We can now stop AIDS in Africa
Epidemiologist Emmanuel Ochola from St. Mary’s Hospital Lacor interviewed during his visit to Italy.
Dr Emmanuel Ochola, 33 years old, Epidemiologist and head of the HIV Research Department at St. Mary’s Hospital Lacor, graduated in Medicine and Surgery in 2005 and obtained his specialization in Makerere University in Kampala in 2008.
“Africa should not lose other generations to AIDS, however, this will only be possible if antiretroviral drugs are available to all patients,” says Emmanuel Ochola, epidemiologist and head of the HIV Research Department at St. Mary’s Hospital Lacor in Gulu, the Ugandan hospital founded by the Italian doctors Lucille and Piero Corti. He is currently visiting John XXIII Hospital in Bergamo: “I wanted to see how it is organized,” explains Dr Ochola, accompanied by Dr Dominique Corti and Achille Rosa, respectively President and member of the Corti Foundation in Bergamo, and Tullia Vecchi, President of Nepios.
Uganda was the first African country to fight AIDS, discovered in the 1980s, with a consistent health policy that helped curb the epidemic.
“In the beginning, Uganda was promoting information campaigns to change the population’s sexual behaviour. Gradually, as new antiretroviral drugs were developed, “treatment is prevention” became the new approach. Patients who tested positive for HIV receive treatment immediately, especially if they are part of a risk group such as pregnant women or hepatitis or tuberculosis patients. Women and children undergo treatment without objection, but men are more stubborn, either because of their pride or because they move around more. However, in order for the treatment to work, it must be administered daily and frequent check-ups are necessary. The epidemiology has also changed: while at first, AIDS affected different population groups such as drivers, soldiers, fishermen or prostitutes, we now find it in families and stable couples.”
How many patients do you treat at Lacor?
“We treat about 12,000 AIDS patients at the hospital and in the village health facilities. Approximately 5,000 patients are on antiretroviral therapy; 66% of them are women, 33% are men and 500 are children under five.”
The hospital is one of the 21 facilities identified by the Ugandan government for AIDS monitoring.
“We are located in a populated area with the virus prevalence rate of 11%, which is almost the same as in the capital, while the national average is 6.4%. The specialized clinic offers counselling services, voluntary testing, treatment of opportunistic infections, prevention of mother-to-child transmission and antiretroviral therapy with clinical and out-patient follow-ups. Patients also receive home care from volunteers from the Comboni Samaritans organization. This network is of crucial importance as it provides information and monitors the situation in the villages. In Uganda people travel mostly on foot and the hospital treats a substantial number of patients from a catchment area of over 100 kilometres. On average, we have one physician per 19,000 inhabitants in the region and living conditions are still very hard after 25 years of armed conflicts that only ended in 2006.”
What do you do to stop mother-to-child transmission of the virus?
“All pregnant women who come to the antenatal clinic for the first time are tested for HIV. In 2012, 9% of these women tested positive, compared to 29% in 1993.”
How do you procure the drugs?
“They are donated. International organizations are dealing with the central government, which then supplies the hospitals. We always fear that the donors will close the taps; we would never make it on our own. The quantity of antiretroviral drugs that we use at Lacor Hospital represents almost half of the entire hospital pharmaceutical budget. If we had to pay for them, the hospital would close down. In addition, we don’t have enough drugs for all our patients, we have to prioritize.”
Is Lacor the only hospital in the region?
“No, but it is the best equipped one. There are other hospitals that treat AIDS in the area, but they refer patients to us who, in addition to AIDS, have other conditions or serious opportunistic infections.”
Do the patients have to pay?
“They pay a symbolic fee that has mostly an educational purpose. We are trying different ways to get funding, such as local fundraisers. A Swiss donor, the Banca del Ceresio, proposed to double the amount that we would collect in Gulu. We decided to go ahead on the occasion of the 10th anniversary of Piero Corti’s passing. We organized concerts where musicians performed free of charge, asked the more affluent citizens for help, met with some institutions, organized soccer matches, auction sales or car washes. The activities are ongoing. We don’t know how much we’ll be able to raise, but the economic result set aside, it turned out important to inform people about what the hospital is doing and how hard it is to raise the money needed to run it. Sometimes we can get the impression that everything is easy for a missionary hospital.”
Why do you speak Italian so well?
“I spent two years in Trieste at the Collegio Adriatico, which is a member of the United World College of Excellence network. I was 18 and ranked as the second best student in my region—in Uganda, we have a national assessment system for students and teachers. My school sent me to Kampala to the national selection for scholarships. This was in 1988 when there was still a war in Gulu and I travelled hidden in the cargo area of a truck. I took the exam and won the scholarship, which brought me to Italy where I completed the International Baccalaureate. The college in Duino is beautiful, but I didn’t pay much attention to it; I did nothing but study, as I did not want to waste the opportunity.”
Have you always wanted to be a doctor?
“Yes, since I was nine and one of my teachers told me the story about a surgeon who contracted AIDS on the job. I was fascinated by the idea of having a job where you are committed to something great. Only years later did I learn that it was Lucille Teasdale.”
What remains of the work of Lucille and Piero Corti, who have dedicated their lives to the Lacor hospital?
“The hospital now has African staff, including physicians and health managers. It survived thanks to the Corti spouses, who kept it open even during the darkest moments of the war. Their philosophy—do the things that are good for the greatest number of people possible, consider preparation and professionalism an ethical duty, never back down, never abandon patients even when the situation becomes risky—is still in the air and has helped us become a university hospital and remain a point of reference for Ugandan health.”
You are also responsible for research. What are you currently working on?
“We are studying the health of the population after years of war and the local economic impact of the Lacor hospital. Other epidemiological research on hospital infections and hepatitis B in pregnant women is being undertaken in Gulu.”