Special Delivery

by Hope Vanderberg

Published 7/13/01; © Medscape 2001

HIV/AIDS patients at a public AIDS clinic in Guatemala who once had virtually no reason to expect that they might survive their disease have been infused with new hope — thanks to a family doctor from the Bronx and many other willing and helpful people. Over the past 6 years, Matt Anderson, MD, has patched together a network of volunteers to gather unused antiretrovirals, antifungals, antimicrobials, and other medication in the United States and put them into the hands of HIV patients in Guatemala who would otherwise go untreated.

It all started when Dr. Anderson, a family practitioner at the Montefiore Family Health Center and Associate Professor at Albert Einstein College of Medicine in the Bronx, New York, took a trip with his wife to visit her family in Guatemala in 1995. During his visit, he met Eduardo Arathoon, MD, Director of the Luis Angel Garcia AIDS clinic at the San Juan de Dios Hospital in Guatemala City. The small, well-kept clinic performs close to 3000 HIV tests a year, and sees 15 to 30 HIV/AIDS patients a day. But the crippling cost of HIV drugs makes it impossible for the clinic, which is funded largely through private donations and by the Dutch government, to provide adequate treatment to all of its patients. Desperate to give his patients a fighting chance, Dr. Arathoon asked Dr. Anderson if he or other physicians in the United States had any extra HIV medicines that they could send down.

The Hidden AIDS Epidemic in Guatemala

AIDS treatment is a struggle in Guatemala, where 85% of the population receives no healthcare coverage. The remaining 15% are covered under Guatemala’s social security system, but even those covered don’t necessarily qualify for HIV medication. Inexplicably, only those in the country’s urban departments, not those in the rural departments, are eligible to receive antiretrovirals. For the vast majority of Guatemalans, who couldn’t possibly afford to pay for medication themselves, a diagnosis of AIDS is a death sentence. On top of this is the stigma associated with AIDS, which makes most patients unlikely to mobilize and demand treatment. And, as in most of Central America, there is little action by the Guatemalan government to tackle the problem. “There’s a lot of ostrich-type behavior — ‘if we just ignore it, it will go away,'” Dr. Anderson says.

As of February 2001, the number of AIDS cases in Guatemala, a country of 11 million people, was estimated at 4031, but this may be an underestimate of as much as 60%, as many cases are never reported. There is also a major undercounting of HIV-infected patients, according to a paper on the emergence of AIDS in Guatemala that Dr. Anderson and colleagues recently submitted for publication to the Pan American Journal of Public Health. Although the prevalence of HIV is thought to be less than 1% in Guatemala, Dr. Anderson and colleagues found that HIV/AIDS is responsible for nearly 6% of admissions to San Juan de Dios Hospital. Routine HIV testing doesn’t exist, and many HIV patients are never diagnosed, or are diagnosed only when they present with AIDS complications.

Special Delivery

Back in the United States, Dr. Anderson took Dr. Arathoon’s request to heart and began asking around. He found that many doctors had leftover unused medications — mostly from patients who had died, and some from patients whose prescriptions had recently changed. “There’s tons and tons of medicine available — more than I can handle,” Dr. Anderson says. The tricky part, he explains, is delivering it quickly and cheaply.

The solution was about as grassroots as it gets. Dr. Anderson stuffed his backpack full of bottles and headed back down to Guatemala City, hand-delivering the medication to the clinic. Since then, he has made numerous trips back, toting suitcases filled with medicine. And, as the project expanded through word of mouth, others have followed in his footsteps. Whenever Dr. Anderson hears of anyone planning to travel to Guatemala, he reserves a space in their luggage for medicine. “I have a med student going down there this weekend, and she’ll be carrying medication in her backpack,” he says.

Recently, delivery has become more efficient. Other Options, an Oklahoma City-based AIDS organization, joined Anderson and his friends in their effort. Mary “Cookie” Arbuckle, Director of Other Options, gathers medicines in the western United States and hands them off to Airline Ambassadors International, a nonprofit organization made up primarily of airline personnel who deliver humanitarian aid throughout the world. Whenever a new donation is made — anything from a couple of bottles to entire boxes of medicine — flight attendants fly it down to Guatemala and hand-deliver it to the clinic.

Donating a few bottles here and there may not seem like enough to make much of a difference, but Dr. Anderson saw firsthand how much every bottle counts when he spent 5 months at the clinic in 1999 on a Fulbright research fellowship. “It really did make a difference for individual patients,” he recalls. Since it opened in 1988, the clinic has provided care to approximately 1500-2000 patients, and donated medicines have played a vital role over the past 6 years. Every packet of fluconazole (Diflucan) samples that arrived in one shipment, for example, meant another day of life for someone. Another delivery contained the antiretroviral nelfinavir (Viracept), used to treat many of the clinic’s pediatric patients. It arrived just as the clinic’s supply was about to run out.

The Lottery

Distributing the limited supply of donated medicines to patients is another challenge. In June 1999, the clinic held a lottery to decide who would receive 1 year’s worth of antiretrovirals. Ninety patients waited to hear if their number would be called. There was enough medication for 4 of them; the other 86 would lose. The winning numbers were picked from a bingo tumbler, an inadvertent reminder of the arbitrary nature of healthcare in Guatemala, and of the gamble for patients’ lives.

That was the first and last lottery the clinic held. Now, medicines are given out selectively, with first priority going to children, women with children, pregnant women, and healthcare workers with needlestick injuries. The group collects about $15,000 worth of medicine per month — enough for perhaps 15 patients.

Expanding the Network

HIV Medicines for Guatemala is an informal network of about 15 volunteers, plus the Airline Ambassadors, and anyone else that chooses to offer a hand. With no funding, the group operates entirely on goodwill and word of mouth. Anderson marvels at how spontaneously the effort has blossomed. “The way that resources would just appear was almost magical,” he says. “You don’t feel alone when you do this project.”

Dr. Anderson continues to visit the clinic about once a year, always armed with medicines. He encourages others, particularly those in training, to consider going there to help out as well. “I feel like I’ve been really privileged,” Dr. Anderson says of his work with the clinic. “For the time I’ve spent, I feel I’ve been well repaid.”

Lending a Hand

How can you help? Dr. Anderson says HIV Medicines for Guatemala is always in need of more donations of unused medicine (monetary donations are not usable, he says). For those who wish to become more involved, the group also welcomes volunteers to help gather medication in their area and prepare it for shipment.

But highest on their wish list at the moment is a CD4 counter.

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