One Life at a Time
In a New Book, Daniel Baxter, MD, Discusses Treatment Challenges & Triumphs in Botswana, the Universality of Suffering & Connecting with Individuals Living with HIV/AIDS
by T.J. Banks

Photographed Exclusively for A&U by Alina Oswald

He is known for his work within the AIDS community in New York and has written about some of those experiences in The Least of These My Brethren: A Doctor’s Story of Hope and Miracles on an Inner-City AIDS Ward (1997). “I am not Mother Theresa,” Baxter said in an interview at that time. “There are many other people who are doing the same sort of work.” True, but over the years, he has developed, in the words of author Thomas Moore, “a perceptive approach to his patients and the stories he told about them inspired me. Here was a doctor who could draw on genuine spiritual resources without all the baggage of excessive piety and anxieties about belief. He [Baxter] understood that the spiritual component is part of what a person is, and in gritty ways he struggled with his difficult patients to unleash their own kind of spirituality” (The Care of the Soul in Medicine: Healing Guidance for Patients, Families, and Those Who Care for Them, 2010).

In 2002, Baxter traveled to Botswana in Southern Africa to work with the HIV/AIDS Treatment Programme; he left in 2008, only to return five years later as a Lecturer and Specialist Physician at the Princess Marina Hospital in Gaborone, Botswana’s capital. His new book, One Life at a Time: An American Doctor’s Memoir of AIDS in Botswana (Skyhorse Publishing), is a powerful and to-the-point account of those experiences: in it, we see Baxter as Moore saw him.

A&U recently had a chance to talk with Dr. Daniel Baxter about his experiences, in the field and when writing his book.

T.J. Banks: Before going to Botswana, you worked at the Spellman Center for HIV-Related Diseases in NY. What led you to become as involved in this field? Would you say it became a calling of sorts? If so, when did you realize it?
Daniel Baxter, MD: Although the science of HIV was fascinating—a tiny invisible virus infects the body’s most crucial immune cells, destroys them, and causes terrible infections and cancers—it was the ethical and philosophical aspects of the pandemic that interested me most. I was appalled how HIV-infected people were treated like lepers, stigmatized and rejected by family, friends, the churches, and even hospitals. My work at St. Clare’s made me realize that we all are HIV-infected in this weary sojourn called life—that is, regardless of whether our HIV test returns positive or negative, we are all on the sliding slope to the grave, pulled down by disease and illness.

It was your decision to give up a high-profile job and go to Botswana, where you became involved in the recently launched HIV/AIDS Treatment Programme. You discuss your reasons for doing so in your new book, One Life at a Time: An American Doctor’s Memoir of AIDS in Botswana. But for the sake of our readers, could you describe some of the strongest ones?
I had always wanted to work in a developing country, and because by 2000, the HIV crisis in America was coming under control, with newer drugs with fewer side effects, I felt that I had a moral obligation to help people less advantaged than me. However, after I arrived in Botswana, I soon realized that my motives were naïve and even self-serving. Much of my book is about this deconstruction and then restoration, played out in Botswana’s immense time and space.

You went back to Botswana as a lecturer and Specialist Physician at the (then) new medical school in 2013. What changes in the treatment of HIV/AIDS in Africa did you note? How much, if any, of the stigma surrounding the disease had been chipped away at during your absence?
On one hand, by the time I returned in mid-2013, Botswana’s HIV/AIDS Treatment Programme had put nearly 100,000 people on life-saving HIV treatments. But, as I soon learned, there were still too many people falling through the cracks, ending up in the hospital with serious complications of AIDS because stigma had prevented them from being HIV-tested. Stigma was less than when I first arrived in 2002, but it was still widespread, along with the shame and guilt of being infected. It will probably take another generation before this stigma is fully extinguished, both in Botswana and in America.

In your book, you contrast the treatment of the disease in Africa with its treatment here in the States? Is the gap between the two as wide as it was when you first went there in 2002, or has it lessened somewhat? Would you say that patients are gradually becoming more empowered? My impression from the book Powered by Love: A Grandmothers’ Movement to End AIDS in Africa is that this is the case, at least in parts of the country.
At present, the HIV drugs used in Botswana are exactly the same as the ones here in America, but the level of in-patient care in the country’s hospitals still lags, as chronicled in my book. Moreover, a major challenge facing the country is the need to seriously address non-HIV medical conditions such as hypertension, heart disease, and diabetes, problems which afflict far more people than HIV. For the past fifteen years, the country’s mobilization against HIV/AIDS consumed its resources, to the detriment of these other medical problems. In terms of patient empowerment, perhaps the greatest change has been the lessening of gender inequality, which, throughout Africa, has fueled the pandemic. Human rights organizations have highlighted the need for young women to be able to protect themselves from HIV infection without fear of retribution or violence from their male partners.

Albert Schweitzer once told the graduates of a nursing school that service “will not always be a comfortable companion but it will always be a faithful one. And it will be able to lead you to happiness, no matter what the experiences of your lives are.” He also spoke of the “fellowship of those who bear the mark of pain.” Would you say that either—or both—of those statements have any bearing on your experiences in Botswana? And if so, how?
This is a vast and complicated question. I would always tell my medical students and residents that their goal in medicine should be to someday reach that state of grace where your patients give you more than you were able to give them. That is, your experiences as a doctor should give you a deeper understanding of yourself and your own suffering as well as the uniqueness of every human life. In Botswana, I gradually realized that the only person I could ever “save” was myself—if I was lucky—and that all I can do as a doctor is give my patients precious extra time for them to save themselves and to put things right in their own lives.

In One Life at a Time, you share the stories of various patients. Looking back, would you say that any one person changed you and/or your outlook on the disease more than the others? If so, how?
Yes, it was Dolly, a twenty-year-old woman who was comatose and dying from AIDS at Marina Hospital, the country’s main referral hospital where I headed up a team of medical students and residents. When I first took over her care, the only thing I knew about her past life was that she had been raped by her pastor at age thirteen. For reasons I later learned, her two aunts—the only family she had left—were trying to change her name in the hospital records. Although I didn’t know for sure, it was highly likely that after her rape, her life took a sudden turn for the worse, with shunning by family and friends, perhaps even her church. Dolly was the tipping point in my eight years in Botswana—it was the moment when I finally understood the universality of our suffering and how no one’s suffering, not even Dolly’s, was greater than anyone else’s. This realization also allowed me to later return to New York to happily treat patients there—patients who, in my prior arrogance, I had regarded as entitled, spoiled, and demanding.

Early in the book, you write about “science collid[ing] with ignorance and denialism” in Africa back in 2000. When did that change? Has it changed in your opinion?
My comment was specifically in reference to the 2000 Durban AIDS Conference, when South Africa’s President Mbeki, who was educated enough to know better, spouted the nonsense that HIV didn’t cause AIDS, that poverty was the cause of AIDS. His intellectual conceit probably cost the lives of at least 300,000 of his countrymen since it delayed for several years the country’s own HIV treatment program, which now is the largest in the world. For the most part, Botswana welcomed scientific innovation and knowledge.

This is going to sound simplistic—naive, even—but do you think we’ll ever see the end of the AIDS pandemic in Africa?
Yes, I believe that the combination of HIV treatment and the promotion of pre-exposure prophylaxis will markedly decrease new infections and will allow the continent to address other serious public health problems. I remember when HIV treatment was felt to be beyond the reach of most Africans, who we thought were doomed to extinction on a massive scale. But with resolve and patience, Africans are doing it, rescuing people from the abyss. And who knows? Perhaps when medical science discovers a “cure” for HIV, it might someday even be available in Botswana!

What would you like readers to take away from your book?
In the face of incredible adversity, the human spirit has the ability to persevere and survive, but we must also feel and respond to the suffering of others and not turn away. And such suffering, as has happened with HIV/AIDS, must be addressed one life at a time.

T.J. Banks is the author of Sketch People, A Time for Shadows, Catsong, Houdini, and other books. Catsong was the winner of the 2007 Merial Human-Animal Bond Award.