In 1975, when Dr. John and Esther Spurrier first arrived at Macha Mission Hospital as BIC medical missionaries, malaria was the number-one cause of admission and death in the hospital. More than a quarter of a century later, in 2001, the disease was still responsible for 1,788 hospitalizations and 64 deaths among children alone.
It wasn’t until the establishment of the Malaria Institute at Macha in 2004 by Dr. Phil Thuma, another BIC missionary in Macha, in partnership with Johns Hopkins University School of Public Health (Baltimore), that the picture really began to change.
“At the dedication of the Institute,” John recalls, “Dr. Thuma talked of his dreams to get rid of malaria in the next 50 years. I don’t think anybody who was there that day except Dr. Thuma thought that would happen.”
But it just about has. Between Phil’s vital work at the Institute, increased support from the BIC Church in Zambia, and new government-sponsored treatments, great strides have been made in the treatment and prevention of the disease.
“In the last 10 years, the number of malaria cases in Macha has been reduced by 95 percent,” reports John. “Pediatrics admissions have gone from nearly 1,800 to 42; deaths from 64 to two.”
And it is the remarkable progress accomplished with malaria that has motivated John and Phil to set their sights on eradiating the HIV/AIDS virus.
The growing epidemic
The first case of HIV/AIDS in Macha was diagnosed in 1986, and it wasn’t long until the virus had fastened its grip on the community. “From 2001 to 2005,” John recalls, “we attended a funeral every week of someone we knew or the family of someone we knew who died from AIDS. And we lost five to eight staff members from the hospital to the virus each year.”
By 1990, the annual number of new cases diagnosed among Zambians countrywide had reached 4 percent of the population. Despite an initial decline to 1.5 percent by 2000, the number has remained the same for the past 10 years, and AIDS still accounts for three out of four deaths among people 20–50 years old.
In response to the epidemic, many different methods of preventing and treating AIDS have been tested, but the use of Anti-Retroviral drugs (ARVs) has proven one of the most effective. Although ARVs cannot cure AIDS, they can, if taken correctly, reduce the virus’ presence so greatly that it can no longer be found in patients’ blood after three to six months.
In March 2005, Macha Hospital opened its Anti-Retroviral Therapy clinic, which offers ARV treatment to patients at no charge. This has resulted in a dramatic change in the Macha community.
“Since we began giving out ARVs in 2005, we now attend a funeral every month or two. We’ve had only three staff deaths in five years, and two of those refused to take the ARV medications,” John shares.
A new hope
In 2009, on the heels of these developments, John had another striking confirmation of the potential effects of ARV treatments. One afternoon, after a long day at the clinic, he was getting ready to head home when a man walked in with his wife, toddler-aged twins, and nursing infant. And so, John sat back down and began looking through the family’s patient files.
“I saw that the father had first come in 2007,” John says. “He had lost 20 to 25 pounds, he was very ill, and he could no longer work or care for his family at home.”
About a month later, the man’s wife had come to the clinic with the twins, and the whole family was started on ARVs.
Then John picked up the fifth file and was astonished by what he found.
“The baby was HIV-negative,” John recounts, fighting back tears. “This family would be very sick and some of them dead by now, but instead, they can live a normal life. The father plants his fields, the mother cooks and cares for the family, the twins are 2 and climbing over everything in the office! And they even have a baby who’s HIV-negative because of the care that we could give to this family at Macha.”
From treatment to prevention
As this family’s story indicates, ARVs not only can treat people who’ve already contracted HIV but can also help prevent mothers from passing it on to their children. If started in early pregnancy and continued through the breastfeeding period, ARVs lower the transmission rate from an HIV-positive mother to her child from 40 percent to about 1 percent.
Furthermore, ARVs can prevent HIV from being passed between heterosexual partners. In Zambia, discordant couples—couples in which one partner is HIV- positive and the other HIV-negative—make up about 11 percent of the population. When ARVs are administered to the infected partner, the transmission rate falls from about 9 percent to under 1 percent.
But preventing mother-to-child and partner-to-partner transmission only works if people know their HIV status and if those who carry the virus have access to treatment. In recent years, this has become the focus of John and his team’s efforts.
A model for change
In 2008, as ARV treatments in Macha began to deliver astonishing results, The Lancet, a British medical jounal, published a bold theoretical model for eliminating AIDS that piqued the Macha doctors’ imaginations. The model projected that if all members of a community were tested for HIV once a year, and if everyone who tested positive was put on ARVs immediately, then in 10 years, the number of new cases of HIV would decrease by 95 percent. This approach, called “Test and Treat,” would essentially eliminate the disease in the community in 30 to 40 years.
When first presented with the idea of implementing a pilot “Test and Treat” program at Macha, John says he and Phil were incredulous: “We agreed, ‘This is way too much work for us. We’ve enrolled over 6,000 people in our clinic already, we have about 2,500 on the ARVs, and introducing this would more than double the number in the clinic and increase by five-fold the number we have on ARVs. And we can hardly keep up with the workload the way it is now!’ So, our initial response was, ‘There’s no way.’”
Other roadblocks also threatened to hamper such an effort. Currently, the Zambian government does not permit HIV-positive individuals to begin receiving ARVs immediately. Instead, they must wait until they reach a late stage of the virus, when they begin getting very sick. Additionally, social dynamics had created an almost insurmountable stigma around the disease, making people reluctant to get tested for the virus or to seek treatment if they were found to be carriers.
Despite these challenges, however, John notes, “We had medical colleagues from around the world telling us that Macha would be the ideal place to try to institute ‘Test and Treat,’ because of the success of the malaria program, which is based on similar principles of treating people in the community who have the disease but who are not yet sick.”
As time passed, John and Phil realized that although the idea presented vast challenges, it was starting to take root in their hearts. “We were both waking up at night and thinking, What would our community look like without AIDS? We’d remember what’s happened with malaria and ask ourselves, Can we do it again with AIDS? We decided that regardless of the amount of work it was, it would be worth it.”
Making a way ahead
The first step, which had also proven to be a turning point in the fight against malaria, was to get community support. “We started by having discussions with Chief Macha and his headmen, and other community leaders,” says John. “They seemed excited about the possibility, but I wanted to make sure that they were really committed.”
So, in the first workshop that John held with the senior headmen, he listed as an objective that everyone present—all 20 people, including the chief—get tested for HIV and reveal their status to the rest of the group.
John recalls, “I was prepared with lots of arguments why we should do this, and—nobody but me knew this—I was prepared to cancel the whole workshop if they wouldn’t agree, because if the leadership couldn’t be open with each other, then what chance did we have of testing 100 percent of the community?”
But to John’s utter amazement, everyone agreed. In fact, Chief Macha even said, “I have to leave early, so test me now.” The next day, the rest of the group members were tested and shared their results with one another.
Slowly but surely, the attitude toward the virus is changing in Macha. “During the workshop,” John shares, “a visitor who was there asked the others, ‘Were you afraid when you went for testing, for fear that you would be positive?’ They replied, ‘No. We know if we’re positive, we can come to the hospital and they’ll treat us and we’ll get better and remain healthy.’”
Drawing momentum from the increasingly open and supportive environment in the Macha community, John, Phil, and their team have started going out into the surrounding villages, gathering people together, offering health education and AIDS screenings, and creating electronic medical records for each of them. As a result, three times the number of people were tested for HIV in 2010 than in 2009.
While the testing aspect of “Test and Treat” has begun, John is still searching for funding to initiate the “treat” side of the model. He and his colleagues have applied for several grants, including from the Centers for Disease Control and the Gates Foundation. And while they hope and pray that this funding comes through, they keep imagining what the future in Macha could look like without the deadly disease.
Says John, “We’ve started down this path, and we’re beginning to dream and ask ourselves the question, Could the Brethren in Christ mission in Macha be one of the first places in the world to eliminate AIDS?”
Help the Spurriers and the people of Zambia pursuing this ambitious goal by giving through the BIC World Missions Partnership Handbook >>