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It is said that HIV/AIDS does not recognize any national boundaries or sovereignty. There is a small beacon for hundreds of thousands of people in the southern African country of Lesotho, however. It is a fledging clinic in Leribe's Motebang Hospital called Tsepong, a Sesotho word meaning "A Place Called Hope."

The Ontario Hospital Association (OHA) and the Change Foundation have partnered with the Government of Lesotho, placing Canadian health-care workers here. Launched on World AIDS Day, Dec. 1,2004, the OHAfrica initiative was a response to the challenge made to Ontario hospitals by Stephen Lewis, the UN Secretary General's Special Envoy for HIV/AIDS in Africa. Lewis encouraged the province's medical practitioners to take a leadership role, in curbing the world's most widespread health calamity.

The OHAfrica teams support local health-care professionals treating people living with HIV/AIDS. They assist in the development of community programs and self-help groups. They collaborate with health-care decision-makers, drafting a sustainable plan for HIV/AIDS care in Lesotho. As well, OHAfrica helps with the blanket distribution of affordable, life-saving anti-retroviral drugs (ARVs). The Tsepong Clinic was the first public ARV clinic in the country.

Dr. Philip Berger was OHAfrica's initial team leader between December 2004 and June 2005. The chief of the Department of Family and Community Medicine at St. Michael's Hospital in Toronto, Dr. Berger has treated people with HIV/AIDS since the epidemic began in Toronto.

"The pandemic (in Lesotho) is greater in numbers than anything that I ever saw in the early 1990s ... There were endless, inexhaustible numbers of people in conditions of dying," said Dr. Berger.

Staggeringly, there was only one local doctor and an AIDS-infected pharmacist at the clinic. There were no nurses, administrators, regular cleaners or lab technicians. The OHAfrica team had to hire their translators. As well, there was a dearth of towels, toilet paper, examination sheets and curtains for privacy. On one occasion, scotch tape was used to fasten an IV tube instead of surgical tape.

According to Berger, "In Lesotho, there are not the health-care personnel or even community individuals to do the work ... There is a severe depletion of highly 'skilled health-care professionals there, because people flee to (United Arab Emirates, U.K. or the U.S.) for jobs that are better paying and with better working conditions. Many more are also sick with AIDS, themselves."

In total, there are only 91 physicians, 1011 nurses and 791 midwives serving nearly 1.8 million people in Lesotho. Dr. Berger said, "We came with the intent of leaving our expertise in the hands of local staff, but that idea had to be abandoned. If we waited for village health-care workers to educate, the ailing Lesoto would never get the drugs.

"The OHAfrica project demonstrated that, on very short notice, and with very little preparation, we can move in quickly and get the drugs out quickly ... We saw what appeared to be miraculous recoveries by some people ... Tsepong is a benchmark clinic, with staff there now prescribing half of the ARVs in the country."

Lesotho is a small, land-locked country within South Africa. It has been dubbed the "Switzerland of Sub-Saharan Africa," because of its picturesque, mountain scenery. It is also gravely impoverished, with families' wealth mainly measured by the number of their livestock. Traditional houses are made of mud or sod walls, with thatched roofs. Lesotho only has a handful of manufacturing industries, so almost half of all men Work in South African mines, factories, farms and households.

Generally, migrant workers fill contract positions lasting from several months to two years. The money they earn there is considered vital to Lesotho's ailing economy. Nevertheless, many men get infected with HIV/AIDS while working abroad. They then return to their homes in rural areas, passing the virus onto their wives and unborn children, it is reported.

Gender inequality and the vulnerability of African women are widely considered the core reasons for the spread of HIV/AIDS. Nearly two-thirds of Tsepong's patients are married woman in their early 30s. Often, they arrive by ox-driven cart, wheelbarrow or on the backs of relatives--their withered frames hidden under layers of clothing and a traditional Basotho blanket. Health-care workers usually see them for the first time gasping from pneumonia. Candida, a yeast-like, parasitic fungus, is sometimes detected spilling from patients' mouths.

"Those who came dying at the door, simply died at the door," Dr. Berger remembered. At times, the tireless, outspoken clinician felt he was merely pronouncing people's deaths. He could only apologize to some families, extending his earnest condolences. Still, the clinic was an "island of respite from an inferno, which was engulfing the country everywhere else," he maintained.

Sr. Christa Mary Jones, a nurse practitioner and former OHAfrica member, is equally contemptuous. Having spent more than 34 years practicing maternal and paediatric medicine in Africa's SubSaharan region, she recently returned to Toronto.

"People are dying. People are being cross-infected and debilitated. Yet where are we in sensitizing each other to the fact that we have this deadly thing among us," said Sr. Jones.

"The citizenry, the people of Lesotho, have been so badly affected by the disease that you don't have high-calibre people to empower. It's now a matter of getting people healthy again and restoring staff to work with foreign and village healthcare workers.

"... But it's really important you don't go in as the great hero-saviour and say, 'here we are.' A partnership needs to exist between the developed world and developing worlds. It's not paternalism. It's hand-in-hand Work that retains the respect of the people receiving care."

It was challenging, she said, "keeping the essential principles of good practice and maintaining high standards of care." But she desperately wanted to give people a reason for living. "It has awakened within me a compassion I did not know existed ... At the end of the day, I didn't just go out and serve; I was served by the incredible humility and courage of the people that I was helping."

Sub-Saharan Africa is the world's most HIV/AIDS-devastated region, home to more than 25.8 million people living with the virus. Lesotho is the fourth most affected country. According to UN-AIDS, life expectancy here has dropped below 36 years-of-age. An estimated 79 Basotho die of the disease each day. In 2000, the Government of Lesotho finally declared HIV/AIDS a national disaster. By September 2005, there were five ARV clinics running, including Tsepong, and another nine in various stages of development. In less than one year, the percentage of people with AIDS receiving ARV treatment in Lesotho rose from less than two per cent to almost 10 per cent, according to OHAfrica.

At Motebang Hospital, patients visit the clinic's pharmacy to receive their first ARV prescription. They then return for monthly assessments and educational sessions. Twenty-eight-year-old, Me Lipuo Booi, was one PLWHA who got better. After four months of treatment and clinic aerobic classes, her weight soared from 37 to 55kg. There was also a dramatic increase in her CD4 count, which measures the strength of a person's immune system. She is now a member of Phelisanang Bophelong, a grassroots support group for HIV/AIDS survivors.

She told Canadian health workers that HIV/AIDS does not have to be a sickness that causes people to die. "It is in my blood, but I am still strong ... I'm so happy that I'm alive," she said.

Dr. Berger said the continued presence of Western physicians, nurses, pharmacists and administers, is needed in Lesotho, adding the country could use 30 equivalent health-care teams. He compared the HIV/AIDS crisis to a natural disaster: if there's a landslide happening, one doesn't have a committee meeting for a year to determine proper action.

"The Canadian government should meet its international development assistance goals (the Pearsonian standard for provisions--0.7 per cent of the Gross Domestic Product--set in 1969). They should fund health-care teams in Lesotho and other African countries on an emergency basis, to intervene with widespread distribution of ARVs and halt the pandemic that is pushing countries into civil chaos and non-existence."

It's not a Herculean task, he maintained. "As citizens living in the West, we have a moral duty and responsibility to bring to bear the remedies that are available in Canada, to people in Africa. And we have the wealth and the resources to do it."

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