Daniel Baxter - One Life at a Time: An American Doctors Memoir of AIDS in Botswana

Copyright 2018 by Daniel Baxter

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Library of Congress Cataloging-in-Publication Data is available on file.

Cover design by Russell Stark

Author photo by Bertrand Toulouse

Print ISBN: 978-1-5107-3576-7

Ebook ISBN: 978-1-5107-3577-4

Printed in the United States of America

To Eleanor, John, Daniel, Jack, and my many patients, students, and colleagues in Botswana

Contents

Acknowledgments

T his book has many authors: my friends and colleagues in Botswana, my many KITSO students, the medical students and residents at Princess Marina Hospital, and, above all, the countless patients I had the privilege of caring for during my eight-and-a-half years in Botswana. I am also indebted to the people and government of Botswana, the University of Pennsylvania, and the African Comprehensive HIV/AIDS Partnerships for allowing me the opportunity to work with the countrys HIV/AIDS Treatment Programme, the first in Africa and salvation for over 100,000 people with HIV/AIDS.

Andrea Nattrass of Pan Macmillan South Africa had the courage and foresight to take on my book, and to shepherd it through the publishing process. Andrea cares deeply about how AIDS has affected not just her native South Africa, but also the entire continent. I am also indebted to Russell Martin for editing and polishing my book for publication in sub-Saharan Africa. My gratitude to them knows no bounds.

Skyhorse Publishing likewise recognized the importance of my book and accepted it for release in North America. Tony Lyons, Andrew Geller, and Mark Gompertz have provided invaluable help in guiding it through the publishing process in New York.

I am also very grateful for the efforts of my agent, Andrew Stuart, the unstinting support of Bob Weil, the staff at the Ryan Community Health Center, and the unconditional love of my wonderful family.

Preface

T he evening before I left New York City for Botswana in 2002, my friend Bob invited me to dinner with two acquaintances of his, a famous cardiothoracic surgeon and his wife, a well-known literary agent. They were the quintessential New York power couple, and the restaurant, Cipriani, was well suited to their cosmopolitan tastes. The surgeon was interested in my decision to move to Botswana, to help its recently launched HIV/AIDS Treatment Programme. He wanted to know why I was doing it, why I was leaving a high-profile job as medical director of a large community health center. Unlike most other people when they learned about my plans, he didnt gush and exclaim how wonderful I was to do such a thing. Rather, he seemed perplexed, even disturbed at my plans. Although I had always wanted to work in a developing country, I suddenly found myself tongue-tied, unable to articulate my motivations clearly. I was annoyed with his questioning what I thought was the fundamental goodness of helping people less advantaged than myself. Flustered, I yammered on about how people in Botswana had the same hopes and fears about suffering as we Americans had, and how I wanted to experience for myself the universality of such feelings. Without the slightest trace of superiorityhe sounded measured and thoughtfulthe surgeon replied, Im not so sure about that. Uncomfortable at my inability to state my motivations for moving to Botswana, I changed the subject.

Although I was unaware of it at the time, my glib answer and the surgeons skeptical reply perfectly framed the illusions that would come crashing down soon after my arrival in Botswana. Only many years later did I fully understand my dinner companions wisdom in challenging the reason I gave for going to Botswana.

This book is an account of my own journey through one of the great human struggles of the early twenty-first century: AIDS in Africa. I had gone to Botswana thinking I had nothing substantial to learn, especially about myself. But soon after I arrived with all of my seemingly goodand often misguidedintentions, Africa punctured my arrogance, exposing my inadequacy and selfishness. But Africas time and space eventually gave me solace, and allowed me to soldier on, transforming my naive altruism into something more honest and substantial.

In the stories that follow, the patients names have been changed, and to preserve confidentiality further, various details and other names have sometimes been altered. Nonetheless, the pages that follow faithfully capture the life-changing experiences of my sojourn with fellow sufferers in Botswana.

Prologue

L ong considered a tourist destination for watching wild animals, Botswana has always been a place most Americans have heard about but few can pinpoint on a map. Indeed, when I was first contacted about a job there in 2002, I had to pretend I knew where it was, before quickly searching for it online. The first internet entry I found explained why Botswana had always been so easy to overlook: its the size of France, landlocked, and mostly desertthe Kalahari comprises 70 percent of itand its one of the most sparsely populated countries in the world. Its 1.6 million people are a million less than the population of Brooklyn. Initially, the article was at best routine, and reminded me of my soporific eighth-grade geography class in Ohio so many years ago. Routine, that is, until the very end, where a brief paragraph mentioned the AIDS epidemic unfolding there: no less than 24 percent of Botswanas people were reported to be infected already with HIV, then the highest rate in the world after Swaziland, a smaller country to the south. Life expectancy was projected to plunge by twenty to thirty years by mid-decade. I already knew that all of sub-Saharan Africa was in the crosshairs of the HIV epidemic, but as an AIDS doctor in New York City, I should have known these sobering statistics without the help of Wikipedia. Being slightly hermetic, an African version of Switzerland, somehow hadnt spared Botswana from the plague.