Mission of Mercy and Education
MADISON - At the end of the interview, Susan Gold pointed to a picture tacked to the wall of her office. In it she sat with six children from Nyumbani, the facility outside of Narobi, Kenya where she cared for orphans stricken by HIV.
The children sat or knelt off Gold's right shoulder, with bright eyes and expressions that blended curiosity and silliness - expressions indigenous to youth. To the uninformed eye they looked healthy, as though they were waiting for the bulb to flash so they could run off to a game of tag.
"Two of them are dead now," Gold said.
For her work with HIV-positive Kenyan orphans Gold, a registered nurse at UW Health's Adolescent Medicine Clinic at University Station, has been awarded the Nyumbani Medallion for Service. The medallion, presented at a dinner in Washington, D.C. Tuesday, September 26, recognizes her dedication to the Nyumbani cause of providing homes, medical care and compassion to Nairobi's HIV orphans.
Gold was also recently given a Fulbright Scholarship that will allow her to return to Nairobi for 10 months in January. She is believed to be the first bachelor-prepared registered nurse to receive a Fulbright, and she will use the grant to create an educational tool that Kenyan medical professionals can implement to help staunch the rampant spread of HIV and AIDS in the embattled country.
"She's not only a practical and loving nurse," said Father Angelo D'Agostino, the Jesuit priest and surgeon who founded Nyumbani. "She's also more importantly a teacher of other women who will become nurses. This is an extraordinary honor and she's very deserving."
"One of the things that struck me was how little these kids know about HIV and AIDS," Gold said. "It's something they know they have but they don't know why they have it or what it does to their bodies."
In response, Gold has developed a four-pronged educational strategy. She plans to begin with lessons on basic male and female anatomy, including sexuality education. Those will be followed by an explanation of the immune system, which will lead to specific instruction on how HIV affects the immune system. The sessions will culminate with a discussion of HIV transmission and prevention.
Students will be given tests before and after the sessions, so Gold can quantify their progress.
Africa has 60 percent of the world's AIDS cases, and Gold believes that these relatively simple lessons will address a key component in its proliferation. Contrasting HIV awareness among African children and teens with their American counterparts, Gold said, "On a scale of zero to 10, American kids would be a 10 and Kenyan kids would be a 0.5. They know they're a boy, they know they're a girl and they know they have HIV. That's about it."
Gold's African journey began in 2001 with a hike to the peak of Mt. Kilimanjaro. During her trip she visited a clinic that treated HIV patients, and the image remained in her mind after she returned to Madison.
"I'd always been interested, always had that wanderlust gene," she said. "Finally I said, 'Do it or stop wanting to do it.' "
She arranged for a leave of absence in 2003 and was assigned to Nyumbani, which cares for about 100 children ranging in age from the recently born to 18 years, through a relief agency. Though exact figures are difficult to find, it is estimated that AIDS orphans in Kenya alone number in the hundreds of thousands, and a large portion of the orphans are infected with HIV themselves.
Asked to described the medical conditions there, Gold needed only one word. "Grim," she said.
There are few qualified health care workers, and they work in antiquated conditions. Gold said there were no diagnostic tools when she began and limited access to medication. Antibiotics were sparse, to say nothing of the expensive anti-retroviral treatments that have proven effective in slowing the advance of HIV.
"I triaged and assessed kids and tried to provide comfort and treatment from what was available," Gold said. "And what was available changed from day to day. Mostly what I provided was human kindness and comfort."
A formidable foe
Kenya's battle against HIV and AIDS, said Gold, has to be fought on multiple fronts and faces numerous obstacles. The government provides inadequate assistance because of a lack of infrastructure and funds. Only four laboratories capable of doing the blood work HIV patients need exist in the country with more than one million infected people. And Gold said that during her last visit the pharmaceutical companies that produce anti-retroviral medication were actively working to prevent the availability of their drugs' cheaper generic counterparts.
"It's a mixture of a lot of reasons," Gold said.
Though much of the news is bleak, Gold has seen some positive developments. She points to the work of The Gates Foundation and The William J. Clinton Foundation as two charitable organizations that channel needed funds to the cause, and applauds the work of celebrities like Bono and Angelina Jolie for enhancing the global awareness of Africa's plight.
And money has been pouring in from all corners of the globe, though the funds are accompanied by myriad political snags. An example is the President's Emergency Plan For AIDS Relief (PEPFAR). Under PEPFAR's terms the United States government pledged to devote $15 billion to relief efforts in Africa and the Caribbean over a five-year period beginning in 2003.
According to the U.S. Department of State Web site, more than $208 million has been earmarked for Kenya, one of the initiative's 15 focus countries, in 2006. Without question it is a generous allotment, but Gold joins many in the scientific community in questioning how the money is being distributed.
PEPFAR regulations say that 20 percent of the funds must be directed to HIV/AIDS prevention efforts, called the ABC approach for "Abstain, Be faithful and use Condoms." Congress has also dictated that at least one-third of that amount go to abstinence programs, a strategy to which many physicians and scientists object.
The Lancet, a respected medical journal published in the United Kingdom, reflected the pervasive complaints in an April editorial, stating, "What is really needed is a complete reversal of policy. Many more lives will be saved if condom use is heavily promoted alongside messages to abstain and be faithful."
Gold agreed. "That money is coming with strings attached," she said. "A lot of it is going to faith-based organizations and not to established relief workers. We are imposing our values on these people and it serves as a deterrent to the people getting the care they need."
Despite the challenges and long odds against prevailing, Gold is determined to push on and contribute what she can to the struggle. Working in an environment defined by human mortality, where death will be staring at her daily through the eyes of a 6-year-old, she defines success in a different, less tangible way.
"My commitment is to their health and to give a name and a face to the kids," she said. "It's so easy to say there are thousands of orphans or that so many of these children died. But if I can say it's Samuel who died or it's John who died, that's how I honor these children. By not being a number to the rest of the world."
More information about the Nyumbani mission can be found at the organization's Web site, nyumbani.org.
Date Published: 06/18/2007