Fran Quigley's "Walking Together, Walking Far: How a U.S. and African Medical School Partnership is Winning the Fight Against HIV/AIDS"

Provocate favorite Fran Quigley, a poverty and human rights lawyer in Indiana with a gift for journalism, wanted to report on the HIV/AIDS pandemic in Africa. When he heard about the start of a partnership between Indiana University Medical School and Moi University Teaching hospital, he immediately got a journalist grant to go to Kenya and begin reporting. From that happenstance, he witnessed the evolution of what appears to be the most transformative AIDS/HIV care programs in Africa. His book Walking Together, Walking Far: How a U.S. and African Medical School Partnership is Winning the Fight Against HIV/AIDS relates that story. Provocatrix Louise Klann met with Fran to talk about his book and to find out what AMPATH has been doing since the publication of his book.





It started with a few Hoosier doctors in the IU Medical School who wanted to partner their school with a medical school abroad. They created AMPATH (Academic Model for Prevention and Treatment of HIV/AIDS), with Moi University Medical School in Kenya . This partnership changed the face of AIDS care in Africa. All other AIDS programs in Africa left every AIDS patient to die untreated in their hospital while focusing their efforts on prevention education. The only treatment for an HIV/AIDS patient is antiretroviral drugs. Antiretroviral medication does more than save the lives of AIDS patients; it is called the miracle drug because the restoration is so rapid and complete. Most international aide programs and the medical community believed that administering antiretrovirals to Africans did more harm than good. The staggering large numbers of AIDS patients and the high cost of the drug per patient meant that scarce resources would be spent on providing "miracles" for a few patients rather than attempting to prevent the spread of AIDS through education campaigns. Moreover, the AIDS virus's proclivity to develop resistant strains when patients do not adhere to a strict pill regimen meant that providing less than complete care to a few patients could make it more difficult to provide treatment for everyone.

AMPATH challenged the entrenched AIDS care approach of the medical community. AMPATH's doctors began administering the antiretroviral medication which in a few weeks transforms the dying patient back into an active healthy member of society. Unsatisfied with simply treating the disease, the AMPATH's program leaders realized that their patients needed much more to become completely well. Many were starving, had no work, and because of the stigma attached to AIDS had been rejected by their families. The doctors felt that in order to treat their patients, they had to address these issues. As program leader Joe Mamlin said "We are in the business of reconstituting lives, not just immune systems" (Quigley, 109). In response AMPATH created farms to feed their patients, counseling to help with their trauma, homes for the orphans and work in lucrative passion fruit farms so they could regain their place in society. In AMPATH's latest development, Kenyan and US lawyers advocate for patient's rights (more on this later). In short, AMPATH re-knits the Kenyan society that AIDS and an unstable government so effectively tear apart.




The ethnic violence surrounding the 2007 Kenyan election tested the resilience of AMPATH's care structure. Kenyan parties, representing different ethnic groups hired thug militias to intimidate opposition. When it became obvious that the election was rigged and the incumbent president claimed victory, mass violence broke out over all of Kenya. AMPATH's accomplishments could easily have been destroyed by the ensuing chaos and brutality, but instead AMPATH demonstrated its strength within the Kenyan community. Most clinics stayed open, serving as sanctuaries for people of all ethnicities who prayed and cried together every night for peace. In the face of ever present violence and widespread displacement, AMPATH's doctors and nurses went to great lengths to bring the life sustaining antiretroviral treatment to their displaced patients while treating the overwhelming flow of wounded victims. I asked Fran about the impact of this anarchic violence on AMPATH. He responded that the elasticity with which the entire Kenyan society snapped back to superficial normal functioning was quite remarkable. Although the unresolved underlying ethnic tensions reinforce concerns that the next election may see similar violence, Fran stated that it does not affect AMPATH's life sustaining function. In fact now they serve 100,000 patients in 23 clinics. Taking care of Kenyans -- whether the need is drugs, food, shelter, or stitching up machete wounds -- drives AMPATH, and apparently no amount of violence can change that.

Another AMPATH extension grew out of Fran's training as a lawyer: LACE, the Legal Aid Center of Eldoret. It functions within AMPATH serving as a judicial advocacy program primarily for the rights of AIDS patients. Fran believes the strength of LACE is that it empowers Kenyan lawyers to change Kenya's judicial climate. Although Kenya has strong laws on paper, corruption and a culture of sexism and violence against women meant that policemen, who double as our equivalent of prosecutors, rarely bring criminals to justice. Fran estimated that 80% of cases that involve violence against women are never filed because most women do not think that a judge would do anything. That is where LACE's advocates come in. When they take on a case, they make sure that the judge follows through until the law is upheld. In this way, LACE builds a culture of justice. As Fran says: "What's missing in Kenya is not signatures on human rights treaties but tangible examples of rights being enforced. That's how you deliver the message that justice should be expected." As LACE ensures that cases increasingly come to court, more people will begin to believe that their rights should be respected and that they too can find justice within the system. After only one year of existence LACE has already served 200 clients many of whom came out of the AMPATH system. LACE owes part of its rapid success to partnering with AMPATH's. AMPATH and its partners all equate trust, legitimacy and competency coupled with the focused desire to improve lives. Working together within and across disciplines has made AMPATH one of the most effective aide programs in Africa.


According to Fran AMPATH's influence is beginning to shape care beyond Eldoret. He pointed out that because Moi University hospital is a state hospital, the government hopes to implement all the best practices of the hospital and program affiliates all over Kenya making it "Kenya's most effective domestic government aide program." So not only does AMPATH create a sustainable life force in Eldoret, where it is based, but it intends to revitalize communities throughout Kenya. The hope is that other established universities will create similar development partnerships in Africa.

Walking Together Walking Far has now become required reading in several universities in Indiana from public policy classes to political science. Fran stated that this inspirational book is "not a medical or health success story. It's a partnership and development success story. It goes far beyond HIV/AIDS. It's what we can all accomplish in our communities if we can create partnerships and don't get intimidated by the barriers. It's just as applicable in human rights and development, discrimination etc." Fran and the AMPATH leaders all hope that the publication of this book will inspire others replicate the amplifying power of partnership. There are difficult obstacles to overcome, but contributing to the stability of developing countries has a global impact that is well worth the challenge.