AIDS Activist Dr. Eric Goemaere

DATE December 10, 2003 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Arthur Hertzberg on his book "The Fate of Zionism" and
present status of Zionism
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest, Rabbi Arthur Hertzberg, has written a new book that he knows will be
controversial inside and outside the American Jewish community. In "The Fate
of Zionism," he writes, `I shall be making the case for Zionism not as a
Zionist zealot or even as a critic adherent but as a disciple of the founders
of the movement. I shall look through their eyes at their vision of
themselves and at the fundamental question they faced again and again: How
could they make peace with the Arabs?'

Arthur Hertzberg is the former president of the American Jewish Congress and
the American Jewish Policy Foundation and former vice president of the World
Jewish Congress. He's a professor emeritus of religion at Dartmouth and a
visiting professor of humanities at NYU. He recently won a National Jewish
Book Award for his memoir "A Jew in America," which was published last year.
I asked him about the form of Zionism he supports.

Rabbi ARTHUR HERTZBERG (Author, "The Fate of Zionism"): I am not a
messianist. I do not believe that Zionism is essentially a religious movement
preparing the way for the coming of the Messiah. I believe that Zionism was
founded, modern Zionism, essentially by two people who didn't agree with each
other but agreed more than they were aware of. One, of course, was Theodor
Herzl, who argued that the Jewish people in Europe, towards the end of the
19th century, was in deep trouble and growing trouble from anti-Semitism, and,
therefore, it needed to reconcentrate itself, or at least a large part of
itself, in its own home preferably in Palestine. And Herzl argued that that
reconcentration would dampen down and perhaps end anti-Semitism.

GROSS: What was the other strain of Zionism at the time?

Rabbi HERTZBERG: The other strain of Zionism is associated with the name of a
great writer and distinguished thinker named Asher Ginsberg, who wrote
under the pen name Ahad Ha'am, `one of the people.' Ahad Ha'am insisted
that Jews in the modern era were running out of steam religiously. The
intelligentsia was more and more secularized, and so there was great danger of
assimilation, which was all around him. Remember, the late 19th, early 20th
century is the era of vast losses to the Jewish people by younger
intellectuals who go into the general culture or try to assimilate into it.
And so Ahad Ha'am proposed that the Jews needed to reconcentrate their
energies in their own homeland, where they could encounter the questions of
modernity in their own terms. They could face the future thinking it through
by the light of their own tradition, not slavishly but as moderate people.

The upshot is, therefore, that Zionism is, as it was conceived a hundred years
ago or so, modern Zionism, a secular movement to solve two problems: the
problem of the Jews, of anti-Semitism; and the problem of Judaism, that is the
modernization of Judaism into the contemporary age.

GROSS: You say that you oppose messianic Zionism.

Rabbi HERTZBERG: Yeah. Right.

GROSS: When do you think the messianic strain of Zionism entered into the
equation?

Rabbi HERTZBERG: Well, after the Six Day War in June of '67, when the Jews
suddenly possessed not a very small piece or a relatively small piece of the
land of Israel, suddenly they were in charge of the West Bank, they were in
charge of the Sinai peninsula. They were very much the masters of the region.
And on the morrow of the Six Day War, messianic dreams were re-evoked and
especially in the hearts and minds of some of the religion. Even the secular
Jews, or many of them, imagined that this was a sign from heaven that a great,
great change was going to happen in the destiny of the Jewish people. But I
was in a meeting with David Ben-Gurion, in which I was the one...

GROSS: And he was one of the people who led the war for independence in the
late '40s.

Rabbi HERTZBERG: And not one of the people; he was prime minister. He was
regarded commonly, even by his enemies, as the George Washington of Israel,
very great, somewhat difficult man. Now David Ben-Gurion got up at this
meeting, and he said, in words of one syllable, unmistakably, `Zionism is not
about this. Zionism is not about victory. Zionism is not about messianism.
Zionism is about making the Jewish people as safe as possible in a bad time,
in a difficult century.' And he shocked his audience, and he made me think
for two years, until I woke up one day and said, `You know, the man is right.'

GROSS: Well, you also say that he said that unless Israel gave back all the
territory that it had captured in the war, with the exception of Jerusalem, it
would be heading for historic disaster.

Rabbi HERTZBERG: That is what David Ben-Gurion said. I listened. It was
hard listening, but I walked away from it saying, `If this great man is saying
this, and he knows more about this than anyone, then what's going on?' And I
finally came to the conclusion that he was right...

GROSS: Why?

Rabbi HERTZBERG: ...that we had to save Zionism from the messianic
pretensions of some of the Zionists.

GROSS: Why do you think he was right?

Rabbi HERTZBERG: Well, let me quote one of his immediate successors, Levi
Eshkol, the man who was in charge during the Six Day War. Levi Eshkol used to
say, `Let's begin at the end. Let me begin at the end.' We now have Israel in
control of the undivided land of Israel to this day; that, therefore, means
that there is already in the undivided land of Israel, between the
Mediterranean and the Jordan River, a near majority of Arabs. Now official
Israeli statistics say that it's about 43, 45, 55 and that we are still about
20 years away before the Arab birth rate swamps the Jewish majority.

This isn't true. It is being whispered in very knowledgeable circles that the
books have been cooked a little bit and that, at this particular moment, we
are maximally seven years away from an Arab majority; that is if the land is
not divided into two states. That, therefore, means that Israel has very few
options. If we are to preserve the notion that there be a Jewish state for
the Jews and a Palestinian state for the Palestinians, we must move very
rapidly towards cooling down the quarrel and towards partition.

GROSS: I want to get back to the idea of a religious justification for the
state of Israel and for Zionism as opposed to a purely political and safety
justification for it. You're a rabbi...

Rabbi HERTZBERG: Absolutely.

GROSS: ...yet you don't think Israel should be using a religious
justification for...

Rabbi HERTZBERG: Absolutely not.

GROSS: Why not?

Rabbi HERTZBERG: If our justification for being there is that God sent us,
then the Arab justification, the Islamic justification, is that the Koran has
said that any land to which the Koran's spread is inalienable, it's dar
Islam. That, therefore, means that we are in a permanent religious
quarrel. It's our absolute against their absolute. If you are in a religious
quarrel, you cannot compromise. The only compromises that can be made are
compromises which are made in secular terms by secular politicians. I would
like, with your permission, to add a little story.

Some years ago I was debating these issues with probably the most brilliant of
the Palestinian and the wisest of the Palestinian intellectuals an old
gentleman named Walid Khalidi, who now lives in retirement in Boston. The
debate was at the National Cathedral in Washington. And Walid got up and said,
in a rather feline way, `I am perfectly prepared to believe that speaking in
Hebrew, God promised the land of Israel to the Jews, but I never heard him say
it in Arabic, in his person, as Allah.' Now so long as we're going to insist
that we have a religious right to the land of Israel, then even Jimmy Carter
will tell us that that isn't what his Southern Baptist teachings has taught
him. The Jews have a religious right to the land of Israel provided they turn
Christian. And Zbig Brzezinski, who was his national security adviser and
is very Catholic, will say, `Yes, the Jews have a religious right to the land
of Israel provided--provided--they accept Christ.' Therefore, let's get out of
the religious issue.

GROSS: My guest is Rabbi Arthur Hertzberg. His new book is called "The Fate
of Zionism." We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Rabbi Arthur Hertzberg. His
new book is called "The Fate of Zionism: A Secular Future for Israel and
Palestine."

Since you obviously feel strongly that Israel and the Palestinians need a
two-state solutions and they need to arrive at a way of doing that quickly,
I'm wondering what you think of the Geneva accord, which is the peace plan
that was negotiated through unofficial channels. Do you think that that's a
workable plan?

Rabbi HERTZBERG: It's not workable. It's the dream of the end of day. The
Geneva solution--and, by the way, I am speaking of friends of mine. Yossi
Beilin is a very good friend. I don't know Abdul Labbo(ph) as well, but I've
known him for years. They are eager, desperate, to make peace, and so they
have produced a plan which tells us what peace would look like. They have not
produced a plan which sits on the militant Palestinians and makes them stop
killing people. They have not produced a plan which has any hope of sitting
on the militant Israelis and asking them to cut it out, to stop being rough
and making war against the Palestinians. And, therefore, until we get to the
intermediate stages of how is all of this going to come about, we're not
really there. And, therefore, I argue in my book that we must first persuade
the Americans, the American government, American leadership, to put enormous
pressure on both the Israelis and the Palestinians to rein in their vehement
and angry people. And once that is done, we can talk of a two-state solution.

GROSS: What are the odds of America taking that much of an active role in
negotiating a peace and then enforcing a peace? Because you're talking about
America seeing to it that hard-liners on the Israeli side cool off and that
suicide bombings stop on the Palestinian side.

Rabbi HERTZBERG: Right.

GROSS: You know, what are the odds of America being quite that active in a
peace plan?

Rabbi HERTZBERG: I think, in the short run, there aren't very large odds
because Bush is campaigning for the second term, and he wants to pick up some
more hard-line Jewish votes. But after that campaign is over, whoever wins
it--and, you know, the present presumption is that Bush will--there is going
to have to be a change for at least one reason: It is an open secret that
there is an awful lot of atomic junk or quasi-atomic junk in or near the Holy
Land. If we are to save the world from an explosion somewhere, let's say near
the shore of the Mediterranean, we have to do it because if we, the Americans,
do not do it, there will be hell to pay. And, therefore, I think this is
becoming evermore clearly a common danger not only to Jews and Arabs but to
America.

GROSS: If you're just joining us, my guest is Rabbi Arthur Hertzberg. He has
a new book called "The Fate of Zionism: A Secular Future for Israel and
Palestine."

Correct me if I'm wrong, but I believe you were a founding member of the
Israeli group Peace Now.

Rabbi HERTZBERG: Yeah. I think...

GROSS: How has your thinking changed about how to bring about a peace since
the group was founded in--What?--the late '60s?

Rabbi HERTZBERG: Well, very fundamentally, contrary to most of my friends,
who are still in the peace process--I sometimes mock it as the `peace
industry'--I have lost hope that Israelis and Palestinians can actually not
negotiate; they can negotiate. Abdul Rabbo and Yossi Beilin proved that they
could negotiate the dream. But I have lost hope that they can enforce it.
Since Arafat has no intention of putting the screws on Hamas and Hezbollah,
etc., since Sharon's government would fall if he really seriously began to
withdraw from serious settlements in the West Bank, I am no longer hopeful
that Israel and the Palestinians can make a deal, not unless the Americans put
major pressure on.

GROSS: You were a former president of the American Jewish Congress...

Rabbi HERTZBERG: Yes.

GROSS: ...and a former vice president of the World Jewish Congress. I think
it's fair to say that you have been a longtime leader of the American, you
know, mainstream Jewish leadership. Fair to say?

Rabbi HERTZBERG: Mm-hmm.

GROSS: How do you think the American mainstream Jewish leadership has
affected the position of Israel on a peace for the future?

Rabbi HERTZBERG: Well, there are two levels of American Jewish leadership
right now. There are those who want to maintain their reputation in Jerusalem
as `regulars,' and, therefore, they will swallow a bitter lot and defend the
existing government of Israel. And then after they get through making the
statements on one of NPR's programs or Lord knows where else, they call up
somebody and they say, `You know, I agree with you.' Therefore, the American
Jewish community is split within itself. I think it's fair to say right now
that the majority, the majority, wants one or the other of the peace
proposals. They are afraid to say that the only way to get the peace proposal
is to put some pressure on both parties because they have been taught that
this is a no-no. I don't believe that this is a no-no. I believe that we, as
part of the Jewish people, have a responsibility to worry about the future,
along with the Israeli leadership. And I do not believe that all wisdom
resides in the prime minister's office.

GROSS: The Bush administration has advocated the so-called road map for
peace, which is a process to get back...

Rabbi HERTZBERG: Yeah.

GROSS: ...on track with the peace talks. Do you think that that's a good
plan? Is that something that you're behind?

Rabbi HERTZBERG: Again, the question is: Who is going to police the bad
guys? All of these plans sound good and true and beautiful and hopeful. They
fall on their faces when we ask the very pointed question: Who is going to
make sure that the bad guys don't have money, they don't have arms and they
keep their promises? And rather than center on the bad guys among the
Palestinians, I'm going to evoke an awful lot of telephone calls to your
program by centering on the bad guys among the Israelis.

It is simply not true that the Israelis signed on to the road map on the idea
that if the Palestinians behaved themselves, they would pull back from the
territories. These two principles are not linked. The Israelis signed on to
pull back from the territories quite without reference to what the
Palestinians were about to do. Remind anyone in the Jewish community of this,
and the screams begin. But let them read the road map.

GROSS: So you're saying that the Israelis haven't upheld their end of the
bargain?

Rabbi HERTZBERG: Neither the Palestinians, nor the Israelis.

GROSS: Rabbi Arthur Hertzberg is the author of the new book "The Fate of
Zionism: A Secular Future for Israel and Palestine." He'll be back in the
second half of the show.

I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music)

(Announcements)

GROSS: Coming up, we continue our conversation with Rabbi Arthur Hertzberg,
author of "The Fate of Zionism."

And Dr. Eric Goemaere of Doctors Without Borders tells us about setting up an
AIDS clinic in a poor South African township. When he started the clinic, a
South African government was challenging whether HIV causes AIDS.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross back with Rabbi Arthur Hertzberg.
His new book is called "The Fate of Zionism: A Secular Future for Israel &
Palestine." This year he won a National Jewish Book Award for his memoir, "A
Jew In America." Hertzberg is a former president of the American Jewish
Congress and is now a visiting professor of humanities at NYU and a professor
emeritus of religion at Dartmouth.

You're no longer a member of a peace group for the Middle East, but you have
just joined another group, and this is called the Clergy Leadership Network.
This is a group within the United States.

Rabbi HERTZBERG: Ahh, you noticed that. Yes, go ahead.

GROSS: And what are the goals of this group?

Rabbi HERTZBERG: Essentially to suggest that American religion--and,
remember, I have not been only in Jewish affairs; I've been in American
affairs. All my life I was very heavily involved in race, in Vietnam, etc.
The function of this group, this group that's being created: in order to make
the point that American religion is not right-wing religion. In other words,
to deny the notion that when you say `religion in America,' you mean
ultra-right versions of religion.

GROSS: When President Bush refers to his faith in talking about Iraq or in
talking about...

Rabbi HERTZBERG: Yeah.

GROSS: ...another--you know, a step his administration is taking, as a rabbi,
how do you feel about it?

Rabbi HERTZBERG: Very negatively. And may I quote him, the greatest of all
the Republicans--there came to Abraham Lincoln, in the middle of the Civil
War, a delegation of clerics who told him that God was on his side. And
Abraham Lincoln responded by saying, "I am much more worried as to whether I
am on God's side." Now let me put it this way. Mr. Bush has had, by now,
innumerable prayer breakfasts. Almost without exception, the rabbis he has
invited to them are Orthodox and politically right-wing. None of the people
who are on the other side have, to my knowledge, ever been asked. Now I think
that George Bush has politicized religion, and the effort that I am part of is
the attempt to redress the balance.

GROSS: When you look to the future--I know that you think that there will be
no real peace until the United States intervenes in a forceful way.

Rabbi HERTZBERG: And steps in, right.

GROSS: However, when you look a few years down the line, past the
Sharon-Arafat generation of leaders, do you feel any more hope?

Rabbi HERTZBERG: Yeah. What gives me hope is the appearance of a few people
on the Palestinian side: Abed Rabbo; Sari Nusseibeh, who I gather, by the
way, is likely to be here by Thursday. And the appearance on the Israeli
side, not only of Yossi Beilin, whom we've known a long time and he happens to
be a very dear friend of mine, even though we disagree at the moment, but the
appearance of the last four heads of Israel's secret service who said jointly
that what Israel is doing may be tactically useful but is a strategic
disaster. I think a new generation is beginning to show up which is thinking
outside the box. I was at the Council on Foreign Relations the other day when
Abed Rabbo and Beilin spoke, and I was reduced to tears by Abed Rabbo, who
said, `I am here because I have lived all my life as a refugee. I don't want
my children to continue with it and certainly not my grandchildren.' And I
gulped, and I think it is that gulp which is the hope.

GROSS: Why did you gulp? Why did that get to you?

Rabbi HERTZBERG: Why did that get to me? Because I have children and
grandchildren; because I was five years old when I was brought to this country
after running away from the kids in the Ukrainian parochial school in the town
of my birth, who chased me up the block to beat me up because they had just
discovered that I was a Christ killer, etc. I know what it means to be a
refugee, and I don't want it to happen, not again and again, to anyone else.

GROSS: I want to thank you very much for talking with us.

Rabbi HERTZBERG: Thank you very much for having me on.

GROSS: Rabbi Arthur Hertzberg is the author of the new book "The Fate of
Zionism: A Secular Future for Israel & Palestine."

Coming up, setting up a pilot project for treating people with AIDS in South
Africa. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Eric Goemaere on his efforts to help AIDS patients in
South Africa
TERRY GROSS, host:

South Africa is at the epicenter of the AIDS epidemic. More than 10 percent
of the population is infected; 600 people die of AIDS every day there. But
until recently the government has refused to provide access to antiretroviral
drugs, challenging the safety and effectiveness of the drugs and questioning
whether AIDS was caused by HIV. My guest, Dr. Eric Goemaere, started a pilot
project in Khayelitsha, a poor township outside of Cape Town, where his staff
provides these drugs to people with AIDS. He hopes to show that the treatment
is effective and that people who are poor and uneducated can comply with the
drug regimen. Dr. Goemaere heads the South African mission of Doctors Without
Borders, also known by its French name Medecins Sans Frontieres.

He chose Khayelitsha as the location for his clinic because local authorities
there had already defied the government by creating a program giving drugs to
pregnant women with AIDS to prevent transmitting the virus to their babies.
Last year the magazine Scientific American named Dr. Goemaere Medical Policy
Leader of the Year.

I asked him how AIDS had already affected Khayelitsha when he started his
program.

Dr. ERIC GOEMAERE (Doctors Without Borders, South Africa): When I first when
to Khayelitsha, it was mid-'99. I used to go there every day, forcing myself
to go. I had no program. There was strictly nothing happening around
HIV-AIDS, hardly even any tests done. Nobody was speaking about it. It was a
taboo. They were not meant to speak about it. And my first and strongest
enemy were the nurses, in fact, of the health staff because they were telling
me, `No, Doctor, sorry. It's impossible to set up an HIV clinic. Old people
here will never come in from the outdoor without imagining the stigma.' But
at the same time...

GROSS: Wait. So nurses were telling you, `Don't even bother to set up a
clinic 'cause HIV has such a stigma, and no one's going to come'?

Dr. GOEMAERE: Yes, of course. Nurses were extremely negative about it. They
didn't want at all me to open a clinic because we opened the clinic inside the
existing hospital. So it was a mix of denial, saying no, or, `People will
never, ever come in from the outdoor because they are not ready to accept that
they're HIV.' And something I discover later: It was also a mix of their own
fear. They had the impression, in fact, that I would bring to them a lot of
HIV-positive people. And I was telling them that, `They are around already.
They are among you patient. You just do not know that they are HIV-positive.'

GROSS: So was part of what the nurses were afraid of catching the disease
themselves because you'd be bringing in more infected people?

Dr. GOEMAERE: Definitely. Condemnation was a fear. But much worse than
that, this terrible stigma around HIV. HIV and AIDS. Them. `We are health
staff. We're all uniformed with all privilege.' You see, when you are in a
terrible situation, when you see the boat sinking, you try to re-establish as
classes. We are on the Titanic here, and the first class doesn't want to mix
with the third class because there's just not enough room on the safety boats.
The good success we had, this was beginning of last year, 2002, is that the
first nurse came to the clinic--in fact, inside her own clinic, where
everybody knows her--and begged for help. She knows perfectly well she's back
to work, and she's, of course, our best argument and advocate against
stigmatization.

GROSS: Now if AIDS was such a stigma in the township where you set up your
clinic, how did you convince people who weren't on the medical staff, the
greater part of the population, to show up for help if they needed it?

Dr. GOEMAERE: Well, it was very simple. Numbers are killing the stigma.
People are desperate to get some form of treatment. They don't want to die.
So you always find people who are ready to go if, of course, in exchange,
coming out positive, they receive a service, which was not at all the case
before. And then, you know, it builds up and the number builds up, and
suddenly people realize that it's not dozens, it's not hundreds; it's
thousands. Only in Khayelitsha, this township, half a million inhabitants, we
estimate we have between 60 and 70,000 people HIV-positive. It's big numbers.
They start to ignore this. You see everywhere in the street people wearing
T-shirts `HIV-positive.' It's even fashionable to wear those things. I think
numbers make an enormous difference, and numbers bring in different power of
balance and force acceptation.

GROSS: One of the things you've had to do at the clinic is to give people
antiretroviral drugs. Those are expensive drugs. Those are drugs that were
particularly difficult to come by in South Africa. What has your technique
been for getting drugs in an affordable enough way, so that you could give
them or sell them--you could tell me which it is (laughs)--to the sick people
at your clinic?

Dr. GOEMAERE: Yes. We don't sell them; we give them for free. And we
believe it's important they are free. But you are totally right, it was a
very tricky situation. And that time, I remember, in '99 here in South Africa
it cost 6,000 US per year per patient, triple therapy, OK? There's no way the
South African government would have been able to afford it. And from the
beginning we said we will drop the price dramatically, and there was only one
way to do so. It was by provoking competition, and the only way to provoke
competition when you have exclusive patent-holder is to bring in generic
copies of that drug. We wrote--that was beginning of 2000--to each of the
patent-holder, Glaxo, Boehringer, saying, `Not one of our clients is able to
afford your drug. So we intend to bring in generics. Please tell us if you
would consider this as a patent infringement.' And, of course, we were
flooded by letter of answers saying, `This will be considered as a patent
infringement.'

GROSS: So once they told you it would be a patent violation for you to import
generic drugs, what did you do?

Dr. GOEMAERE: Well, we were, first, very nervous about it, but we decided
that we would do it and would let the world know that we would do it. They
didn't dare to sue us. They didn't dare to sue us because, in the meantime,
MSF and other groups, Takia(ph) locally and several groups in United States,
were extremely active. Like, you know, ACT UP and Tug(ph) made huge effort to
explain the situation, to explain that there's no way the huge majority of
people affected by AIDS will one day be treated, if there is no access to
generic, to bring the price down. And as a result, we were never, ever sued.

GROSS: So where do you get the generics from?

Dr. GOEMAERE: Initially from Brazil because we wanted to get them from
state-controlled company that could give us--we wanted to make sure they would
be at-cost in price. And the only one who accepted to give us the breakdown
of price was a Brazilian, so we imported from Brazil. And as a result, it
cost us exactly for triple therapy 1.08 US dollar per day. So it makes it,
more or less, 3.60 per year more, down from 6,000 US dollar. You see the
difference.

GROSS: That's per person?

Dr. GOEMAERE: Per person, yes.

GROSS: Yeah, very big difference.

Dr. GOEMAERE: It's a big difference, definitely. Nowadays we have worked on
different other scenario. We still import some from Brazil. We import some
from India. The ultimate goal, of course, was to get a local production
because we were convinced that it would certainly change the president's mind
if instead of paying in the US dollars every month a huge check, because
inevitably it would be a huge check--if this could be produced locally, paid
in rand and create jobs, it might change his mind. And as a matter of fact,
as I'm speaking to you, it has started now. The first antiretroviral is
produced here close to Port Elizabeth by a company called Aspen Pharmacare,
and, of course, we use it.

GROSS: I know that one of the biggest concerns about distributing
antiretroviral drugs to people who are poor and uneducated is that they might
have difficulty complying with the complicated regimen. There's several drugs
you have to take in the AIDS antiretroviral regimen. They have to be taken at
the same time every day. So what are some of the problems--have you had
problems with compliance in the township in South Africa where you work?

Dr. GOEMAERE: Yes, we have had problem of compliance for the good reason that
compliance is not an easy issue. But, generally said, we have been completely
surprised by the fact that the result we achieved here were, as a matter of
fact, much better than everything you read published throughout the United
States. Why so? The first reason is a social reason. We deal with a
less-problematic population. We deal, in great majority, with mothers, their
child, their partners who are trying, with the faculty, of course, to build a
family. We don't deal, like in large proportion in Western countries, with IV
drug users, with prostitutes. Here, HIV-AIDS, it's part of the environment;
it's everybody. It's normal. So the first reason, I would say, is social
reason.

Second reason, people are very aware that they have an extraordinary chance to
benefit from those drugs, and they want every single one. And I can tell you
that they stick religiously to the treatment because they know very well,
contrary to impression, again, we can have in the West, that if they miss that
chance, they won't have another one.

And the third reason is probably the most powerful. You know, the young
generation in Europe doesn't see anymore their peers, their friend, their
colleague dying. Here, I can tell you people still die on a daily base. The
main activity's to go to funeral every single Saturday. So they know very
well each time one brings one in terminal stage in the waiting room, like it
happened again this morning, everybody look at each other, say, `Uh-oh. I'm
going to take my pills.' So I think that must make the difference.

GROSS: My guest is Dr. Eric Goemaere. He's the head of mission in South
Africa for Doctors Without Borders. We'll talk more after a break. This is
FRESH AIR.

(Soundbite of music)

GROSS: My guest is Dr. Eric Goemaere, and he's Doctors Without Borders' head
of mission in South Africa, where he set up a clinic to treat people with
HIV-AIDS.

You estimate that about 25 percent of the population in the township where you
work is HIV-positive. A lot of people are dying of AIDS where you are. Do
you see the evidence of that in day-to-day life?

Dr. GOEMAERE: Oh, for sure. You see this evidence in the fact that this
township is, for the moment, getting poorer and poorer. HIV strikes mainly
the middle-age population, the economically active. Once you have someone
sick in your family, the African tradition forces you to take care of the
sick. And whatever means you have, you are obliged to give all your means for
the sick. So, I mean, we are surrounded by people--on a daily basis we have,
suddenly, 10 or 15 people come in to collect money for the funerals of this or
to pay the drugs of that one. It does complicate, change, the life of a
township. And as a result, you see kids dropping from school, you see nurses
stopping their jobs, so that they can get what they call a package. It means
the pension money to be able to pay for drugs for their partner or for their
children who are sick.

GROSS: I don't know where else you've worked for Doctors Without Borders, but
have you ever been surrounded by as much death as you've seen in the township
of South Africa where you're based?

Dr. GOEMAERE: Yes, because I've worked for 22 years with MSF. So I've seen
more dramatic war situation, like in Chechnya, or refugee situation, like in
Kisangani or eastern Congo, where I've seen--I've counted much higher number
of dead. But there's a big difference. When you have in the morning dozens
of deaths on the ground, in fact, you don't know them, so you don't--you're
not shocked the same way. When you deal with HIV-AIDS patient, you know all
of them because they are chronic patient; they come regularly. And each death
is much more difficult to assume.

GROSS: How are you personally dealing with all the deaths that you're seeing,
deaths in many cases of people who you know?

Dr. GOEMAERE: Of course, I have ups and downs, like every single caregiver.
We have a very strong team, a team made out of counselors, nurses and a few
doctors. In fact, we have three clinics here in Khayelitsha. We've known a
lot of individuals who've passed away. They're always young, less than 20
years most of the time, looking at you in the hope you can save them. And
then, well, when you don't succeed, of course, you feel suddenly extremely
lonely and ashamed. But, yeah, the best way to cope with it is share it with
the team, and that's what we do.

GROSS: Do you have a lot of people who come to you hoping that they could get
treatment, but their AIDS is too advanced to be helped by the antiretrovirals?

Dr. GOEMAERE: Yes. Yes. It's very common because now the rumor has spread.
And we have people who traveled hundreds of kilometers. Last week I had a
young lady who had traveled, I've calculated, 1,800 kilometers. She was
weighing 32 kilos, had most probably TB, totally out of prep, totally anemic.
She was literally dying on the table. She had done in desperate and she knew
the condition of transport--she had done in despair, 1,800 kilometer because
she felt that the only place where she could be safe, and she passed away the
same night.

GROSS: That must have been rough. Did she have family with her?

Dr. GOEMAERE: Yes. Her mother was with her.

GROSS: So then her mother had to make that long trip back alone.

Dr. GOEMAERE: Yes. Yes, unfortunately. But I would say to that that, since
I've been working here, never felt any sense of anger against us. We mourn
the death with the mother. And, you know, she looked at me and said, `Well,
we'--in her words; of course, she wasn't speaking English, but something like,
`We have done what we could.' And, you know, the huge majority of people
living with HIV in this country--and, again, there are five million--do not
expect to be saved. In fact, a lot of them know very well that they will not
be saved because this is almost an impossible task. But people are extremely
sensitive and know what they want in the name of what they fought for under
apartheid. The definition nowadays of democracy, like Nelson Mandela was
saying in a concert Saturday, it's to be given the right to be seen, to be
treated as long as you have tried and tried with all your means to do
something. If it doesn't work, it doesn't work. But if you haven't tried,
you are not entitled to be part of that democracy.

GROSS: I want to thank you very much for talking with us, and good luck with
your program.

Dr. GOEMAERE: It was a pleasure. And thank you for your interest.

GROSS: Dr. Eric Goemaere is the head of mission in South Africa for Doctors
Without Borders. He spoke to us from Cape Town.

(Credits)

GROSS: I'm Terry Gross.

(Soundbite of music)

GROSS: We're closing with a recording by the Cuban pianist Ruben Gonzalez.
He died Monday at the age of 84. Gonzalez was one of the older Cuban jazz
musicians who were considered old-fashioned after the revolution. His career
was revived, and he became popular in America as a result of Ry Cooder's 1999
documentary, "The Buena Vista Social Club."

(Soundbite of music)
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