I was unusually apprehensive as I boarded the plane to Kenya and Egypt in late July. I was to spend one week in Kenya on an AIDS project and one week in Egypt to see the temples of Luxor with my wife. I was particularly concerned about AIDS exposure to our research team in Kenya and political terrorism in Egypt.
I've traveled and worked in Kenya many times, but not since the AIDS epidemic, and I'd never been to Egypt. We had been told that tourism there was nearly nonexistent since the terrorist attack that killed 58 tourists in Luxor in November 1997. Thus, it was darkly ironic that I was in Luxor when I heard about the attack on the U.S. embassy in Kenya, just three days after I left Nairobi. The most dramatic thing that happened in Luxor was that the hotel electricity failed for one hour.
As I watched the rescue effort on CNN, the medical terror of Africa loomed large in my mind, since I had just spent a week studying the AIDS epidemic in Kenya. The high risk of AIDS exposure to the Kenyan medical caregivers principally results from the fact that about 25 percent of the young adult population of Nairobi is infected with HIV and that any contact with blood and other secretions to the broken skin, the eye or through an inadvertent needle stick can led to a fatal HIV infection. This risk is particularly high in the emergency room when one is dealing with severely injured, bleeding patients.
In our AIDS project in remote villages in West Kenya, we minimize this exposure by using an experimental way to test for AIDS, a rapid saliva test. Our results so far indicate that it is an accurate, readily performed and accepted test with minimal risk to health care personnel. We also found that more than 20 percent of the young adults in these villages are HIV positive, although nearly all are asymptomatic and had been unaware of their infection.
During my stay in Kenya, I met a young American surgeon who was going to a rural mission hospital in West Kenya to perform complex head and neck surgery as a volunteer. We discussed the precautions he was going to use to prevent HIV exposure during surgery. He had brought sufficient surgical gloves to use two pairs of gloves (double gloving) on every case, eye goggles and face shields, a personal supply of AZT and two other anti-AIDS drugs that he could take immediately upon accidental exposure (and which are unavailable in Kenya) and an insurance policy that would pay him to fly to a European hospital in case of a medical problem necessitating a blood transfusion.
Reflecting on all the protections for this one individual, I found it almost inconceivable to imagine the complexity of coping with 5,000 injured, bleeding patients after the embassy bombing. Even Johns Hopkins Hospital or UCLA Medical Center would be hard-pressed to handle such a catastrophe, even without the specter of AIDS. The Nairobi Hospital, where many of the first victims were taken, is a small, private, well-equipped hospital for wealthy Kenyans and tourists, but the other Nairobi hospitals are chronically short of supplies and medicines, lack high-tech equipment such as CAT scans and respirators, and have no blood bank to rapidly provide HIV-negative blood.
The television image of the heroic Kenyan doctors and nurses who were providing emergency care to the bleeding patients, many of whom were not wearing gloves, sent shivers down my spine. It was a grim reminder of the great difficulties that Kenya and other African countries have in coping with this epidemic without readily available HIV testing, a safe blood supply, anti-viral drugs, and well-equipped hospitals and clinics. Sadly, the AIDS epidemic will claim many more lives than the bombing, and will surely include some of the exposed health-care workers.
The only end to the AIDS terrorism is a preventive vaccine, and that is a distant promise. A vaccine would be America's best contribution to African prosperity and stability. Its cost, though, will far exceed that of the rebuilding the American Embassy.
Dr. E. Richard Stiehm is a professor and chief of pediatric immunology at the UCLA Medical Center in Los Angeles.
Pub Date: 8/24/98