From Zambia to America, a plea to continue the global fight against AIDS, TB and malaria

Luwiza Makukula
Luwiza Makukula

It’s hard to imagine Luwiza Makukula of a dozen or so years ago.

“Things were very difficult in Zambia then,” said Makukula, a soft-spoken and elegantly dressed grandmother of two I met briefly during a visit to Seattle this week. Her visit was sponsored by the anti-poverty organization RESULTS, a group which the Seattle Times’ columnist Danny Westneat once described as “the most influential anti-poverty group you’ve never heard of.” One of the reasons for this is the way RESULTS has operated for some 30 years – quietly, persistently and face-to-face.

That’s why Makukula came here from Zambia to tell her story.

“I lost my husband to HIV in 2001,” she said. “We didn’t know but after he died I started getting sick with fevers, in and out of the hospital.”

Makukula was eventually diagnosed with TB, and then found to also be HIV-positive. By then, she was in a wheelchair, suffering from exhaustion and cognitive lapses. They put her in an isolation ward that she said “felt like jail.” The drugs she needed to stay alive cost about $200 a month, in a country which at the time had an annual per capita income of about $1000.

She wasn’t alone in her deadly predicament. At the time, HIV and TB were burning a wide swath across much of southern Africa.

“A lot of my friends and relatives died because they could not afford these drugs,” Makukula said. Her family helped her pay for her medications but the long-term outlook was grim. Many simply gave up and accepted death, she said, because the cost was not sustainable.

Then came the Global Fund to Fight AIDS, TB and Malaria.

“I am alive today because of this,” Makukula said. “That’s why I am here. I want people to know how thankful I am.”

It’s perhaps just as hard to imagine the former Luwiza Makukula as it would be to imagine what the world would be like today without the Global Fund.

Since it’s launch in 2002, the Global Fund is estimated to have prevented more than 6 million deaths and today is providing HIV drugs to more than 4 million people, TB drugs to more than 9 million and has distributed more than 300 million insecticidal bednets to prevent malaria.

“We need to make sure that we can continue that trajectory with at least $5 billion in replenishment funding from the US,” said Joanne Carter, CEO of RESULTS. The Global Fund, Carter noted, is entering its new three-year ‘replenishment’ funding phase and the amount the US donates tends to drive the support globally. A minimum of $15 billion from all global donors is needed, she said, for the next three years if only to maintain the project’s life-saving activities.

Given the nature of the current budget talks between Congress and the Obama Administration, Carter said it’s going to be critical for advocates of this stunning success story in global health to press for the US government to continue its leadership.

The Global Fund is not the only major initiative out there focused on fighting diseases of poverty (there’s Pepfar, for example, which is a major contributor to the fight against HIV/AIDS in Africa). But the Global Fund is a uniquely multilateral approach that, if weakened, many experts say could undermine the international collaborative spirit that has revolutionized global health over the past decade. It didn’t have an easy launch, politically, and like most multilateral efforts is subject to attacks on all sides.

“The Obama Administration has been a strong supporter of the Global Fund but it must continue,” Carter said. “If they cut their support for the fund in their 2014 budget, it will be disastrous and short-sighted.”

These are large-scale policy questions. Foreign aid, though less than 1% of the federal budget, is a hard sell and at high risk in these times when every politician seems to be looking for something to cut, or maybe shrink. The numbers can be mind-boggling. That’s why Carter and other members of the RESULTS team like to bring around folks like Makukula, to Seattle as well as to meet with members of Congress (which is where she’s headed next).

“We like to meet with people directly and engage them,” said Carter. “RESULTS was started 30 years ago when very few people were working on global poverty and hunger. We had the resources to end hunger and to greatly reduce poverty, but we lacked the political will.”

RESULTS team Joanne Carter, Bob Dickerson, Makukula and Lisa Marchal
RESULTS team Joanne Carter, Bob Dickerson, Makukula and Lisa Marchal

Many organizations today believe the best way to create political will is through mass mobilization, through social media and thousands of emails, she said. That works well enough, Carter said, but there’s something uniquely powerful and persuasive about meeting someone face-to-face and hearing their story. That’s how RESULTS works.

While talking with Makukula, I couldn’t help but think of another Zambian, the economist Dambisa Moyo, a widely quoted critic of foreign aid (author of the book “Dead Aid”) who contends humanitarian aid weakens Africa and encourages dependency. Since Moyo wasn’t there, I asked Makukula what she would say to someone like Moyo or a member of Congress who might argue that foreign aid is either a waste or a luxury and that U.S. taxpayers shouldn’t have to help pay for health needs in Zambia. We have our own problems.

“I would say that you need to look at the people who will die,” said Makukula, who is now an activist and administrator of a health program in Zambia called the Community Initiative for TB, HIV and Malaria. “It’s not acceptable for us to think that the problems of others is not our problem. This is about human life.”

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.