STEVE INSKEEP, host:
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Once you understand the scale of poverty in Africa, you're left asking why. Other parts of the world have made big strides in reducing poverty while the number of extremely poor people in sub-Saharan Africa has increased.
This week we've been hearing some of the reasons from Jason Beaubien. He's an NPR correspondent who recently finished four years in Africa. He's reported on Africa's wars, its bad governments and its trouble with farming. Now here's another factor as he continues his series this week: disease - malaria, cholera, polio, and HIV, the disease that is ravaging the country where Jason begins.
JASON BEAUBIEN: Swaziland is a tiny kingdom of just a million people squeezed between South Africa and Mozambique. It's also the country with the highest HIV rate in the world. At some prenatal clinics, more than half the women are HIV-positive. Nationwide about 33 percent of adults are infected with the virus.
Even before the AIDS pandemic, Swaziland was in the ranks of the world's least-developed countries. HIV has contributed to keeping it there. Take, for instance, 27-year-old Pindile Polatwana. She had to quit her job in a textile factory because she was having trouble breathing.
Ms. PINDILE POLATWANA (HIV Positive): I was sick. Then I just - and they say that I've got TB. Then later, they told me that I'm HIV positive.
BEAUBIEN: Polatwana moved back in with her mother in a cluster of ramshackle buildings in the dusty low veldt of southwest Swaziland. HIV, she says, has devastated her homestead. In the last five years her father passed away after a long illness, two of her siblings died of AIDS, and Pindile's become so sick she can no longer work.
Ms. POLATWANA: The disease is making me very poor because my fifth sister died and my second brother was working as a teacher, so he - now no one is working, so that's why we're become very poor.
BEAUBIEN: AIDS wipes out some of the most productive members of society, in the prime of their lives. Pindile's siblings who died were the most educated members of her family, and they both passed away at the age of 32. Pindile's family now relies on relief supplies from the World Food Program to survive.
The U.N. estimates two million Africans die each year of AIDS and 24 million people on the continent are infected with HIV. But HIV isn't the only health problem plaguing Africa. This is the landmass that spawned Ebola and the Marburg virus, sleeping sickness, river blindness, yellow fever, cholera, bilharzia, tick bite fever. Diseases unheard of in the developed world are all too common in Africa. Polio is making a comeback here after being on the verge of being wiped off the globe. And malaria alone kills almost a million African children each year.
(Soundbite of babies crying)
BEAUBIEN: In western Kenya, the Nyanza Hospital in Kisumu smells of pus and iodine disinfectant. The vast open wards are so overcrowded that two patients are squeezed into most of the single beds.
Dr. JAMES GESAMI (Chief Medical Officer, Nyanza Hospital, Kisumu, Africa): Forty percent of our morbidity is actually just malaria. And the malaria is number one killer disease in the region.
BEAUBIEN: Doctor James Gesami, the Chief Medical officer for the hospital, says the malaria problem in western Kenya has been getting worse in recent years.
Dr. GESAMI: These malaria parasites have developed a resistance to drugs. We are now actually seeing that the best way of managing this issue is to prevent it in terms of sleeping under mosquito nets, and also, you know, not getting mosquitoes from the environment, which is very difficult.
Mr. JON LIDEN (Global Fund to Fight AIDS, TB and Malaria): Geographically malaria is endemic in most of Africa.
BEAUBIEN: Jon Liden is with the Global Fund to Fight AIDS, TB and Malaria. Liden says malaria places a huge burden on Africa.
Mr. LIDEN: It reduces productivity severely. It takes resources away. It reduces school attendance because infants or children are ill. It kills off children, which, you know, then has all sorts of negative consequences. And it makes whole areas of Africa unsuitable for intensive foreign investment, for example.
BEAUBIEN: He adds the dilapidated African healthcare systems are unable to deal with the numerous medical problems facing the continent. Clinics are ill-equipped and underfunded. In the Congolese capital of Kinshasa, for instance, patients have to purchase all their own medical supplies before being admitted to the central hospital. The facility doesn't even provide bandages.
And the continent has a serious shortage of medical professionals. Liden points out that Malawi has only 130 doctors serving a country of 12 million people.
Mr. LIDEN: What do you do with 130 doctors? How can you actually develop - how can you fight one of the most complicated and difficult epidemics of the world, AIDS, when you have 130 doctors who are supposed to do both administration of the health services of the country and try to go out there and actually treat people? It's incredibly difficult.
BEAUBIEN: He argues that Africa needs a huge influx of foreign aid to build up effective healthcare programs.
Mr. LIDEN: There are countries that spend 10, 12, $15 per capita per year on health. You can't buy anything for that, a couple of dressings, a few medicines. I mean there - you cannot run a health system at that level of funding.
BEAUBIEN: The global fund was launched in 2002 to provide billions of additional dollars to fight AIDS, TB and malaria in Africa and the rest of the developing world. Liden and others acknowledge, however, that the battle against these three diseases still has a long way to go.
Disease is part of the poverty trap in Africa. People get sick because they're poor, and they get poorer because they're sick. For instance, a man can't afford healthcare. His condition worsens until he can't work, and soon his entire family is malnourished as a result of his illness. Or even worse, the primary breadwinners of a family could die.
Back in Swaziland, 66-year-old Choate Maseko(ph) says in the last couple of years, HIV has surrounded him.
Mr. CHOATE MASEKO (Swaziland): Here we have got a serious disease. Everybody calls the diseases HIV and AIDS. But here, it's my - I think it's my first time I see this serious disease (unintelligible) HIV and AIDS.
BEAUBIEN: Maseko just came home from helping prepare funerals for three of his neighbors who died of AIDS. He points to a shack and an adjoining plot and says that the woman there just lost her husband to the disease.
Maseko and his wife live in a simple three room house without electricity or indoor plumbing. Over the last four years, the couple lost three of their adult daughters to AIDS and they now look after eight orphaned grandchildren.
Mr. MASEKO: (Speaking foreign language)
BEAUBIEN: Switching to speaking his native SiSwati, Maseko says he never expected that at the age of 66 he'd be raising eight young children. The youngest of the orphans is three-year-old Pastile(ph).
Maseko lost a leg years ago in an accident at a sugar plantation where he used to work. Now in his old age he tries to grow food to feed his vastly expanded family, but he says his fields can't produce enough to last the entire year.
His wife, Josephine, opens the door to a room where six of the eight children sleep. There are two beds. Three children sleep per bed. Maseko says other members of the family don't want to get involved with the orphans because they're afraid they'll get stuck with them when he and Josephine pass away. And when that happens, Maseko says, he doesn't know where the kids will go.
Mr. MASEKO: (Speaking foreign language)
BEAUBIEN: We are so worried, he says, and it is our prayer to God that we live long enough to see these children grow up, so they're able to help themselves.
Thus the disease in one generation of this family ends up affecting two others. And the effects of HIV on the Masekos, from 66-year-old Choate, all the way down to three-year-old Pastile, make it harder for a family, a community and a country to move forward.
Jason Beaubien, NPR News.
INSKEEP: Jason's series continues tomorrow with a report on agricultural subsidies and the way they undermine African farmers.
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