Caring for AIDS patients in South Africa in times of (financial) change

(Vatican Radio) Since AIDS was identified 30 years ago, the United States has played a leading role in achieving scientific progress, and in translating science into programmes.

Ten years ago, the US Congress passed a legislation that established an historic and transforming global health programme, known as PEPFAR: the Pressident’s Emergency Plan for Aids Relief.

Since 2004 PEPFAR has committed more than $30 billion to funding for the AIDS epidemic. It represents the largest financial commitment by a single country to responding to HIV and AIDS worldwide and it has been described as the “largest and most successful bilateral HIV/AIDS programme ever.

Much of that funding has gone to Sub-Saharan Africa and in particular to South Africa, the country with the highest number of people infected with HIV in the world.

The news this year that PEPFAR funding to South Africa is decreasing and will no longer go into the heands of field operators, but will be injected directly into the National Health Care System, was received with shock by thousands of patients, NGOs and other care-givers that operate in the sector.

The South African Government assures that there will be no interruption of treatment and care services during the transition of direct service provision to the South African Government and says that an advantage of the transition is that overall costs will be reduced, allowing assistance to reach more people in need more comprehensively under the South African National Primary Healthcare System.

But many NGOs and missionaries who operate on the ground, and who for years have borne the weight of caring for destitute people and their families who are infected or affected by HIV/ Aids are suddenly faced with the urgent need to find funds elsewhere or see entire communities sink back into despair.

One such person is Benedictine Monk Gerhard Lagleder, who spoke to Vatican Radio's Linda Bordoni when he stopped off in Rome during his fundraising tour of Europe.

Listen to the interview…

Gerard Lagleder is a Benedictine Missionary from Bavaria who was sent to South Africa 26 years ago as a missionary. He first spent time in a tiny bush parish where he learnt the Zulu language as well as the culture of the people. In 1990 he was sent to become parish priest in a community called Mandeni, located halfway between Durban and Richard’s Bay, the two largest harbors of Africa.

Today Father Gerard runs an organization that heads a vital project for the community there. It’s called The Brotherhood of Blessed Gerhard, Blessed Gerard being the founded of the Order of Malta. Father Gerhard explains that his is the South African branch of the order, which he founded 21 years ago.

He says when he was a parish priest he was sent out into the slums in the Mandeni area and came face to face with the harsh reality that there were hundreds of sick people who nobody cared for. So as Church, he decided to do something for these people. On one occasion he said he was sent out to take Holy Communion to a dying woman, and when he got to her he found that she was literally dying of neglect. He asked her why no doctor had been called in to tend to her wounds and she explained that she couldn’t afford one. So father Gerard took her to a good doctor who happened to be the pastoral council chairman of the township community. He sent her to hospital and that same night she died. The doctor himself then approached Father Gerard expressing the need to do something for the many people dying from neglect and destitution. Father Gerard said he knocked on “open doors – because I had been involved in working with the Order of Malta in Germany since 1969, and I had been part of the German Relief Organization of the Order of Malta so I knew how to organize help”.

So he decided to set up an organization that would care for the sick and needy of the area. But he wanted to do so involving the local population so that they would “take possession” of it so that it wouldn’t break down once the “specialists” left.

Today, Father Gerard says, the organization counts over 2500 members. He says “we have a very good reputation so patients are brought in from far afield”.

AIDS is endemic in the area and the Brotherhood of Father Gerard offers vital services such as a clinic, a hospice, a crèche, a nursery, an AIDS education service, an ambulance, funds for helping young people to study, emergency funding for people in need of immediate aid, a children’s home which – father Gerard says – was a consequence from the hospice. In the home he says there are mostly abandoned children, children who are infected by HIV/AIDS and are being treated. From the hospice he says “we run a large treatment programme and this has become our biggest activity”. Through this programme the Brotherhood provides Anti-Retro-Viral drugs to hundreds of patients.

Father Gerard says the "Brotherhood" has become a point of reference for the poor and the sick of the area. If they can’t come themselves – he says – we fetch them in our ambulance, if home care is possible that is what we do with a specific programme, but where home care is not an option, we have an inpatient unit. From here we started an AIDS treatment programme which is extremely busy and active.

He says that in January last year “we had 440 patients in AIDS programmes, 1 and a half years later we have nearly 1000 patients in treatment, so in one and a half years the number of patients has doubled, the other 440 have built up in 9 years, so we are exploding at the moment”.

And this brings us to the crux of the matter.

Because, Father Gerard explains “the finance is not exploding concurrently. In fact we have a problem because the American funding, the Presidents Emergency Plan for Aids Relief – known as PEPFAR is coming to an end”.

He says “the South African Bishops Conference was supported for close to 10 years by PEPFAR and this funding is coming to an end in June next year”. He says that they have already received an extension – the funding should have ended in May – but because of their good reputation and track record – the "Brotherhood" received a one year extension in funding. But, he says, but from next year on the programme has to be mostly self-financed.

“Thank God – says Father Gerard - the Bishops Conference spoke to the South African Government that in turn spoke to the National Department of Health and to the Kwa Zulu Department of Health, and in many parts of the country the Government AIDS Treatment Programmes have taken over the patients of the Catholic Institutions”.

He points out that the Aids Treatment Programme of the Catholic Bishops Conference had by November last year 40,000 people initiated on Anti-Retro-Viral treatment. “Most of them have been transferred to Government Programmes but in our area, the Government clinic is so over-swamped with patients, they could not take over our patients, so we have no choice, but to carry on”.

Father Gerard attributes the explosion of patients in the fact that finally people have overcome the fear and the stigma of having an HIV text, because of the successful use of peer counselors who have made a huge difference to the attitude of the people.

Also the Brotherhood of the Blessed Gerard’s excellent track record is one of the reasons they have so many patients. This is due, father Gerard explains to “our high success rate founded on proper preparation for the treatment and on the presence of therapeutic councilors who make sure patients take their medication and step in if there is a problem.

Regarding the PEPFAR funding situation, Father Gerard explains that at the moment his organization is receiving funding from the Government “not in a financial way, but the Government pays for about 37% of our treatment costs by paying for the Anti-Retro-Viral drugs, and also for the medication for the so-called opportunistic infections that flourish in bodies that are immuno-compromised. And as from the beginning of July the National Service has promised to take over all laboratory testing meaning that blood tests will be taken care of by government services.

The Bishops Conference has extended their help making up a total of 24% of our costs, but as from next year “we will have to pay for about 50% of our costs ourselves”. “To say it in plain English we will have to finance about 150,000 euros per year until June 2014, and from then it will be about 300,000 euros which we will have to finance from our side to supplement what is necessary to run the programme”.

That is why, Father Gerard says, “I am in Europe today: to beg. I always say jokingly that the Benedictines are not a mendicant order but I have become a beggar because it is about saving lives…”

To find out more about the Brotherhood of Blessed Gerard and its activities, go to the webpage at www.bbg.org.za