Sunday Times (Johannesburg) - March 14, 2009
Claire Keeton

In rural Mpumalanga and Limpopo - notorious for their failed health services - are two dazzling examples of how to get it right.

An HIV/Aids clinic and a state-of-the-art research laboratory have such high standards that they not only match, but in some cases surpass, services available to urban patients.

The Acts community clinic near White River and the Wits Ndlela HIV Research and Clinical Trials Unit in Bohlabelo (Bushbuckridge) demonstrate how visionary doctors, with partner support, save lives.

The efforts of Acts pioneer Dr Margie Hardman, backed by the treatment NGO Right to Care, have resulted in more than 28000 HIV patients on their books, 1737 of whom are on antiretrovirals.

Hardman, 64, treated patients with these life-saving medicines before the government roll-out.

She says: "Before ARVs, I used to sign about three death certificates a day. Now I hardly ever sign one."

The first impression of the Acts clinic, on a hill looking out towards mountains, is that it is spacious and calm. The staff book on average about 120 patients a day and all files are computerised.

Most HIV patients are in their 20s or 30s, but a handful are in their 80s. The patient fee is R80 and covers all treatment. Right to Care pays the cost of the drugs, as well as staff salaries.

The consulting rooms are clean, well equipped and private. There is also a small X-ray unit, since about half of the patients have TB.

Patients who test HIV-positive get the results of blood tests within hours and know the same day if they need to start treatment.

Acts has more than 140 children on antiretrovirals, and Hardman says its programmes have prevented 180 babies being born with HIV.

Acts, which already has a hospice in the Nganduzweni community, is setting up a 20-bed in-patient hospice.

The clinic has six full-time doctors, in a province with a doctor-patient ratio below the national average (20.9 per 100000 uninsured population).

Hardman says they have had no problem attracting doctors. "(Our) doctors do not want to leave South Africa or to work in the private sector. They want to work in a place that provides good-quality care, medication and is well run and equipped."

Acts has a total staff of 84, many of whom are HIV-positive and were unemployed.

Acts is a contrast to the largely understaffed, overcrowded and under-stocked state facilities.

Hardman's vision was shaped by an exploratory trip to Uganda and Zimbabwe in 1999.

"I came back all fired up, resigned from government and started Acts in 2000. I wanted to treat opportunistic infections and to offer patients palliative care with dignity and respect. At that stage, no ARVs were available.

"By 2004 I was desperate for ARVs to turn lives around and went into partnership with Right to Care."

Partnerships play a major role in supporting outstanding projects in South Africa.

For instance, the newly inaugurated Wits Unit in Bohlabelo has many donors, including the Italian National Aids Centre and the International Aids Vaccine Initiative.

Ndlela was set up in 2006 as a rural HIV vaccine trial site, but the director, 46-year-old Dr Eftyhia Vardas, had greater ambitions.

A clinical virologist, Vardas wants to measure how HIV and TB affect people living in that area, as well as test ways to stop these diseases.

The unit is gathering data to inform its battle against disease. For example, Vardas is investigating what strains of HIV dominate in that community.

The unit is recruiting volunteers for clinical trials.

A community action group is driving this, and spokesman Sydney Sibuyi, a teacher, said: "We are very excited. Ndlela will bring good services closer to us."

Villagers benefit from the high-tech laboratory, which can assist in emergencies, like cholera outbreaks.

The director of another Wits/Medical Research Council unit that has been working in the area for 16 years, Professor Stephen Tollman, says Ndlela will be researching in a setting where many of South Africa's poor live.

"Ndlela is about doing the best science with the best scientists and confronting the real issues with the tools to do this properly."

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