Chicago Tribune - November 22, 2005
David Greising, dgreising@tribune.com, Chief business correspondent

Across the way stands a building that may be a sign of Tanzania's future: an outpatient clinic that had been gutted, redesigned and rebuilt in two years with funds supplied by Abbott Laboratories of North Chicago, Ill.

In a separate building nearby, Abbott stocked an expansive new laboratory with $1.8 million of diagnostic equipment, the biggest single investment of the $35 million Abbott has spent so far to help Tanzania combat AIDS.

The new laboratory can process 8,000 diagnostic tests each day, up from 75 before. It can handle up to 400 blood tests daily, a fourfold increase. Two of Abbott's top lab equipment specialists are spending a year training the hospital staff, so the equipment will not sit idle after Abbott leaves.

Tanzania's government is making changes too. Two years ago, the health ministry recruited a new chief executive, David Tregoning, and gave him a daunting task: Transform a national hospital that had fallen behind nearby private hospitals, had seen its sprawling campus become strewn with garbage and could not recruit good medical staff.

Tregoning has introduced systems that record patients' health history, treatments and hospital stays. Those are typical rubrics of health care but innovations at Muhimbili.

AIDS patients are mixed with others, and the refurbished outpatient clinic treats and tests for AIDS alongside all other illnesses. Both changes are hallmarks of Abbott's initiative to reduce the stigma of AIDS.

When Abbott chief executive Miles White first visited Muhimbili in 2002, he had to step over end-stage AIDS patients lying on the floor of an open-air ward. "It was like a warehouse of the dying," he recalled.

Visiting again in early October, White peppered Tregoning with questions as the hospital chief showcased the improvements.

But problems linger. Muhimbili's CEO disclosed that the hospital's new computerized data system is too complex for the hospital staff. He believes his predecessor jumped too aggressively into computers.

"Most of them had never seen a computer before. They didn't know how to turn a computer on, much less use it," Tregoning told White. "I would have done computers later. Improving working practices was a bigger priority."

AIDS patients occupy up to 60 percent of Muhimbili's beds. Children lie three to a bed in the pediatric and neonatal wards, in part because AIDS and related illnesses attack children in disproportionate numbers. Good doctors and staff don't stay. The hospital's chief financial officer recently quit, doubling his salary at a private-sector job.

Some on the Muhimbili staff wonder whether the emphasis on integrating AIDS patients into the general hospital population might actually hurt patient care because AIDS patients might be overlooked, says Dr. Ferdinand Mugusi, a lecturer at Muhimbili University of Health Sciences who admits patients into Muhimbili.

"If you go all the way on reducing stigma, you may not succeed, and you may be denying the patient the treatment he requires,"Mugusi added. "It's very easy to require these general measures without really realizing what the patients need."

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