Archbishop's web site Denver Catholic Register Parishes Catholic Pastoral Center
May 22, 2002
U.S. doctor in Swaziland frustrated by rules on use of AIDS drug
Anti-AIDS drug not approved in small country with high AIDS incidence
By Bronwen Dachs
CAPE TOWN, South Africa (CNS) — A U.S. Catholic doctor who volunteered at a hospital in Swaziland said he was frustrated by regulations that prevented him from administering drugs that could help prevent the transmission of the virus that causes AIDS from pregnant women to their babies.
"It's so frustrating not being able to help people when we so easily could," said Dr. Leo Motter of Hershey, Pa., who returned to the United States earlier this year after spending five weeks working at Good Shepherd Hospital in Siteki, a small town in the Diocese of Manzini.
Clinical trials show that a single tablet of the anti-AIDS drug nevirapine given to an HIV-positive woman in labor and a small dose of nevirapine syrup given to her baby within 72 hours of birth can reduce the HIV transmission rate by up to 50 percent.
"Knowing this and not being able to provide this drug to women who come here is a big moral dilemma," Motter said in a telephone interview during his stay.
About 2,000 babies are delivered every year at Good Shepherd Hospital, which has 125 beds.
A study done at the hospital in 2000 found that 34.2 percent of pregnant women who visited the hospital for prenatal care were HIV-positive. About 30 percent of HIV-positive mothers transmit the virus to their babies, mostly during labor and delivery. Most HIV-positive babies die before their fifth birthday, many succumbing to chest infections and pneumonia.
Nevirapine has not been approved for use in Swaziland.
Motter said AIDS was a major topic of discussion at the Bible study group he attended in Manzini.
"Some people feel strongly that our first loyalty must be to our patients and argue that doctors in our situation should be AIDS activists," he said.
The Catholic Medical Mission Board has begun a five-year, $5 million AIDS program in South Africa, in which nevirapine is distributed. However, there are no plans to extend the program to Swaziland, said Ann Doherty, director of the board's Africa programs.
Dr. Aby Philip, medical superintendent at Good Shepherd Hospital, refused to discuss the use of anti-AIDS drugs.
Salesian Father Larry McDonnell, who represents Swaziland on the AIDS committee of the Southern African Bishops' Conference and is on the board of Good Shepherd Hospital, said anti-AIDS drugs are not available in Swaziland.
"Nothing is free here," Father McDonnell said, noting that "poverty is the bottom line in virtually everything, including AIDS."
"We're a small country and don't attract a lot of attention," he said.
Swaziland, a landlocked country with South Africa on three sides and Mozambique to its east, has a population of about 1 million.
"While there are lots of committees and studies on AIDS being done, not much is happening on the ground," Father McDonnell said, noting that AIDS is a "disaster" for Swaziland.
Motter told Catholic News Service he was "struck by the poverty" in Swaziland.
"It costs less than a dollar to be seen by a doctor at the hospital, but many people have a hard time paying that, which limits the services they can have," he said.
The dedication of doctors at the hospital is inspiring, Motter said, noting that many doctors take food to starving children whose parents have died of AIDS-related illnesses.
Although the technology at Good Shepherd Hospital is rudimentary, "I feel I'm doing so much good," Motter said.
"At home I treat people for diabetes and hypertension. Here I'm helping people in life-and-death situations every day," he said.
With polygamy an acceptable practice in the rural kingdom, it is "not uncommon to see men arrive at the hospital with multiple wives," Motter said.
"Polygamy helps the spread of HIV, especially among women," he said.
In August 2000, Tfohlongwane Dlamini, chairman of Swaziland's National Council Standing Committee, told an AIDS conference in Durban, South Africa, that the country should consider keeping those infected with the HIV virus in camps to prevent them from infecting others.
Dlamini, who chairs the committee that advises Swazi King Mswati III, said HIV-infected people were "bad potatoes" that needed to be kept away from others.
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