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What's involved in introducing first-world medicine into a third-world, developing country?
In rural Haiti, Dr. Joia Mukherjee, along with colleagues Drs. Paul Farmer and Fernet Leandre, has established the HIV Equity Initiative to treat patients with HIV infection using highly active antiretroviral therapy. This program was the first of its kind in a developing country and is helping to change the global medical establishment's views about what can be achieved clinically and socially in remote and impoverished settings. Indeed, the HIV Equity Initiative has become a model for the Millennium Development Goals, the World Health Organization's 3 by 5 Initiative, and the Global Fund to Fight AIDS, TB and Malaria.
Dr. Mukherjee's experience with the HIV Equity Initiative is not simply medical in nature – learning to work in Haiti, to be in Haiti, has changed her. Here's how she has characterized her entry into a world removed by more than miles from her academic home in Boston:
Arrived in Haiti under the full moon – which revealed that we have now entered the dry season; faces, leaves, and shacks are white with the dust stirred into the air by ancient and overloaded trucks trudging up and down the mountains bearing ... coal ... the end product of the deforestation of the country side. Stacked with abandon, the coal is commingled with a few goats, hapless chickens hung by their feet, and, of course, legions of people precariously balancing – with grace even – as the erosion of the 200-year-old dirt road goes on unchecked underneath bald tires, crooked axles, and bent frames … and the thousands of feet … feet too poor for the truck fare … the route to market … or hope, or the city, or a better life ... the distance between selling a sack of coal and starvation made on vehicles discarded on the junk yard of Haiti by the Americans or the French as too old, unfit, unsafe for their smooth, cool pavement and the precious cargo ... I could talk about the road and its metaphors for a lifetime. You can see into the past and future by the shape of this road ... the neglect, the poverty, the despair, the precarious nature of life and death, and the risks that cannot be avoided by the poor … and here we begin to treat HIV…
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