Dr. Michael Alkan examines a patient in Botswana – In Israel, we have 25 antibiotics to work with and in Botswana they have five.When Dr. Michael Alkan received the invitation to join the front lines of the war on AIDS in Africa by setting up clinics in a remote village nestled in the desert plains of Botswana, the response of the Ben-Gurion University of the Negev professor was immediate.
“When does the next plane leave?” he asked.
The professor at the university’s Faculty of Center for Health Sciences and Soroka University Medical Center and a world-renowned expert on AIDS doesn’t let long stretches of time pass without boarding an airplane. In the past, the 64-year-old Israeli has helped set up a medical school in rural Kenya, and worked under the most difficult conditions in Ecuador, Nepal, and Papua, New Guinea, Thailand and Cambodia. Most recently he was on the ground in Southeast Asia providing relief to the tsunami victims.
“I guess you could say my ‘hobby’ is providing health care to the Third World,” he told ISRAEL21c, adding his favorite joke: “They say that the best doctors go to hell.”
Despite his lighthearted tone, there is nothing frivolous about what Alkan does. And of all the projects he’s undertaken over the years, he regards his recent mission in Botswana to set up AIDS clinics as the most important medical work of his career, potentially affecting the lives of millions.
Alkan, incumbent of the BGU Werner J. and Charlotte A. Gunzburger Chair for the Study of Infectious Diseases and founder of the infectious diseases unit at Soroka, was handpicked by the Israeli branch of the Merck, Sharpe and Dohme pharmaceutical giant, to join an international team that is working to save Botswana, and create a model of treatment that can be replicated across Africa, a continent that is literally dying every moment.
The numbers are almost too staggering to believe. AIDS has the potential to utterly destroy Africa. 40,000 Africans per week are dying each week: that means 8000 per day – 333 per hour, or five Africans a minute. The disease, that has become treatable, if not curable in the West, could kill 10 million people on the continent of Africa by the end of the decade if it is not unchecked.
A number of reasons have made Botswana ground zero for the world battle against AIDS. First, in Botswana is one of the most stricken countries. More than a third of the 1,600,000 citizens have the HIV virus – the highest prevalence in the world, due to a tradition of promiscuity that has made attempts at AIDS education almost futile.
Just as importantly, Botswana is rich – perhaps the richest nation in Africa on a per capita basis.
“This is a wealthy country, their money comes from diamond trade, raising cattle and tourism,” explains Alkan. “It is a very special African country because people can become wealthy through work. And it is a democracy with zero tolerance for corruption, whose government has been brave enough to step out of denial, declare AIDS a crisis, and commit budget and resources to fighting it.”
All of these factors together have made a myriad of international bodies interested in saving this nation. The most significant contribution came from Merck and the Bill and Melinda Gates Foundation, each of whom gave $50 million to treat health care personnel in Botswana to treat HIV AIDS using the latest drug cocktail. That treatment has turned the disease in the West from one that promised short-term death to a chronic illness that can be controlled by drugs long-term.
Botswana is the first African country that is providing AIDS treatment free of charge to its citizens – a revolutionary move. But merely providing pharmaceuticals – even free of charge – is not enough.
The drugs themselves can’t do any good if clinics aren’t set up to make sure they are administered properly. In a country that doesn’t even have a medical school, this was a challenge. Which is why Merck located between 20-30 doctors from around the world – including Alkan – who would be willing to go into the remote parts of Botswana in order to set up clinics, and teach locals – both medical professionals and untrained – how to treat AIDS.
Alkan was born in Jerusalem in 1941 and studied at Hebrew University, which, at the time, was the only medical school in Israel. He came to Beersheva and BGU in 1974 where he founded Soroka University Medical Center’s infectious diseases unit.
“I went into infectious diseases because people get well, and then along came AIDS, and suddenly I was faced with more dying patients than the oncologists.”
Thankfully, in recent years, the cocktail of drugs has allowed AIDS patients to survive and lead productive lives in western countries, including Israel. The project in Botswana is trying to make this happen in Africa as well.
Alkan joined his counterparts and for an orientation process, and was then sent to the town of Ranzi in the middle of the Kalahari Desert for two months to set up a clinic and train its staff. His work was so successful, he returned later for another month to the town of Gamara, which is even more remote.
“The desert there isn’t the desert as we know it in the Negev,” he said. “It’s really a prairie, covered with abundant trees and lots of wildlife. You have to be careful when you drive, because an elephant, giraffe, or a lion can just show up and cross the road.”
That wasn’t the only challenge. Alkan also faced fighting the deadly disease with the severe limitations on medical supplies, equipment and drugs. Test results that would take hours to receive if done in Israel sometimes took weeks.
“It can be very frustrating,” he admits. “My mantra is always that I haven’t come to change the standard of care, I look and see what is the best way to give care within the limitations of that place. In Israel, we have 25 antibiotics to work with and in Botswana they have five. So when I give a lecture, I’m going to talk about what it is possible to accomplish with those five antibiotics, and not mention the ones they don’t have.”
Alkan’s mission was not only to teach the local staff the technicalities of AIDS treatment, but to inspire them to convince their countrymen to be tested and to fight the disease, and not surrender to it fatalistically. In a country where AIDS education for prevention has been a devastating failure, half of all adults between 25-29 have the virus, including more than half of the pregnant women. The life expectancy is age 40, and soon it will reach the point where half of the children of the country will be orphans raised by their other family members, until they too die.
“The main problem is young girls aged 15-25 who are experimenting with sex and are acculturated not to say no to men who want it. They bear children out of wedlock that are raised by their mothers and sisters, then when they eventually get married they have more children – and then eventually that husband goes out and tracks down more young girls. Preaching against this doesn’t work and education to use condoms doesn’t work. I tried to convince one man to use condoms and he said, ‘I don’t eat bananas unless I peel them,’” says Alkan.
But despite those obstacles, Alkan has seen progress in the clinics he created. In Gamara, by the time he was finished with his stint, there were 300 patients coming regularly to the new clinic and sticking faithfully to the regimen that was keeping them alive. Two years ago, only 3500 Botswans who were being treated with the AIDS cocktail, now 19 clinics are up and running and treating 33,000 patients. The most important patients are pregnant women, who by getting treatment, can avoid passing the virus to their unborn children.
The numbers may be small – a drop in the bucket compared to the numbers that are dying – but the survival of the patients being treated at the clinics sends an important message to their community: it is possible to live with AIDS. This, according to Alkan, motivates others to be tested and seek treatment instead of fearing the stigma more the disease.
Alkan says that he and the other participants will only truly consider this program a success if it is taken and replicated in other African countries. And he’s ready to hop on any plane that will make that happen.