MELISSA BLOCK, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.
Today we begin a series of special reports on global health. We focus on AIDS in the developing world. One of the key developments came four years ago when wealthy nations established a major fund to help fight AIDS, malaria and tuberculosis. The funds was seen as a necessary and moral step to provide life-saving drugs to people who can't afford them. It turns out this humanitarian response may have some unexpected benefits. Our focus today is on the West African country of Ghana, which was the first to receive a grant from the Global Fund. NPR's Richard Harris reports.
RICHARD HARRIS reporting:
When Ghana applied to the Global Fund for its first AIDS grant, its ambition was simple. The disease had not overrun the country, as it has others in Africa, and health officials were determined to keep it that way. About 3 percent of the population is infected. At the time, nobody expected that the Global Fund would also stimulate new business in Ghana, but it has.
(Soundbite of ambient noise in factory)
HARRIS: What appears from the front to be a drugstore in an industrial section of the sprawling capital of Accra is actually the facade of a brand-new three-story pharmaceutical factory.
Mr. YAW ADU GYAMFI (Dan Adams Pharmaceuticals): We started construction on August 6th, 2004, and we spent about nine months to put it up.
HARRIS: Yaw Adu Gyamfi realized that there's a growing market for AIDS drugs and, with the Global Fund, a pile of money to buy them with. He found a Chinese drug company to bankroll and build a factory. Gyamfi heads this new enterprise, Dan Adams Pharmaceuticals, which the president of Ghana personally inaugurated in June. Gyamfi happily takes us on a tour of the new white-and-green building behind his pharmacy.
Mr. GYAMFI: This is where we are going to change and go into the factory.
HARRIS: We slip on protective clothing, put plastic booties on our feet in a changing room and then step through another doorway.
Mr. GYAMFI: This is the washing place. The water comes. You wash your hands.
HARRIS: We walk down a long hallway lined with doors. The first one opens to a receiving room for the active ingredients and additives, all shipped here from China. Gyamfi takes us room by room through the plant. Each room has a gleaming piece of equipment in it labeled in Chinese and tended by Chinese and African technicians.
(Soundbite of machinery in use)
HARRIS: Today round, white tablets are spilling out the end of this production line.
Mr. GYAMFI: What they are doing here is that the powder is put in here after they put all the powder together. Then when they put it in here the machine is actually producing the tablets, and this can produce about 200 to 300,000 tablets an hour.
Unidentified Man: Wow.
HARRIS: Today the line is producing antibiotics, but Gyamfi's ambition is much greater.
Mr. GYAMFI: We looked into the pharmaceutical industry in Ghana and we saw that basically people were just making vitamins and all other things. But the two main endemic illnesses in Ghana were not being tackled, and that is the AIDS epidemic and malaria. So we said, `OK, then we will look into those two areas and produce drugs to combat these diseases.'
HARRIS: His AIDS drugs are not yet for sale but, thanks to the Global Fund, Ghana and its neighbors now have the money to buy them. Dan Adams Pharmaceuticals is planning to produce generic versions of seven drugs that form the backbone of AIDS treatment. The company has plenty of room to expand and ambitions to provide these AIDS drugs to countries throughout Africa. Gyamfi says his enterprise is good for Ghana's economy and good for its people.
Mr. GYAMFI: Apart from just business goals of making profits, what is our social responsibility to meet the needs of our people? And with these two areas that we are focusing on, malaria and HIV, I think we have a long way to go and we are very confident that we will arrive there.
HARRIS: As we shall see in a few minutes, success is not quite as simple as it sounds, but there's no question that there is a compelling need for these drugs in Ghana. They are saving lives and changing the course of the AIDS epidemic here.
(Soundbite of street sounds)
HARRIS: Just a few miles down the road from the factory, a rutted dirt alley dead-ends at a house surrounded by a white wall. The sign calls this place Pro-Link, but everyone around here just calls it `AIDS house.' Bernice Haloo(ph) is simply Mamee(ph) to the people who gather here for social support.
Ms. BERNICE HALOO (Pro-Link): They are coming, trickling in. By 10:00 we'll have a full house.
Unidentified Woman #1: Hello.
Ms. HALOO: (Foreign language spoken)
HARRIS: Thank you. Good morning.
Unidentified Woman #2: Good morning.
Ms. HALOO: We are just living a normal life over here.
HARRIS: One woman in this association of people with AIDS sets up a Coca-Cola stand to sell to anyone who wanders down the lane. Some days the women make batik cloth. Today they are stringing tiny beads making lapel ribbons. The yellow ones memorialize orphans. Daniel Wooleta(ph) is making a red one for AIDS. He was a tailor until AIDS made him too weak to work. Daniel, like others here, is taking the new AIDS drugs. He says they have brought him back from the brink.
Mr. DANIEL WOOLETA (AIDS Victim): Oh, before I can't eat too well. And then I can't walk around ...(unintelligible) because I am too tired and weak. That's right. Since I started about three months ago, everything changed. I can eat again.
HARRIS: He pays about $6 a month for the medicine, which the Ghanaian government purchases and distributes using Global Fund money. But even that price is a stretch in a country where many people earn less than a dollar a day. Daniel says his wife ran out of money to keep buying the anti-retroviral drugs, or ARVs.
Mr. WOOLETA: She lost her mother. That's why she stopped the ARV.
HARRIS: Why? Why would she stop taking the drugs because she lost her mother?
Mr. WOOLETA: OK, the family would step in here to buy a coffin to bury their mother and so forth, and she don't have money. So she stopped taking it.
HARRIS: How do you feel about that?
Mr. WOOLETA: I feel very, very bad about that. I'm not happy with that.
HARRIS: How's her health since she stopped taking the drugs?
Mr. WOOLETA: Now she has been getting weak. And it's about a year now she stopped the drugs.
HARRIS: Thus far, Ghana has put about 3,000 people on these life-saving medications. The challenge in the next few years will be to provide these drugs and associated medical care to another 25 or 30,000 people who would otherwise die of AIDS. And, as it is, the demand for these drugs is straining the system.
Unidentified Woman #3: (Foreign language spoken)
Unidentified Woman #4: (Foreign language spoken)
HARRIS: The pharmacy at Saint Martin's Hospital, an hour outside of Accra, is just one of five in the country that's currently dispensing AIDS drugs. On this morning, the benches in this open-air waiting room are filled with dozens of people dressed in colorful batiks. A large crucifix adorns the wall just outside the exam room door.
Unidentified Woman #5: (Foreign language spoken)
Dr. HENRY NIGAI(ph) (Family Health International): (Foreign language spoken)
Unidentified Woman #5: (Foreign language spoken)
Dr. NIGAI: (Foreign language spoken)
HARRIS: Henry Nigai of Family Health International sees patients one right after another. He's the lone doctor at this AIDS clinic.
Dr. NIGAI: (Foreign language spoken)
HARRIS: Treating AIDS is not simply a matter of passing out drugs. Everyone needs individual medical attention, and Dr. Nigai says treatment does more than help individuals. It's helping to stem the epidemic.
Dr. NIGAI: The fact that people know there is treatment, that is anti-viral drugs are available, have more or less made people to be open about their condition.
HARRIS: Now that drugs are available, people step up to get tested for HIV, and people who are infected can then take extra care not to spread the virus. But the program hasn't been entirely trouble-free. At the moment, Nigai has run out of one AIDS drug; another is in short supply. And he says bigger challenges loom as Ghana attempts to scale up its program to dozens of sites around the country. The country simply needs more medical personnel who can manage patients on these drugs.
Dr. NIGAI: The workload is becoming overwhelming because I come in the morning, for example, and I have to see almost a hundred clients before I close. Look at the numbers that are being recorded every day. I'm afraid the human resource problem will worsen with time.
HARRIS: Even so, Nigai knows many more people would benefit from these drugs so he is actively promoting them even as his workload grows. A local musical group called the Queen Mothers Association even composed a song about the benefits of AIDS drugs. It's the theme for a radio show about the disease.
(Soundbite of song)
QUEEN MOTHERS ASSOCIATION: (Singing in foreign language)
HARRIS: Radio shows, billboards and news reports build demand for AIDS drugs, so Ghana now needs to expand its program to the entire country. That means strengthening the medical infrastructure everywhere.
Professor FRED CY(ph): (Foreign language spoken)
HARRIS: Professor Fred Cy is a senior statesman of public health in Africa. We settle into chairs in his tranquil garden in Accra. Cy says the Global Fund can play a critical role in Ghana, not just for its AIDS funding but for its broader ripple effects on society.
Prof. CY: Can it really make that big a difference? It can make that big a difference because a ripple would be to strengthen the health services generally. That, to me, is the biggest, biggest ripple. And if you free the health service economically so it can develop itself and provide better service all around to the people, that is a major, major input into health care development in this country.
HARRIS: Good health is an end in itself, but it's also necessary for a healthy economy, and that brings us back to the topic of the new pharmaceuticals factory in Ghana. Fred Cy sees the appeal in locally produced drugs for local people. In the long run, stimulating economic activity is what Ghana needs to bring the country out of poverty. The Global Fund wasn't designed to do this, but it may end up playing a role by creating this vast new market for anti-AIDS drugs.
Prof. CY: It would be good, but they must ensure quality control so that the product exiting our factories are products that can be depended upon.
HARRIS: Bad drugs could be worse than no drug at all. They could help the AIDS virus mutate to become resistant to treatment.
Back at the Dan Adams drug company, Chief Executive Officer Yaw Adu Gyamfi is still working to prove that his drugs are just as good as anybody else's. They have to pass a strict test. Ghana cannot use Global Fund moneys to purchase Gyamfi's drugs unless they have been reviewed and prequalified by the World Health Organization. That is a long and demanding process.
Mr. GYAMFI: We have written a letter of interest that we want to be inspected for prequalification. So once all the checklist is done, then I think we are ready.
HARRIS: So far just about the only AIDS drugs that have passed that test come from the United States, Europe and big drug companies in India. It's a tough club to join. So much of the Global Fund money used to buy AIDS medicines simply flows back into the rich donor countries, into the coffers of GlaxoSmithKline, Bristol-Myers Squibb and other drug companies. Gyamfi would like to change that with cheaper drugs that also leave some of the profits in Africa.
Mr. GYAMFI: Americans made what America is. Ghanaians have to make what Ghana to be. Africans have to develop what Africa can be. So we need to look into the future, like our mission is, we look into the pharmaceutical industry and we see that there's a need and we want to fulfill that need. Africa is a gold mine. You just need to know what you want to do. We will get there.
HARRIS: His dreams still depend, though, on money from the Global Fund. Ghana has just received the promise of another $97 million to expand its AIDS program, but that money won't flow until the fund has cash and, as of now, the Global Fund is underfunded by $300 million. Richard Harris, NPR News.
BLOCK: Other stories from our series on global health are at npr.org.
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