Watchung-Warren Rotary Club

How I got involved with the Clinica Familia MIR in the Dominican Republic

A Nun, a Doctor, and a World of Need

The International Family AIDS Program is an extension of work that started in Harlem 20 years ago.  For me, the moral equation changed when I realized that pediatric AIDS was disappearing not just in Harlem but in the United States.  Most people are surprised to learn that Pediatric AIDS, the leading cause of childhood death in Harlem a decade ago, is becoming rare.

The efforts of my career since the mid-1980 have singularly focused on children with HIV in New York City. In the early 1990's, 30 to 40 new HIV-infected babies were born at Harlem Hospital every year; however, only 1 new infected baby has been born here in the past 3 years. Most of the patients I cared for as babies are now teenagers.

How is this possible? The unimaginable has become a reality because AIDS drugs (1) greatly reduce the chances that a pregnant woman with HIV will transmit the virus to her baby and (2) prevent HIV-infected children from getting sick, allowing survival into adulthood and hopefully old age.

For me, the moral equation changed when I realized that pediatric AIDS was disappearing not just in Harlem but in the United States. With a world filled with HIV/AIDS, I felt for the first time obligated to look beyond our shores for ways to be of assistance. But where?

My friend, David Pincus, saw the answer. I had worked for years to build hospital-universitychurch-philanthropy alliances and had worked in Washington Heights with a mostly-Dominican staff. One day over lunch, he said to me, "The next logical step for your efforts is to build a program in the Dominican Republic." It was not an idea that had occurred to me. But it was a moment of epiphany. A few months later, I made my first trip to La Romana, a town in the southeast of the Dominican Republic.

There, I met Sister Juana María Alcantúd, a short, lively, and charismatic Spanish nun who had dedicated her life to ministering to sex workers and now found herself caring for over 200 HIV-infected prostitutes.

"Can I speak to you alone?" she asked.

I smiled inwardly. Years earlier, I had begun to work with seven short, ancient and gifted Irish Catholic nuns to create Incarnation Children's Center, a residence for AIDS in New York. In the interim, I learned that when the mother superior wants to meet with you alone, you're either in trouble or about to agree to do something you don't really want to do.

Juana María proceeded to tell me about Ingrid, a devout woman whose husband, a lawyer, left her with HIV, hepatitis B, syphilis, and pregnant before he died from AIDS. She was refused care by the local hospital because of her HIV disease; she then came to the nuns, knowing they provided care for HIV-infected individuals. The nuns had gotten funds from the Knights of Malta to help care for AIDS patients. Juana María wanted Ingrid to have the best medical care possible, short of sending her to the United States, in hopes that her baby wouldn't become infected.

In this picture, I am together with Ingrid and Esmerelda, now 4, at Complejo Micaeliano in La Romana, Dominican Republic, 2004.

With reluctance- because I knew it would be expensive in a setting with so few resources, but in accordance with Juana María's wishes- I laid out the "golden Cadillac" regimen to prevent mother-to-baby HIV transmission, with prenatal care, oral AZT for two trimesters, intravenous AZT during labor and delivery, a Cesarean section, formula and AZT for the baby, and close newborn follow-up. After Ingrid received this regimen, her baby, Esmerelda, was born uninfected.

That was the beginning, nearly 10 years ago. A high standard for care had been established, not by a committee analyzing cost effectiveness, but by a compassionate nun wanting the best for a woman in need. And thanks to the generous support of a handful of friends, we have been able to maintain and expand that standard of care.

Today, over 250 HIV-infected women have received the same high-quality care, and we currently support care for over 1500 HIV-infected men, women and children. We started Clinica Familia MIR, one of the first family AIDS programs in the Dominican Republic, which was modeled on Harlem Hospital's Family Care Center, founded and directed by my colleague and friend, Dr. Elaine Abrams.

We are playing a central role in training pediatric AIDS teams throughout the D.R. as AIDS drugs are introduced, not just to prevent mother-to-baby HIV transmission but for the lifelong treatment of men, women and children with HIV/AIDS.

And we have created a variety of training rotations for students and health professionals in the D.R., Haiti and Africa to improve health care not only internationally but- full-circle-- here in northern Manhattan.

These are exciting times, filled with realistic hope, and we invite your participation and support as our program evolves in an effort to bring more hope to resource-poor areas of the world.

Yours in Rotary Service

Steve

Dr. Stephen W. Nicholas Professor of Clinical Pediatrics and Clinical Population and Family Health Columbia University 60 Haven Avenue B2 (HDPFH) New York, NY 10032 Email: swn2 @columbia.edu Phone: 212-304-6128