(This feature story on Sen. Bill Frist's work in Africa originally was published Jan. 13, 2002.)
Letter from Kenya: Nashville to Nairobi
By Eli J. Lake
UPI State Department Correspondent
NAIROBI, Kenya, Jan. 13 (UPI) -- Charity said less than 20 words in the half-hour the American priest, the senator from Tennessee and the Kenyan social worker spent in her 10-foot-by-10-foot metal-roofed shack. She didn't need to, her deep sunken olive eyes -- moist from what could only be sobbing -- told the story of the death sentence she shares with her daughter.
Charity is one of a handful of mothers in the Kangemi slums of Nairobi lucky enough to participate in a program that feeds, cares for and educates children with AIDS. Caroline Matsalia, the social worker in charge of her case, says many of the families of Kangemi want to enroll HIV negative children in the Lea Toto clinic because it is one of the only ways poor youngsters can get an education in a country without public schools.
The discarded kids that line the orange dirt roads of Kangemi wear flip-flops at least three sizes too big and hand me down T-shirts, many emblazoned with the logos from American sports teams. Their neighborhood reeks of rubbish chickens and goats won't eat before it is burned in small piles. On a façade above a row of butcher shops a painted sign taunts, "Happy, Happy Center makes us all equal."
Three swaths of different patterned linoleum separate our shoes from the rocky earth below in Charity's home. Her bed is set apart from the rest of her quarters by a tattered cloth curtain. Seven people sleep there, including her cousin who works in one of Kangemi's many "hotels," a polite Kenyan term for brothel. Matsalia is training her cousin to be a caregiver for Charity's daughter, also named Caroline like the social worker, once the mother dies.
For Matsalia this was just another day at the office, but for U.S. Sen. Bill Frist, a Republican from Nashville, this was legislative research. He says all of the AIDS and Africa-related legislation he has authored in his seven years in the Senate are based on his experiences on these kinds of trips.
He doesn't like to tell the State Department where he is going and he avoids congressional delegations and bringing journalists with him on his visits to Africa. But a chance meeting in a Nairobi hotel led to his taking at least one reporter on his current tour. He said somewhat grimly, "We're going to the slums tomorrow. It will be fun."
Frist, a heart surgeon, is the Senate's leading crusader on HIV issues in Africa. Considered by many an adviser on health issues to President Bush, he convinced the White House last spring to embrace the U.N. AIDS initiative and contribute $200 million to an international trust fund to address the pandemic. Now he hopes to convince Democrats in the Senate to at least consider new legislation consolidating and strengthening current American AIDS programs.
At the Lea Toto clinic, Frist peppers Matsalia with questions on Charity's condition -- how often does she treat Caroline?, and what more can the U.S. government do for the clinic's program? He asked the 32-year-old AIDS victim how she was feeling. She responded in raspy, whispered Swahili that she was doing better. But Matsalia tells the senator that she became quite sick at Christmas.
When asked about her medical regimen, she places her cough medicine, vitamins and anti-bacterial drugs on a table covered in a plastic yellow sheet bearing the name of Kenya's national beer, Tusker.
Charity and Caroline do not have access to the anti-retroviral drugs that have proved in the west to significantly prolong the life of AIDS patients. This is despite a law passed last spring in Nairobi that would allow Kenya to either import or manufacture much cheaper generic versions of the medicine.
Father Angelo D'Agostino, a stout Jesuit who works with the Lea Toto clinic and runs a nearby orphanage for children with AIDS, believes this is a crime. He said Friday the anti-retroviral drugs "could be available for a low price but the international drug cartels have refused to reduce the price to an affordable level: so the people in Kenya are dying at a rate of 700 per day."
He likens the situation to the holocaust. "Hitler only killed 7 million people, they are killing 25 million by withholding the drugs that would prolong these people's lives."
Senator Frist in an interview Saturday said that the price of the drugs the priest wants for his flock has dropped significantly, from about $10,000 to $500 in 12 months.
But the senator comes from Washington, a place that views the horror of Charity, Caroline and Kangemi by the numbers. "When you see three quarters of a million people in one day, probably 40 percent are infected," he said. "In Kenya right now all of the health costs comes out to about $2 a year per person. So how do you put out a drug that costs $500? This can't be done."
Like the World Health Organization, Frist believes that the most cost effective way to address AIDS in Africa is through prevention, but he doesn't write treatment off.
He said, "I would get things like retrovirals in there to select groups -- like women, parents, like that woman we saw today. What's going to happen to that baby when she dies? If we could get it to her in a situation like (the clinic), which is a rich environment where there are people who care about her, if we could extend her life another 10 years, that's going to be a lot cheaper than taking care of that orphan."
Very few politicians speak this frankly about the life and death economics of AIDS in Africa. But then again, very few politicians spend their vacations touring the continent without cameras, diplomats and security officers.
And Frist is the only lawmaker in America to travel to the middle of Sudan's civil war to perform surgery in a hospital nearly bombed by the north.
At every stop in Nairobi children sing for the senator and he responds "that's great." In one classroom in Kibera, fourth graders sang in English, "We are happy to share each other's burdens." Clearly the surgeon from Tennessee agrees.
