As we mark another World Aids Day, here are my brief reflections on my many decades of dealing with some aspects of HIV/AIDS as a physician.
In the mid-1980s, the AIDS epidemic erupted in Zambia, and soon turned into a tsunami. The whole nation faced a relentless enemy that initially killed ALL patients.
Most of the dying were in the very prime of their lives, but die they did, in their tens and tens of thousands.
Cumulatively, worldwide, about 40 million people have died from AIDS since 1981. In Zambia, I do not have figures for the numbers of HIV/AIDS related deaths for the last 40 years. But I believe these figures are in hundreds of thousands, if not millions. In this country this is still the leading cause of death. If in 2022, 20,000 people died from HIV/AIDS/related illnesses in Zambia, how many have died in the last 40 years? That’s a lot of annī horribilis.
In the late-1980s and the 1990s, the situation in Zambia and many other African countries was apocalyptically dire.
The first drug, Zidovudine, became available in Zambia in the 1990s. Zidovudine (abbreviated ZDV, also known as azidothymidine, or AZT) was only found in private hands and cost an arm and two legs. Only a miniscule number of patients could afford it. The rest died.
HIV/AIDS is now a manageable one or two tablet a day chronic illness that is mostly paid for by the state and international donors.
It was not always like this.
The much-maligned Americans, through PEPFAR – The U.S. President’s Emergency Plan for AIDS Relief – have saved many millions of Zambian lives. PEPFAR — don’t look a gift horse in the mouth — was started under George W. Bush. That is why when I recalled how Zambians were dying before any meaningful drugs were available, I was taken aback when President Michael Sata – MHSREIP – ticked off former President George W. Bush at State House for being tardy. The man has never been back to Zambia since being dissed, because I am sure he thought our treatment of him was turdy.
As a young doctor in post graduate training I, like many of my colleagues at the time, started seeing undeniable evidence that AIDS had made landfall in Zambia in 1985. Patients started trickling in with severe weight loss, chronic diarrhoea, herpes zoster, severe thrush, and other signs and symptoms characteristic of a suppressed immune system. As doctors we realised that this was it, AIDS was here. It took the Ministry of Health a little longer to publicly state that Zambia was now part of the AIDS family.
But this was only the calm before the storm. As physicians in 1985 we did not realize this was the calm eye of the storm. The AIDS hurricane, a category 10 hurricane at that, was waiting to make landfall, which it did by 1986-87.
Then the s**t, literally, hit the fan.
When it did medical services at the UTH where I was working were completely overwhelmed. We could only give supportive treatment, as there were no drugs then to slow down the HIV virus.
The hopelessness that we felt, and the daily deaths of all and sundry — relatives, friends, patients, strangers, people from all walks of life — was emotionally deeply traumatising. Given the fact that we were from the same society as all those dying around us, we never knew if or when you the healer would be next. And we lost many, many medical personnel from HIV/AIDS; many.
The many accidental needle pricks when drawing blood and during surgery, suddenly loomed large and threatening. Statistically, there was a small chance of getting HIV from needle pricks. But, we knew that the real danger was from the pricks that we were born with.
We called Phase V Admission Ward, Beirut. This was because it resembled a war zone in the Israel-Lebanon war. In this ward, floor beds were normal, with medical staff stepping over dying patients all over the floor.
Many were cachetic, on their last legs, their dignity shorn off, silent, but with their eyes entreating loudly: Dr, please save me. At that time we could not save any of them. My soul withered with each unrequited request. It was not always possible to follow Rule No.2: Physician do not get attached to your patients. Rule no.1 is of course: Do no harm.
Many admissions were new but some were our old patients who we knew and had been battling to prolong their lives. Some were back only a day or so after discharge. Many were now like “old friends”.
By the end of the post admission round some patients would be found spaces in the E wards. A significant number would take the elevator to the below-ground mortuary. Some would remain in no man’s land as command was handed over to another unit to take over the mayhem of Phase V.
I would often wander out of Phase V and look up in the sky and rail to the heavens: God, are you really up there watching all this carnage nonplussed? The same God who saved his flock from bondage in Egypt, do something! Anything!! Tell me, is this a race thing or what, God? Or was Africa South of the Sahara now Purgatory?
Getting no answer, I would get into my pushmatic Fiat 127 that was always parked on an incline near Casualty and give it a hand push then quickly jump in and clutch start it. With God’s grace, my pushmatic would usually start.
Now, many decades later, after counting my numerous AIDS-deceased brothers, sisters, cousins, friends etc I look up in the same sky and say, I am still here, and I know that it’s thanks to the same God that I once doubted. He had spared me and allowed me to perform my medical ministry on a countless number of Zambians from every walk of life. He also allowed me to tutor and lecture many, many medical students.
Back to the late 1980s. Emotionally, we physicians were badly traumatised for many, many years. Trained to heal, we watched helplessly as thousands of Zambians slipped through our fingers and died, every single day. But there was hardly any psychological support for many of us. Mental survival in that inferno meant you had to inure yourself to the Kafkaesque human tragedy playing out everyday. Otherwise, a mental breakdown and burnout was a thin line waiting to be crossed, and some did cross it.
As a doctor in wards E21 and E22 at UTH, it was not uncommon to do a a morning ward round to create space for the expected new patients and come back the following morning to find half of the patients you left gone, dead. Some days were that bad.
Soon, the relatives realised that we were clueless and not able to save the AIDS patients in our care. A stable patient would suddenly develop severe jaundice or acute kidney failure. What just happened here?, we would ask ourselves.
Soon, we caught on: in addition to our remedies the relatives were also busy giving all sorts of herbal concoctions and other traditional nostrums to patients! This usually expedited the patient’s inevitable demise. But some churches played a detrimental role as well: they told patients to stop whatever drugs they were taking and that prayers alone would suffice. Wrong. That also expedited those patients departure.
Emotional and psychological weakness in African men is frowned upon in our society. Awe iwee!! You’re a man. Stop crying, for God’s sake! Nomba nga niwe uli kuntanshi mu musowa, nga bana mayo? ( If you break down like this, what will happen to the women?).
So, though I lumped it, deep inside me I suffered and I cried.
When I lost 4 young brothers and 4 young sisters to HIV/AIDS, I cried. When I lost 9 uncles and aunties to HIV/AIDS, one after another, I cried. When I lost 6 of my closest cousins to HIV/AIDS, I cried. When I lost 3 of my best friends from Munali, I cried.
On a couple of occasions, the Sisyphean task and it’s repetitive outcome took me to the nadir, and I did not cry; I wept.
Another stopper to my emotions was that when these deaths of familiy and friends started I was a senior Army officer (the ones with red collars) and I had to show leadership and strength, and public tearing up just doesn’t cut it.
Health personnel also suffered from another not unexpected mental problem: any symptom in medical personnel, especially doctors, had an AIDS related differential diagnosis: loose stool for 2 days!! Could this be the start? But wait a minute, I tested HIV negative two week ago! This cough, a week! Could it be…Nay, just a normal viral bronchitis!
After my post graduate training it was back to the Defense Force Medical Services where the AIDS carnage was just as bad, if not worse. This was partly because of the military operations taking place on our borders.
In the military, we have what is called NOTCAS (sorry civilians, I can’t reveal what it stands for as it’s top secret). Reading that list daily was a depressing routine: Your batman, dead; Batallion Adjutant X, dead; Commanding Officer Y, dead; Sgt Z, dead!
Every evening, in the messes, as we embarked on yet another valiant effort to reduce the huge stockpiles of beer at Zambian Breweries depots across the country, we stopped discussing who had died that day. Instead, we cheered ourselves by discussing who was still alive. Capt X, still alive! A round, gentlemen! General T, alive! A double round for that! RSM Maliongo? Alive! Barman, another round! Mornings during weekends and holidays were spent looking for the hair of the dog that had bitten us.
In the maelstrom of death and unrelenting suffering caused by HIV/AIDS, hard drinking became a legit pasttime in Zambia. The supporting actors were Mosi, Rhino Dark, Olsons, Konyagi, Lavelle, and Duncan’s. Only ancestors will recognize some of those brands.
The HIV virus laid siege to the Zambian nation. At the height of the decimation of Zambians we on the front lines, seeing every victim dying, were mired in hopelessness. We truly feared that this nation might not survive. If you were not there, do not argue.
At this very dark, dark hour our Commander-in-Chief, Comrade KK – MHSRIEP – led from the front, lest we forget.
As Commandant of a military hospital, which was considerably less chaotic than UTH, my friends and relatives were constantly knocking on my door. As a result, Maina Soko Military Hospital became a departure lounge for my relatives and friends.
As an army, our “peacetime” loses to disease compared to operations/battle loses were sobering. We lost far more men and women in uniform to AIDS than to the conflicts we were containing on our borders with Mozambique, Angola, South Africa/South West Africa and the rebel racists across the Zambezi.
I said “peacetime” though in reality the whole country was at war, at war with an enemy that initially was taking us to the cleaners.
Fellow Zambians, the COVID epidemic was bad-bad-bad and killed thousands of Zambians including hundreds of health care workers. But fortunately, the worst of COVID lasted for only a year or so. As I reflect from my rocking chair, many medical personnel, especially in the so-called developed contries, are still in therapy after the COVID epidemic. HIV/AIDS was a thousand times worse, because it went on and on and on for decades, and is still going on! But we had little to no pyschological support to help us deal with the sheer daily psychological trauma that we were experiencing.
Only later did I realise that medical personnel dealing with HIV/AIDS were also dealing with an ongoing personal traumatic stress disorder.
Are we any better now at caring for the carers? I hope so. Does our society as well as it’s government appreciate the role and sacrifice of the health care workers in the AIDS, cholera, SARS, and COVID pandemics? Maybe.
Oh, I almost forgot the recurring plague outbreaks in the Eastern Province – Ku Chipata nako, kaya mwandini!
The sheer bravery of heath care workers during the COVID pandemic is a case in point. The workers went to work each day and night to look after COVID patients knowing and accepting that they might contract the disease from patients and probably die. Many did catch COVID from patients and some died. All true heroes.
We don’t need medals, but we do need recognition and appreciation for our sacrifices as health care workers. This recognition and appreciation should be to the living and not songs of praise at burials. A day set aside by Government to appreciate ALL health care workers would be nice.
I am not talking about a public holiday, no. I am not talking about international days for doctors, nurses, etc, no. I am talking about a day of commemoration that reflects the unique journey undertaken by all health care workers in Zambia.
To those in the health profession who died and to those who survived — some by God’s grace and sheer luck and others by condomising or by being faithful or by abstinence — I salute you. You faced the HIV/AIDS challenge with a large dose of compassion, empathy, and a few drugs like septrin, imodium and iv fluids, and I salute you. Some got the virus and continued healing till they were no more. I salute them. Others got the virus and are still with us today, healing others. I salute you.
To all those health care workers who followed us and had drugs that could control HIV and worked tirelessly and successfully to control the plague, I salute you. To the administrators and researchers of that time who tried to make sense out of the mayhem, I salute you. Many health care workers continues to tackle this scourge as clinicians, administrators, or researchers at local and international levels, I salute you all.
Though the health care workers bore the blunt of looking after patients, spouses, children, parents and other family members and friends together with people in the communities the patients lived in were usually supportive. I salute you all.
To the many journalists who joined in the fight by disseminating the needed information to the public, I salute you.
I salute all Zambians who ensured the survival of our society as the HIV virus shredded the social fabric that had held us together for centuries.
Allow me to mention a few people in this pantheon of many activists: Comrade KK was indefatigable. One doctor luminary among the many is Dr Mannaseh Phiri, MHSRIEP. What an AIDS/HIV advocate he was! Then there was Winstone Zulu – MHSRIEP – what an HIV/AIDS trailblazing impi he was! And then last but not least, the ZNBC journalist Faith Kandaba – MHSRIEP – who took up AIDS/HIV reporting.
A number of us survived the social, political, theological, economical, medical, and psychological aspects of HIV/AIDS.
Without doubt, most of us had to deal with burnout and post traumatic stress disorder (PTSD) on our own. Survivor’s guilt? Oh, yes (I am not a robot!). For me, all this was mitigated by the relief of being around to see my children grow up and to cuddle my grandchildren. 30 years ago, this was not a given.
Then those of us who survived became surrogate parents and grandparents to dozens of orphans in our families. Some of us even ended up as surrogate children and grandchildren!
Thank God for the strong cultural African norms that made this looking after the needy in our families seamless. Seriously, without this Africaness in us, the Zambian society may not have survived the AIDS epidemic.
Dear Zambians being at the frontline AIDS/HIV fight we had to emotionally swim or sink, mostly on our own, aided by various coping mechanisms.
My coping mechanism took me to writing down what was happening all around. That led to my first book, *TOO YOUNG TO DIE* . This book was funded by the Norwegian Agency for Development Cooperation, then known as NORAD. The book was used in schools to teach about HIV/AIDS and sold to the public.
Here is an except, 3 elegies from the second edition of the book.
*1. THE FRUIT OF THE HIV SEED*
And so to Leopards Hill
A place of grim repose
Where all and sundry quietly lie
Six feet under
When they die
It’s a place to be visited by the brave
With thousands upon thousands of graves
Many full, many undug, some empty
Waiting to feed
On the fruit of the HIV seed
Causation known
Prevention known
Palliation known
But onwards they march
Like the lemmings they are
Left, right, left, right, they march
To the condomless tune
Of the ghoulish AIDS Piper
Fueled by sex hormones and alcohol
And by poverty and gendernequity
The once radiant, promising flowers
Soon wilt and turn into
The sick fruit
Of the HIV seed
And oh, what a bitter, bitter fruit!
*2. THE ENEMY IN OUR MIDST*
He takes a last lingering breath
Then lies forever still
In death as still as stone
The grave his home to be
Until reclaimed by dust
He’s taken in his prime
Untimely is the word
His death a macabre dance
Painful, slow, unstoppable
But dead and gone he is
He leaves a yawning void
His kith and kin
In grief, profound and plain
His country has lost as well
Humanity poorer by one
The cause of his demise is AIDS
Striking not once
But again, and again
And again, and again and again
The enemy in our midst.
*3. TOO YOUNG TO DIE*
Too young to die
Yet too ill to live
Stricken by the bug
That knows neither age
Nor colour, creed or gender
Stay negative, my friend
Take heed, take good care
And sow not among the thorns
Or that ripe old age will be nothing
Nothing but a mirage
**Chishimba M. Lumbwe*
