The Chris Hani Baragwanath Hospital is in Soweto, a township in Johannesburg where Nelson Mandela once lived. It is the largest acute care hospital in the Southern Hemisphere, with over 3000 beds serving over 3 million Africans.
While it is not possible for an observer like me to understand the struggles of this understaffed public hospital, I was told that there were many bright spots of medical care. Dr. Neil Martinson, Director of the Perinatal HIV Research Unit, showed me one of them – a floor where clinical trials were being conducted. There were TB patients being counseled, nurses and other clinical research associates handling the documentation, and a small pharmacy buzzing with a dozen pharmacists preparing for over 17 simultaneous trials. The medical staff here was proud of the fact that the infrastructure and level of care are nearly on par with those of European and U.S. clinical trial sites.
But Dr. Martinson said that there were few clinical trials for TB patients with HIV. There were numerous reasons for this, including the fact that such co-infected patients have a high mortality rate which would generate onerous reporting tasks. Yet, it is precisely these patients who need novel drug therapies and are most willing to participate in clinical trials. Tens of thousands co-infected with TB and HIV die every year in South Africa, with many more in other developing nations worldwide.
I would like to end this brief week note with observations about the researchers I have met here in Johannesburg. What I have seen, time and time again, are people who believe in the future, even with the complex hardships and difficulties that this country and the rest of the continent faces. And, there is more than belief and hope here – there is the drive to find creative solutions to problems that seem unsolvable. My wish is that our project can provide the ideas that the people here can use to enable new systems of clinical trials for the patients who need them most.