are to be drawn? The “HIV” virus which scientific authorities have peremptorily – and in the absence of any concrete evidence - declared to be the cause of AIDS has never allowed itself to be isolated, cultured and analysed in compliance with the criteria laid down in classical virology. In spite of the very intense reactions that such pronouncements invariably engender, it must be stated clearly that the very existence of an “HIV” virus remains a mere hypothesis, that the “evidence” of its presence in a patient’s blood (as determined by HIV and viral load testing) only indicates the presence of particular proteins and genome fragments of undetermined origin. These tests have no specificity and thus do not constitute proof of the presence of a new pathological virus.

The Kagera experience clearly shows that the viral hypothesis put forth for AIDS does not accord with the reality on the ground and that the causes of immune system breakdown in Africa are obviously extreme poverty as well as the lack of basic sanitary infrastructures.

This plain common sense position, held by numerous scientists and doctors throughout the world, is, however, largely ignored, ridiculed or even violently rejected owing to the high stakes involved in the fight against HIV.

At present, the Great Lakes Region no longer makes the headlines. Rather, it is countries such as Botswana or South Africa, said to be “contaminated to the extent of 40 or 50% by HIV”, which are the object of apocalyptic forecasts. Now it is President Mbeki who is in disgrace because he dares to question the basis of the fight against HIV.

Can one ignore the fact that, in spite of its status as a “rich” African country, South Africa remains profoundly scarred by the apartheid regime? This regime, which ceased to exist, from a political standpoint, in 1994, continues to survive in every economic and social aspect. Most of the land is still in the hands of a minority of large landowners; this state of affairs deprives rural people of any food self-sufficiency as well as of the possibility of living with dignity. A high urban crime rate and drug use (which, along with malnutrition, constitutes another major cause of immunodeficiency) are thriving against the backdrop of a deplorable economic situation; the politics remain indulgent vis-à-vis the business world as well as the foreign banks, holders of enormous debt claims inherited from apartheid. The GEAR, a “made in South Africa” structural adjustment scheme put into place in 1997 (with the applause of the IMF) is a dismal failure for the majority of the population.

Will Mr. Thabo Mbeki and his government, who inherited this highly tense situation in 1999, have the will as well as the means to reverse present trends and implement a real social policy? Will they take the necessary measures? Will Mr. Mbeki succeed in implementing a basic health and social programme, comparable to what has happened in the Kagera region, in his vast country? Will he be able to set, for all of Africa, the example of a great country which has freed itself from this epidemic of misery? This is within the realm of possibility and it is what we hope will come to be.

AIDS IN AFRICA

Travel

*Partage** Tanzania*

Kagera

The Partage Tanzania Programme

Unorthodox observations

Results

Contacts

Other

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