A GOOD MAN IN AFRICA

The last time Dr Sandy Logie was in Zambia he contracted HIV. Now he's returned, to confront the past - and the gulf between Aids haves and Aids have-nots. Mary Braid reports
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The Independent Culture
A NURSE was wrestling with the agitated young woman, suffering from Aids-related pneumococcal meningitis, when Scottish consultant Dr Sandy Logie, 60, came upon them at St Francis Mission Hospital, in Katete, a rural backwater near Zambia's border with Malawi.

Every time the drip was set up, the restless young woman pulled it down. When the nurse eventually attempted to give her an injection in the back of her hand, Sandy went to help. He remembers now how poor the light was as he tugged at a knot to release a tourniquet on the woman's arm. His hand slipped and the needle, which had loosened from the woman's hand, plunged through his skin. The chance of her infected blood entering his bloodstream was very slight; but, automatically, he followed the drill, squeezing his flesh around the needle mark. He watched his blood ooze out, in theory flushing out any foreign blood that might have entered. He then washed his hand.

The next day, the woman died. When the needle entered into Sandy's hand, she was probably at the height of infectivity. Even so, he wrote it off as nothing much to worry about. Yet in fact that incident, six years ago, was to be the defining event of his life. For it was then, Dr Logie is almost certain, that he contracted the HIV virus.

Then 54, Sandy Logie, a consultant specialising in diabetes, was visiting Katete on a four-month stint as a bush doctor. It was supposed to be the first step in realising a dream which had tantalised him and his wife, Dorothy, for 30 years: to work in Africa. In the late Sixties, following Dorothy's graduation from medical school, they had worked briefly in Gambia for the Medical Research Council, and, although they loathed the suffocating colonial arrogance - "a clapping of white hands and all the servants come running" - they had fallen in love with the place. That adventure was brought to a premature end by Dorothy's first pregnancy, and two more children, a mortgage and two careers - Dorothy tailored her ambition to GP practice to combine family with career - ensured that while their passion for Africa endured, it remained largely long distance.

Then, in 1993, following early retirement, Sandy set off alone for Katete. Dorothy claims to have been "bloody furious" to have been left to look after Andrew, the only child left in the nest. But both hoped this would be only the first of many African stints. It was not to work out that way.

Sandy tested HIV positive a few months after returning to the UK. At first, such was the stigma attached to Aids, he and Dorothy kept the dreadful news to themselves. Government guidelines directed that there was no obligation on HIV-positive doctors to disclose their condition, as long as they did not perform invasive surgery; and his health board advised him to keep his condition quiet.

As doctors, the Logies are used to bad news and hiding their feelings, and are not at all the sort to fashion drama out of a crisis. But occasionally, beneath their shared reserve, you catch a glimpse of the anguish of the early days, when, after waiting for the results of a second more conclusive test Sandy broke the news to his wife.

They both talk of their "numbness". "It was like a sudden bereavement," Dorothy remembers. "HIV was a death sentence then." Sandy merely mentions the "night terrors" when he lay contemplating his own imminent annihilation. Though both were in shock, Dorothy still honoured the on-call rota at her surgery that weekend - "I remember just sitting in the room holding the phone telling myself that all I had to do was focus on this" - and Sandy still attended a two-day camp for children suffering from diabetes.

The Logies also kept Sandy's HIV secret from their children, hard though this was. Dorothy remembers the isolation, and how she began to cross the road rather than speak to friends. "An unreality enters into relations with other people," she says.

In 1995, the situation became almost farcical. Sandy fell perilously ill during a visit to South Africa and was flown home and hospitalised in Edinburgh. He was registered under a pseudonym and given a false national insurance number. When his son Andrew, still in the dark, rushed to see his father, he was turned away because there was no "Sandy Logie" on the ward.

In 1996, following three years of deception, Sandy decided to "come out". The media - outraged that an HIV positive consultant was treating patients - descended on the Logies' home in Melrose, in the Scottish borders.

Despite everything, the Logies do not seem to have wallowed in self-pity. "I never suffered from the `why me?' syndrome," Sandy says simply. And all along the couple have believed that their own tragedy pales into insignificance against Zambia's, where they knew that most, if not all, of the Sandy's patients would already have died.

SIX YEARS on from that fatal slip, Sandy and Dorothy Logie alight from a narrow, bullet-shaped, 19-seater plane at Chapata "international" airport (actually a short strip of untarmaced earth), near Zambia's border with Malawi. With their reserved Scottish manner, they seem a little out of place amidst a posse of rich western tourists, all fleshy white knees, ostentatious stetsons and Out-of-Africa safari suits. Dorothy, 56, small and motherly, has never been to Zambia before, while Sandy, tall, thin and unusually gaunt, is here for the first time since his disastrous sojourn six years ago. The tourists already look bored, but the Logies are absorbed to the point of rapture in their surroundings. An hour's drive away is Katete, a dusty one-horse town, a world apart from Zambia's exclusive $250-a-night game lodges.

As we bump along the pitted road to Katete, in a mission minibus, past monotonous washed-out olive scrub, only occasionally relieved by spectacular splashes of purple jacaranda, nothing contradicts Zambia's rating as one of the poorest countries in the world. The road is ghostly quiet - the price of petrol has doubled in the past two years, more proof, Zambians claim, of the way stringent loan conditions, imposed by the International Monetary Fund, have only made them even poorer.

Even in the Seventies and Eighties, when Kenneth Kaunda, Zambia's first post-colonial leader, governed with an idiosyncratic mix of Marxism and African values, there was still a little money around, though nothing to spend it on. Now people say there is plenty for the country's burgeoning nouveau riche to buy but little within the means of the impoverished majority. The telephone line running alongside the road is testament to social desperation. Every third metal pole has been stolen - although public-spiritedly the thieves have left just enough to keep the line open.

All this the Logies take in, mostly in silence. Despite everything, the Anglican mission hospital is still dear to Sandy's heart - and he is anxious to see how it is handling the unrelenting onslaught of a virus with which he, and his wife, are now on strangely intimate terms.

Excitement, he confides, is mixed with trepidation, for he is only alive today because of the new anti-Aids wonderdrugs, protease inhibitors - which in the west appear to have transformed infection with the virus from a immediate death sentence to a chronic disease. These are prescribed to him on the NHS but are completely unaffordable to people on the continent most ravaged by Aids.

It puts the Logies, Africa lovers, critics of global inequality and supporters of the campaign to cancel the Third World's debt, in a uniquely uncomfortable position. "I think there might be hostility because I have medicine that people here cannot have," says Sandy, "and that makes me feel guilty." Though not so guilty, he adds, that he would throw out his drugs in a symbolic act of solidarity.

Finally the minibus rolls into St Francis, past the de rigueur cross and crucified Christ, and scores of bare-footed mothers with babies on their backs. It sweeps round the orange earth drive and stops before a scatter of low buildings. Hundreds of sick and dying Zambians - most carrying the virus - arrive here every day, travelling up to 50km by foot, bicycle or ox cart.

Suddenly the quiet Sandy is rather excited. He limps into the hospital canteen, gangly and startlingly thinner than in 1993. The limp was always there, though now it is exacerbated by the much-lauded wonderdrugs which are also devouring his body fat and muscle, and have brought chronic diarrhoea and gout. When he meets hospital cooks Julius and Wilfred, Sandy is touchingly grateful that they still recognise him; that perhaps his time here meant something. "It makes me feel lumpy in my throat," he says shyly.

BARRING a medical miracle, one fifth of Zambia's adult population will die in the next 10 years. Aids has so far claimed 11.5 million lives on the continent - 1.8 million last year alone - and infected 34 million people. One Zambian in five is HIV-positive. For the world's poorest nations Aids has appalling social and economic ramifications. Yet the Logies have come to Zambia seeking hope that, despite the grim statistics, Africa can somehow beat Aids.

Back in 1993, long before his own public vilification, Sandy concluded that the social stigma surrounding HIV in Zambia was accelerating its spread. The common overseas assumption was that with so many dead and so many orphans - 500,000 in Zambia alone - much of the stigma attached to Aids must have vanished in Africa. In fact, around Katete, Sandy's fears appear to be as real as ever. Montford Phiri, 55, co-ordinator of an anti-Aids project run by St Francis and funded by Christian Aid, says that the year after Sandy left, volunteers were recruited to cycle to remote villages to stamp out ignorance around HIV and encourage villagers to help their sick neighbours. But when the bicycles broke down there was no money for repairs. The scheme died for want of a few hundred pounds.

A few miles from the mission, in Ndebvu, a village of mud rondavels, the Logies can see the high cost of that failure. Montford, struggling to resurrect community-based care on a tiny budget, visits Lekesina Phiri (no relation - Phiri is an extremely common name here).

While HIV usually brings death far more quickly in Africa than Europe - even before the new drugs arrived - even in this ravaged continent some of those with the virus are surviving. Mrs Phiri, 52, has been positive for eight years. She is stick thin, with skin as parched and cracked as the soil around her, but she is alive, and some days she even feels well. She is clutching a St Francis appointment card, wrapped in a religious pamphlet, along with a faded birth certificate, issued by the the Seventh Day Adventist Church. "Be Faithful Unto death," it reads. "And I will reward You."

Unusually, Mrs Phiri is open about her HIV. She is rewarded by home visits from Montford - which are made on condition of openness - and his pitiful medical supplies, paracetamol for excruciating pain, vitamins to boost the immune system and rehydration salts. But she is shunned by her neighbours. When she is too sick to tend to her vital maize crop, no one will help. "My husband left when I became ill," she says flatly. "And this illness has made me lonely. The intimacy with my neighbours is gone."

Montford and the Logies go to the rear of a nearby hut. Blackson Phiri, 30, receiving his first home visit, is agitated and nervous, for he is not yet "out", though black cancerous lesions - Kaposi's Sarcoma, the mark of the virus, from San Francisco's gay bath houses to Ndebvu's mud huts - cover his face and peep from under his shirt.

Blackson agreed to be tested for HIV at St Francis - patients generally decline. But he refuses to inform his young wife, who watches from a corner, with a new baby on her back and a toddler on her knees. There is no need to test them, he insists, when they are so fat and healthy. His wife is at terrible risk but he will not discuss condoms, insisting, unconvincingly, that he no longer has sex.

The problem of the continuing stigma attached to Aids in Africa is compounded by campaigners' failure to make a real impact on sexual behaviour. Infidelity is expected of men, to whom women are raised to defer.

In the village of Galuwawo, the drums are sounding for a female initiation ceremony, for girls who have begun menstruation. Like many old women here, Magdelena Mwanza, 72, is spending her old age caring for grandchildren, orphaned by Aids. "I was Christianised when I was young and life was good," she says. "Now I wonder why a loving God allows us to suffer like this."

Yet Galuwawo's grannies are passing on the same old wisdom at initiation, telling girls to be submissive in marriage, which takes place at around age 15, but sometimes as early as 10, and never to deny husbands sex. Women obey even when their husband is HIV positive, or unfaithful, and refuse, as most do, to use condoms. That leaves Blackson's wife, and millions like her, highly vulnerable to the virus. Physiologically, women are already far more likely than men to be infected during sex.

"The greatest HIV risk factor for Third World women is marriage," says Sandy.

"What is happening here is criminal," says Dorothy.

Since her husband was infected, Dorothy, a Catholic, has split with her church, incensed at its opposition to condoms. Abstinence is the Church's fundamental message, though some African priests have even suggested condoms spread Aids. Even at St Francis, government condoms - erratically supplied - are usually only distributed to married couples. It makes quiet, sweet Dorothy furious. "I've written in such strong terms about this that I've almost excommunicated myself," she says. "It's OK for Cafeteria Catholics, who don't have to listen to everything priests say, but in Africa the church is hugely influential."

In spite of the new drugs, Sandy is still vulnerable to infection and has come to Zambia at considerable personal risk. But he cannot control the urge to help. He opens informal surgery at every village he visits, kneeling in the dust, feeling withered arms and swollen joints and asking questions about all-too-familiar symptoms.

At Chilambie, Laurence Phiri, 6ft tall and weighing six stones, tells Sandy that he has been vomiting blood for weeks. He would be dead already if it were not for "the old mama" sitting behind him in the dirt, among the hens and pigs. His wife has left, and he and his old mother have drifted gradually into isolation as, one by one, neighbours have deserted them, and the disease has taken control.

Sandy is particularly vulnerable to HIV-related tuberculosis, which is almost certainly what Laurence has. Nonetheless he examines him, taking the same calculated risk he did in 1993 when he was stabbed with the infected needle.

When asked how he feels, Laurence smiles. "I don't feel anything now," he says. "Because any time I know I am dying." Too poor to afford the charges St Francis has had to introduce to keep pace with inflation, Laurence visited the local witch doctor. "But it was no use," he says, somehow finding another smile. "Gradually you see you are not healed and they are taking all your money."

Sandy wants Laurence in St Francis's immediately. But all that is available is two days' worth of paracetamol and rehydration salts. Laurence must make his own way to the hospital later, assuming he is still alive.

THE SCALE of the dying here is matched only by Africa's capacity for denial. Shelagh Parkinson, 36, a British doctor who has slogged away at St Francis for two years now, takes Sandy on her rounds. More than 80 per cent of patients here have the virus - in 1993 only 40 per cent of Sandy's patients were positive - but the hospital, though the best for miles, must battle on with shortages of basic drugs and equipment.

In the Good Shepherd paediatric wing, babies lie in rows of Fifties metal cots, beneath jaunty painted cartoon characters who advise "Don't Worry Be Happy". Mothers are told they are too "anaemic" to donate blood to children when in fact they almost certainly have the virus. Generally their babies are already infected too.

A young man tries to walk in a straight line for the doctor but staggers like a drunk. Though his memory and speech are going he refuses to be tested. His wife says he is sick because he fell off his bicycle. She stands up revealing she is pregnant. "The baby is moving well," she says happily.

Meanwhile emaciated Hastings Namakondo is nursing his own fiction. He will die soon and Dr Parkinson believes he knows it, and knows why. But when asked what has made him sick he says it is a mystery. You want to weep when he adds, grinning: "But I am a little bit OK." The front may be for his wife and two young children - probably infected - and his haunted- eyed mother, who has travelled for days from the Copper Belt to see him.

In a land where paracetamol and rehydration salts are the main medicines, it is rational for people to refuse blood-tests and hide from the truth, and for the hospital not to press for more costly testing. There are no anti-Aids drugs on offer. In the Bethlehem delivery suite, HIV-infected mothers breastfeed, despite a 70 per cent chance of transferring the virus to their baby. There is no alternative. They are too poor to buy formula milk, or a $150 course of AZT, a drug which dramatically reduces the chances of transferring the virus rom mother to child.

For the Logies, poverty underpins the whole disaster. Our grandchildren, Dorothy believes, will look back to the time Aids raged across Africa as an era of shame. "I think the IMF and structural adjustment will be remembered like the concentration camps and slave trade," she says. What future generations of Africans will conclude can only be guessed at.

SANDY swallows 22 pills a day. But he does not believe they are the answer for Africa. Apart from cost - around pounds 8,000 a year - the drugs require frequent monitoring which Zambia's shattered health service could never provide. Without it, there is a very real risk that a new strain of HIV could develop. Also, the drugs must be taken with four meals a day. "What meals?" asks an African Aids patient in a popular cartoon. The answer for the Third World is prevention, Sandy argues, or an affordable vaccine. His own guilt is linked to the disproportionate share of the world's Aids budget spent on developing his drugs. "Of the people affected by Aids, 93 per cent live in the Third World and only 9 per cent of Aids money is spent on them," he says. "And of the money spent on research and development less than 10 per cent goes into researching a vaccine."

The Logies sincerely believe that everyone who visits the continent would be appalled by the misery of African Aids if they came out of their game lodges and just touched, smelled and felt it. "I will never be able to do what I intended with the rest of my life," says Sandy. "The trip rubs that in." But at least, he points out, he is alive. In Africa, meanwhile, the bodies just keep piling up. And Zambia, like many other nations, shows few signs of winning an obscenely unequal battle.

In a quiet, private moment, Montford Phiri asks about the new super drugs, unaware that Sandy is infected. The villagers he visits have never heard of the scientific breakthroughs in the west, but Montford has read about them. He has been HIV-positive, and healthy, for almost 10 years. "Perhaps you could get them and send them to me," he says. His earnestness is painful.

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