20 years later, AIDS battle in Africa turns toward the spiritual

MBARARA, Uganda — The emaciated woman lies on a wafer-thin foam mattress, jammed in the corner. Her only pillow is a pile of rags stuffed under her head.

As visitors enter the room, her sister gently covers the woman’s shrunken ankles. The woman reaches her toothpick-like arms out in greeting, then brushes away the flies swarming around her mouth. She cannot lie still—even morphine cannot dull her pain.

The volunteer missionary says a quick prayer under her breath, asking God to ease the pain. This isn’t the first time she has seen someone in the last stages of HIV/AIDS. Although it’s been nearly 20 years since the missionary and her husband saw their first case, not much has changed on the surface. People are still dying—and no one mentions the cause of death.

Rick and Susan Goodgame served as International Mission Board missionaries in Uganda during the 1980s—when HIV/AIDS first appeared. The missionary doctor was among the first to study the mysterious disease from an African clinic. Recently the Texas couple jumped at an opportunity to return to Uganda for six months, filling in for a missionary physician and his family who were going on stateside assignment.

“I remember when we first started seeing this new disease around 1981. It involved profound diarrhea, weight loss and a skin rash,” Rick Goodgame said. “I presented a series of these cases at a conference and asked what it was. People concluded it was severe tuberculosis, pancreatic insufficiency, cancer and malaria.”

By 1982, Rick became suspicious that this strange disease might be the same AIDS talked about in San Francisco and New York.

“The ‘gay’ thing threw us off until some cases were confirmed in Haiti,” he said. “By 1984, we knew what we were dealing with.”

Changing stigma
In the ‘80s no one talked about AIDS or even knew how it was contracted, the Goodgames said. Most thought it was a curse and the best way to combat it was through a variety of cures offered by witch doctors. Rick recounts how most people were angry with him for telling his patients they were HIV- positive.

“Now, the stigma of HIV is not as bad, but it’s still there and oppressive,” he said. “When we started our Bible-based AIDS education effort years ago, there was a lot of ignorance. Now, education has maxed out—people know how HIV is spread and how to prevent it—yet it keeps spreading.

“It’s now a spiritual battle: How can I control my sexual behavior?”

On the mission field, the Baptist missionary doctors approach HIV/AIDS with a holistic view, Susan said. The treatment at the clinic ministers to physical, emotional, social and spiritual needs. After patients are seen by the doctors, most are visited in their homes by a team of counselors. These counselors help tell other family members about the test results and answer questions related to living with HIV. They also present the gospel and pray for patients.

“Ugandans are definitely more educated about this disease, but they are still inundated with illness, death and dying. It’s everywhere,” Susan said. “This state of affairs does tend to make some people more open to getting right with God ....”

One of the big differences between the 1980s and 2005 is the availability of drugs to treat HIV/AIDS. When Rick began working with HIV patients, there were no medicines that had been proven effective. Now, not only can medicine prolong life, but the drugs are available at a reduced rate or free for many in the developing world who are in the later stages of HIV.

“The option of antiretrovirals has changed everything,” Rick said. “People can live longer, healthy lives. Now that these drugs are free for some through the global fund and U.S. money, more will get the benefit.”

Effective medication
The effectiveness of these drugs, costing between $20 and $80 a month, is dramatic—especially in a developing country where most cannot afford the treatment.

“It is amazing to see the people I started on therapy just four weeks ago,” Rick said. “They start eating and gain weight, and even the skin begins to clear up from itching and sores. It is so thrilling to be able to start people on free antiretrovirals or to tell people who have spent their last shilling and have resigned themselves to die that the free medicine has finally come.”

For some, however, the medicine arrives too late. The Goodgames say some are unbelievably sick and there is a point where they have to decide to admit them to the hospital or simply pray for comfort.

“Lord, have mercy on this household,” Susan prays as she takes the limp hand of the woman lying on the mattress and says goodbye.

As the missionary leaves the small, mud home, she glances back at the sister caring for the woman. She also is one of their patients. Susan wonders who will take care of the sister when she develops AIDS.

She also wonders if, 20 years from now, people will still be dying from AIDS.

Published, March 2005

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