CRISIS - NO AIDS DRUGS!!

Today I saw 6-year-old Anita, who has been my patient since birth. She was one of the first children started on ARV's (antiretroviral drugs) in our clinic, and responded wonderfully. Her CD4 counts are excellent, her mother caring and faithful. She does not miss appointments or forget to take medicines. She is exactly who USAID, EGPAF, Uganda MOH, JCRC, Baylor, etc. etc. labor to save, and infant who would likely have died by now but instead turned into a growing normal-looking girl. And up until today, she represented the way things are supposed to work. But today, there was not ONE SINGLE antiretroviral pill in our clinic, or in any other clinic in the district. We've watched the supply dwindle. We've made reports, follow-up phone calls. We've switched regimens to economize and use every possible pill. We've been told to ration, to not start any new patients on drugs, to be patient ourselves, to hang on because the supplies are coming. But they never did. The margin has long been tenuous, but the shocking truth is that today dozens of clients left the hospital without medicine. By next week half of the hundreds of people on ARV's in Bundibugyo will be off therapy. And even more shocking: a phone call to Kampala confirmed that this is a nation-wide stock-out of drugs. What happens in the world if one of the countries with the highest number of AIDS patients, one of the places were the epidemic began and gathered momentum, suddenly takes thousands and thousands of patients off meds? In the short term, some people who were barely surviving, early on therapy, will die. In the long run, it sounds like the perfect scenario for a drug-resistance nightmare. I sat outside our clinic in the hot sunshine after my phone calls, crying. Crying for Anita, for injustice, for the inefficiency and poverty and poor management that led us to this point, crying for my own frustration of impotence to do anything about it (these drugs are tightly controlled and not available to just run out to the store and buy). So at least I will give voice to the Anitas of Uganda.