Dr. Serena Koenig on HIV in Haiti

Dr. Serena Koenig starts her talk with a quote from Martin Luther King: “Of all the forms of inequality, injustice in health care is the most injust and inhumane…”

She works in Haiti on a project called Partners in Health, which tries to address this injustice and inhumanity. She notes that Bill and Melinda Gates have said “we cannot turn our backs” on the millions of people who have AIDS. She points out that there are other diseases killing people in the developing world, like malnutrition, malaria and TB – all preventable diseases that are claiming millions of lives.

She tells us the story of Coralie Roger, an only child living with her mother in Haiti. In late august, she showed up at a hospital with pneumonia and severe anemia. She was diagnosed with acute myoblastic leukemia. There’s no treatment for the disease in Haiti. Coralie’s mother ended up putting an ad in Haiti’s newspaper, asking for help. Her aunt, in Canada, called a hospital and was told not to come in unless she had $100,000.

Koenig met Coralie and her mother and intervened, asking her colleages at Mass General to put the case in from of their Free Care committee. The committee approved, managed to wrangle a visa for Coralie and her mother, and the girl is now in treatment in Boston, with every chance of surviving.

She asks, “Is this really cost effective? Is this how you should spend your time?” She points out that Partners in Health treating 1.5 million patients in Haiti, and has only sent ten to the United States. But the ability to send the most critical cases to the US “brings dignity to a very dark place.”

Partners in Health has been working on fighting HIV and TB in Haiti since shortly after the virus was discovered. By treating TB by feeding patients and giving them transport vouchers to get to the clinic, they’ve had an almost 100% success rate. They’ve gone after HIV and TB using the same techniques as have been used in the US, attacking multiply drug resistant TB with off patent medicines.

The struggle Koenig faces is that most public health and pharma people believe that some death is going to be unavoidable in very poor nations. She disagrees, and argues that by using the treatments we know how to use, even places like Haiti can have AIDS survival rates comparable to those in the US. By leveraging funding from the Global Fund, “we’ve now got universal treatment for HIV/AIDS both in rural Haiti and Port au Prince.” They leverage AIDS treatment as a way to address any medical problems a patient comes in with. She ends with an amazing set of photos: emaciated patients who recover from TB and HIV over the course of six months, turning from near skeletons to healthy people.

She gets a long, long round of applause when she sits down…