Bringing Africa back to life: The legacy of George W. Bush


On a beautiful Saturday morning, Delfi Nyankombe stood among her bracelets and necklaces at a churchyard bazaar and pondered a question: What do you think of George W. Bush?

“George Bush is a great man,” she answered. “He tried to help poor countries like Zambia when we were really hurting from AIDS. He empowered us, especially women, when the number of people dying was frightening. Now we are able to live.”

Nyankombe, 38, is a mother of three girls. She also admires the former president because of his current campaign to corral cervical cancer. Few are screened for the disease, and it now kills more Zambian women than any other cancer.

“By the time a woman knows, she may need radiation or chemotherapy that can have awful side effects, like fistula,” she said. “This is a big problem in Zambia, and he’s still helping us.”

The debate over a president’s legacy lasts many years longer than his term of office. At home, there’s still no consensus about the 2001-09 record of George W. Bush, with its wars and economic turmoil.

In Africa, he’s a hero.

“No American president has done more for Africa,” said Festus Mogae, who served as president of Botswana from 1998 to 2008. “It’s not only me saying that. All of my colleagues agree.”

AIDS was an inferno burning through sub-Saharan Africa. The American people, led by Bush, checked that fire and saved millions of lives.

People with immune systems badly weakened by HIV were given anti-retroviral drugs that stopped the progression of the disease. Mothers and newborns were given drugs that stopped the transmission of the virus from one generation to the next. Clinics were built. Doctors and nurses and lay workers were trained. A wrenching cultural conversation about sexual practices broadened, fueled by American money promoting abstinence, fidelity and the use of condoms.

“We kept this country from falling off the edge of a cliff,” said Mark Storella, the U.S. ambassador to Zambia. “We’ve saved hundreds of thousands of lives. We’ve assisted over a million orphans. We’ve created a partnership with Zambia that gives us the possibility of walking the path to an AIDS-free generation. This is an enormous achievement.”

Bush remains active in African health. Last September, he launched a new program — dubbed Pink Ribbon Red Ribbon — to tackle cervical and breast cancer among African women. The program has 14 co-sponsors, including the Obama administration.

Falling death rates

Nyankombe sells colorful batiks, purses and other crafts to benefit Mothers without Borders, a charity that looks after orphans. When AIDS tore unchecked through southern Africa, millions of children lost their parents. Nearly one in five children in countries like Malawi and Lesotho were orphaned. In Zambia, it was one in four.

A decade ago, AIDS was killing 630 of every 100,000 Zambians, according to the World Health Organization. That was 100 times the AIDS death rate in the United States.

In neighboring Botswana, the toll was 750 of every 100,000 people. That was four times the rate for the leading cause of death among Texans (heart disease).

In 2001, four in 10 adults in Botswana were infected with HIV. President Mogae went before the United Nations to plead for the life of his country.

“We are threatened with extinction,” he said. “People are dying in chillingly high numbers. It is a crisis of the first magnitude.”

Bush, with bipartisan support from Congress and $15 billion, mobilized the U.S. government with the President’s Emergency Plan for AIDS Relief. In 2008, Congress agreed to provide $38 billion more.

By the time Bush left office, the death rate from AIDS had fallen more than 60 percent in Botswana. There are now 330,000 taking anti-retroviral drugs.

The death rate fell by nearly half in Zambia. There are 418,000 Zambians taking the drugs.

One of them is 46-year-old Teddy Njapau. He makes a living as a Lusaka sidewalk peddler selling copper and brass jewelry with bits of malachite and other stones added for color. He’s been HIV-positive for at least five years.

“After my wife and I separated, I got sick,” he said.

Njapau takes anti-retroviral drugs supplied free at government clinics.

“They’re helping me very much,” he said. “Without them, I don’t know where I’d be now.”

“George Bush is a good man,” he added.

‘Moral responsibility’

AIDS is still an incurable disease. Anti-retroviral drugs keep people alive but must be taken daily. Erratic use can lead to drug resistance. Unless prevention slows the spread of the disease, more and more people will need to go on drug therapy — risking an expanding, open-ended commitment of U.S. tax money.

Bush’s achievement endures because of continuing support from President Barack Obama and Congress and also because of progress in slowing the rate of infection. The percentage of adults living with HIV has fallen in 22 African countries, according to the Joint United Nations Program on HIV/AIDS.

Drug treatments are themselves one of the most important prevention measures, since people taking anti-retroviral drugs are less infectious. Another success has been saving infants from being born with the disease when their mothers are HIV-positive. Before U.S. assistance became available, four in 10 HIV-positive mothers in Botswana transmitted the disease to their children. It’s now down to 4 percent.

Dr. Mark Dybul, who served in the Bush White House and as the U.S. Global AIDS Coordinator, remembers that many AIDS specialists doubted the program could succeed.

“When we started, people said, ‘Africans can’t possibly do this. They don’t have the education. They don’t have the infrastructure,’” Dybul said. “Bush refused to accept that. He had a visceral reaction against the idea that Africa cannot do it. He also felt we have a moral responsibility not to let 30 million people die, that it wasn’t morally acceptable.”

The former president has said he was urged by Condoleezza Rice, who became his national security adviser and then secretary of state, to help Africa beat back the plague of AIDS.

“When I first got going, Condi Rice and I had a discussion at the Governor’s Mansion about the importance of Africa,” Bush said in an interview with this newspaper in December.

“What got me interested was the AIDS pandemic. I didn’t want to look back at a presidency that did nothing about a pandemic that was destroying a generation. When I got into office, the devastation was becoming so real that to have done nothing about it as president of the wealthiest nation would have been immoral.”

Bushes’ commitment

As the death toll from AIDS has ebbed, other killers have emerged. Women who were living with U.S.-supplied drugs that checked the advance of AIDS were dying from another infectious disease.

“It’s not enough to save a woman from dying from AIDS and have her succumb to cervical cancer. It’s unacceptable,” Bush said in September, when he announced an $85 million campaign against women’s cancers led by his SMU-based presidential institute.

Secretary of State Hillary Rodham Clinton, attending the kickoff event, praised the former president and said the Obama administration would provide $30 million of the funding.

Clinton kiddingly thanked former first lady Laura Bush and daughter Barbara Bush “for getting him to do it,” then added, “What we see here is a continuation of the Bush family’s commitment to global health, especially to the health of women, and in particular to the women of Africa.”

As part of the Pink Ribbon Red Ribbon campaign, Bush said, he wants to cut the cervical cancer death rate by 25 percent. There are 15 partners, including the United Nations; the Dallas-based Susan G. Komen Foundation; the drug companies Merck, Bristol-Meyers Squibb and GlaxoSmithKline; and the Caris Foundation, a medical mission based in Irving.

The executive director of Pink Ribbon Red Ribbon is Doyin Oluwole, a Nigerian physician now living in Dallas who has spent decades working on Africa’s myriad health problems. She was in Lusaka recently to see how quickly the campaign could boost Zambia’s cervical cancer screening and treatment into a model of excellence for Africa.

Oluwole told Zambian officials she carried a charge from her boss to save lives, and to do it quickly.

“President Bush is on our backs to ask what we have done in Zambia. He wants to know we are not just talking, but what we are doing,” she declared in one meeting. “I want to know at the end of six months how many lives we have touched, because without this, I will not leave Zambia.”

Cancer of the cervix is typically caused by a sexually transmitted virus. It is picked up by more than 6 million Americans every year.

Ninety percent of those infections are fought off by the host’s immune system. Years later, however, the surviving virus can start causing cancerous lesions on a woman’s cervix. If unchecked, the lesions can become tumors, and cancer can spread to other parts of the body.

Before Pap smear exams became routine, cervical cancer killed more American women than any other form of the disease. Today about 12,000 American women come down with cervical cancer every year; about 4,000 die from it, according to the federal Centers for Disease Control and Prevention.

Cancer care crisis

Hardly any Zambian women get Pap smear tests.

There are 1,300 doctors in Zambia, a country with 14.3 million people. There are just 15 gynecologists.

One of those is Christine Kaseba, the wife of Zambian President Michael Sata. She is hosting a meeting of African first ladies in July to discuss women’s cancers.

Another of Zambia’s few gynecologists is Groesbeck Parham, a tall man with a gray Afro and an Alabama accent. In the United States, Parham earned degrees as an ob/gyn and oncologist at Alabama and California. He’s also studied in London, Kenya and Sudan. He was active in the U.S. civil rights movement and then promoted healthy diets among black Americans.

He came to Zambia in 2005 to direct the cervical cancer program for Zambia’s Ministry of Health.

The problem was acute. Between 2002 and 2007, some 4,500 Zambian women needed chemotherapy or radiation treatment for advanced cervical cancer.

“Three hundred and fifty were sent to South Africa for treatment,” Parham remembered. “The rest died.”

Because of their weakened immune systems, HIV-positive women are much more likely to develop cervical cancer — and at a younger age. Zambia needed a screening program in a hurry.

Pap smears take cell samples from a woman’s cervix that need to be examined by a pathologist — a process that, in many parts of Africa, can take months or even a year. If there’s a problem, the patient needs to come back for further treatment. But even finding her again can be a challenge.

Parham turned to a simple screening process using household vinegar.

When smeared on the cervix, vinegar turns lesions white. The screener takes a digital photo of the cervix that can be examined closely on a laptop computer screen. If the lesions are significant but still in an early stage, they can be burned off during the exam session with liquid nitrogen.

Empowering nurses

With so few gynecologists in the country, Parham trained nurses to do the work, and they, in turn, are training other nurses. They’ve now done more than 80,000 screenings.

More serious cases get referred to Lusaka’s University Teaching Hospital, where Parham and his colleagues perform surgeries. The hospital now has a cancer center that provides radiation and chemotherapy as well.

Bush came to Lusaka in December to see for himself how this was working. He visited the George Clinic (named for an old property owner) in a poor part of the city. Thousands of Zambians squashed together nearby, hoping to catch a glimpse of the former president.

“There were crowds of people jumping over each other to see and touch him,” said Storella, the U.S. ambassador.

When Oluwole came to Lusaka, Parham described how $4.5 million to $5 million could turn Zambia’s cervical cancer program into a center of excellence for all Africa. Nurses and doctors from across the continent would come to Lusaka for training, including surgical techniques. Clinics would be extended across Zambia and then elsewhere to provide screening for both cervical and breast cancer.

Pink Ribbon Red Ribbon is trying to help Parham realize his dream.

Zambia’s Ministry of Health, meanwhile, plans to start vaccinating schoolgirls later this year to make them immune to the strains of the human papillomavirus that cause cervical cancer. The work has started with an education campaign aimed at the girls’ parents.

The current focus of the President’s Emergency Plan for AIDS Relief is on seeing host countries take over the effort as they are able, so that the work can be sustained into the future.

Oluwole says the most important accomplishment of the American anti-AIDS campaign was to help Africans turn from a plague of death to the struggles and joys of ordinary life.

“Life comes back,” she said. “People are able to do what needs to be done to get on in their lives.”

This Op-ed appeared on the Dallas News

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