Dec. 1 - 7, 2003 - Trip to Africa as part of Secr. TGT's delegation. Cameroon (fuel stop + ambassador handshake), Zambia, Rwanda, Kenya and Uganda. Most incredible visit. Included Julie Gerberding (CDC), Elias Zerhouni, Randy Tobias (Ambassador for President's Emergency Program for AIDS Relief (PEPAR), Richard Feachim (Director of Global Fund for AIDS, Malaria, and TBC), Peter Piot (UNAIDS), Amb. Richard Holbrooke (UN Ambassador for Clinton, now representing business coalitions), Bill Winkenwerder (DoD), Senator Don Nichols (R-OK), Congressman Dave Weldon (RFL), Linda Conlin (Assist. Secr. For Trade Development, Dept. of Commerce, Ann Peterson (USAID), plus many other VIPs plus a large number of CEO-types in industry such as Hank McKinnel (CEO-Pfizer), CEO Peter Dolan of BMS, Chris Viehbacher (Pres., GSK), John Martin (CEO, Gilead), Per Wold-Olsen (Pres. Merck Europe/Middle East/Africa), etc. In addition, many people from faith-based organizations such as Father O'Brien (Pres. Les Aspin Center at Marquette) and Shepherd Smith (Institute for Youth Development). Christy Feig from CNN was on board as was Sabin Russell from San Francsico Examiner and Marilyn Marchione from Milwaukee Sentinel. Purpose of the visit was fact finding and to get industry involved in economic impact of AIDS in Africa. So many incredible aspects to trip with the underlying theme that the Africans (particularly in Uganda) are showing that they are ready for implementing the PEPAR and the Global Fund (see below the experience in Tororo, Uganda). Also, many new friends from the delegation. Zambia (Dec. 1-2) - Greeted by US Ambassador Martin Brennan and Zambian Minister of Finance and Economic Development Emmanuel Kasonde and Zambian Minister of Health Brian Chituwo. Stayed at the Zambezi Sun Hotel at the evening had a local dinner (open pit outdoor barbecue) at a Boma. Also, walked down to Victoria Falls which was absolutely breathtaking. Looked across the Zambezi River to Zimbabwe. Participated in a World AIDS Day parade through the city center of Livingston. Many locals came out to greet us. Visited a faith-based organization St. Francis Community Home-Based Care Center as well as LISCA Linda Center giving care to children - called LISCA. Rwanda (Dec 2-3) On afternoon of Dec. 2, flew to Kigali, Rwanda and immediately went to the Genocide Memorial. Clearly this was one of the 2 most important parts of the trip. I spoke with many Rwandans who suffered from the genocide and the enormity of it really is not appreciated by the world in general. In 1994, over a 4 week period in April, the majority Hutus slaughtered 800,000 to 1 million Tutsis while the world watched and did nothing. In fact, the French actually came in to protect the Hutus against Paul Kigame's (Tutsi) rebel army that came in from Uganda to stop the massacre. I ultimately had an audience with now-President Paul Kagame in the Presidential Palace. We also spoke with many Rwandans whose families escaped. (Please refer to history books about the massacre). Of not, as in my visit to South Africa in 2002 vis-à-vis Apartheid, the Rwandan Society in dramatically impacted by the genocide. Most ministers are people who fought together with Kagame to stop the genocide. Those who were there said that atrocities were unimaginable. Machete-killing of tens of thousands of people, women, children per day until bodies cluttered the streets and the rivers. Of note, 13% of the population of 8.2 million are infected with HIV and so AIDS potentially will kill more people than the genocide massacre. During visit, met with US Ambassador Margaret McMillion. Visited Kabgayi Hospital 1 hour outside of Kigali. TGT gave a gift of a cow named "Elroy" (after his hometown in Wisconsin). On the previous night (Dec. 2) we had an extraordinary discussion among the delegation. We had just received a high red alert that there would be a terrorist attack against US interests, particularly hotels and possibly ground to air missiles at aircraft in Kenya the next day. There was a frank discussion at dinner at the Milles-Collines Hotel among delegates led by Jay Hodes (chief of DHHS Security) and TGT. Decision was that anyone among government people could opt out and go straight to Uganda skipping Kenya; however, all non-government people were bumped off and sent directly to Uganda except for a very few like Sabin Russell and some others. I definitely wanted and did stay with the group as did Julie Gerberding and Elias Zerhouni. The Milles Collines Hotel was where the Hutu Command post was during the genocide. The next day we went to Kabgayi (see above), then flew to Entebbe Airport Uganda, left off about 70 people and the remaining 25 - 30 went back to Kenya. We were flying on a German Charter (same one as last year with German pilot Chris who formerly was a Luftwaffe Major). On the approach to Nairobi airport, Chris slowed down for about 15 minutes to "cool" the engine ( to decrease chance of hear-seeking missiles) and then dove sharply to the landing field. All went well. Kenya (Dec 3-4). In Kenya, we went to a rather boring Global Coalition Event and then had a reception at the residence of US Ambassador William Bellamy. Security was depressing. From the airport, we were escorted downtown by a truck-load of Kenyan Army soldiers all with AK47s. The entire perimeter of the hotel was blocked off to traffic and the hotel road had a truck full of soldiers. On my floor (room right next to TGT) there were 3 armed police throughout the night. Next day we went by plane to Kisumu, Kenya to tour the HHS Kisian facilities run by CDC and Kenya Medical Research Institute. We had a nice lunch at the Kisumu Yacht Club on the shores of Lake Victoria. Uganda (Dec 4-5). Flew to Entebbe on Dec. 4, then drove to Kampala to join rest of delegation. During takeoff from Nairobi Airport, pilot Chris made a very sharp and steep turn to the right an up to avoid any possible surface-to-air missiles. Had casual dinner and exchanged stories in Sheraton Hotel. Dec. 5 was clearly the highlight of the trip. Drove to Tororo (4 hour drive) to visit the TASO Program of Home Based AIDS Care (HBAC). We broke up into more than 20 groups of 3 to 5 people and were led into the bush by a lead community person ona motorcycle. We followed in a van. Our lead cyclist was a beautiful 25 year old Ugandan named Irene Athiene. She took us to 2 homes (mud and/or brick complexes) where TASO clients were in their first few months of ARVs that are delivered to them by Trene. In my van was Sabin Russell, Tom Ansfield (Univ. of Wisconsin Medical Center), 2 others and Alex Coutinho, CEO of TASO. Coutinho is amazing!! A true hero. He knew the details of every patient and their families and was truly a man of the land of Uganda. He was totally comfortable in the bush and the clients loved him She lived with her mother-in law and about 7 children. Note -- she was one of 3 wives of the husband who died last year of AIDS. One of his other wives died of AIDS and the other left for Kampala (HIV-status unknown). Of the 7 children only 3 ver and the others were from the husbands other wives. She had just lost her 1 year old baby to AIDS and 2 of the other children of other wives were infected with HIV. She was taking care of all of them with the help of her teen-age daughter. Her 17 yo son helped out by working. She owns 6 acres, 3 pigs and some chickens. Ugandan women cannot own turkeys. Her husband stone grave was clearly visible on the property. Her major concern was to stay alive long enough for her 17 yo son to become 18 so that he could inherit the land. It is tradition in Uganda, that when a man dies of HIV, when his wife then dies of HIV or anything else, the property goes to the brothers-in-law unless there is an adult male in the house. P| in-laws have been abusing her since her husband died and she did not trust them. The Ugandan government under Pres. Museveni is trying to change some of this. She was a wonderful and courageous woman who understood very well what HIV was, what her CD4+ T cell count was (10 cells) and how she would need to train her children to avoid infection. The myth that one cannot deliver treatment, prevention and care in rural Africa is just nonsense, particularly here in Uganda._The second home was that of a40 yo woman with a similar story to that of =_ She live in an extended family compound of 6 huts. She too had children (3), but none were infected. The "co-wife" moved to Kampala after the husband's death. Also living there is her brother-in-law who is infected, her mother-in-law and several children. lis very serious, but incredibly dignified. She is highly intelligent and knows all about her disease (CD4 count, etc. 179). TASO is working miracles here. Also, on ana were 2 graves -- her the > of Tikrit, Iraq!! husband and other brother-in-law. She is not abused by her in-laws and states proudly that they love her very much. It was clear from their reaction that she was correct. After Tororo, we went to the Grandmother's (JAJA/Mildmay) house in Jinja, Uganda. This was a beautiful facility that was more a referral facility that a primary care place. Next day (Dec 6) went to Mulago Hospital grounds and visited the TASO Mulago Center for a ribbon cutting of a new building largely built by Pfizer through a donation from Hank McKinnel. It is a beautiful facility. After this we went to Entebbe and visited the Uganda Viral Research Institute on Lake Victoria. I gave a small speech. The Rakai group supported by NIAID gave a booth presentation led by Noah Siwanuka (Spelling?). After this we had dinner at the Lake Victoria Hotel in Entebbe and took off for Frankfurt right after midnight on Dec. 7 with a fuel stop in Larnaca, Cyprus. General Comments: See above in Introduction. Also, in Uganda, CDC program director Jonathan (Jono) Mierman was wonderful...very enthusiastic and goodaggressive person. Also, interacted with Minister of Health Jim Muhwezi. He has an interesting history. He is trained as a lawyer, was a political activist against Idi Amin and Mobutu. Was jailed, shot himself (3 escaped and 1 was killed) out of jail, escaped to a hotel that was surrounded by hundreds of troops that were looking for him. He dressed like a woman and slipped away right in front of the soldiers. He escaped to the North where he joined Museveni. He became a Brigadier General in the Ugandan resistance army and after Museveni won, he was made chief of intelligence. After 10 years there, he was made Minister Of Health. Similar to the Kagane story in Rwanda, practically all of the ministers started off as fighters in the resistance army with the person who ultimately became President, in this case Museveni. None of these places are really a democracy since opposition parties are generally restricted. It just happens that Museveni is an enlightened President. Became friends with Tommie Thompson, TGT's daughter who is very nice. Also, developed beginnings of bonding relationships with many people including Sen. Nichols, Cong. Weldon, Randy Tobias, Richard Holbrooke and many of the staff at HHS that I already knew well, as well as Elias Zerhouni. As experienced as I am, I was greatly moved by the trip. I learned much and was deeply moved by the experience in Tororo. I felt so good and yet humbled about my role in developing the $15 billion PEPAR program. It may turn out to be my greatest accomplishment.