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World AIDS Day: The small African nation predicted to go extinct due to HIV/AIDS

With both outpatient and inpatient services, including life-saving treatment for patients like this child, a snake bite victim, The Luke Commission Miracle Campus Hospital serves as a referral hospital in Eswatini.
With both outpatient and inpatient services, including life-saving treatment for patients like this child, a snake bite victim, The Luke Commission Miracle Campus Hospital serves as a referral hospital in Eswatini. | Courtesy of The Luke Commission

As the world marks another World AIDS Day, the plight of Eswatini, a small country in Southern Africa, serves as both a testament to the devastating impact of the HIV/AIDS pandemic and a beacon of hope for a brighter future.

Twenty years ago, the United Nations issued a chilling warning about the potential extinction of Eswatini's population by 2050 due to the severe HIV/AIDS crisis, with a staggering 27% prevalence rate. Today, as we reflect on our journey in this resilient nation, we find that while the pandemic is not over, the end is in sight.

In 2005, at the peak of the HIV/AIDS pandemic, our family, which at the time included 3-year-old triplets and a 2-month-old baby, embarked on a life-altering mission to Eswatini, then known as Swaziland. We were armed with a calling from God and a commitment to provide compassionate, comprehensive healthcare, especially to those suffering from the complications of HIV/AIDS. Our small team ventured into a seemingly silent landscape where people were dying everywhere, and treatment options were virtually nonexistent. Our daily mission was not just a medical one; it was a testament to Christ’s love.

But how do you treat a condition that is rarely discussed? A disease that is thought to be shameful and patients struggle to acknowledge the reality of HIV, let alone allow themselves to be tested for it.  Our approach from the outset was to treat each person with compassion and destigmatize HIV, recognizing that only by doing so could we increase the uptake of health services for all patients. Instead of overtly promoting HIV testing, we focused on what brought patients to us — be it difficulty seeing, disability, a rash, a cough, or any other condition — and then provided a full panel of comprehensive services, including HIV testing. Led by our Christian faith, every patient, irrespective of age, economic status, or health condition, was treated with dignity and confidentiality. As we treated their physical needs, we also shared with them the spiritual healing found in Jesus.

Over the years, advancements in antiretroviral treatment (ART) have transformed the narrative surrounding HIV/AIDS. No longer is it an inevitable death sentence; instead, it has become a manageable condition. Eswatini was one of the first African countries to reach the UNAIDS 95-95-95 targets for treatment and viral suppression of HIV/AIDS. With a goal to eliminate HIV/AIDS as a public health threat by 2030, Eswatini has made significant strides, yet the crisis's impact lingers.

The HIV/AIDS crisis left a trail of orphans, a challenge our ministry, The Luke Commission, has taken head-on. With over 700 staff, 97% of whom are Emaswati, we have become a leading healthcare provider in Eswatini. We choose to care for every last patient with compassion, no matter the cost of time or energy. Like the shepherd who leaves 99 safe sheep for one vulnerable sheep, we are unshakably committed to serving all that we can. This includes our staff.

Recognizing that many of our staff were among the orphaned and are now caring for others, we established Base Camp, a 10-week onboarding program that offers counseling opportunities to help staff process pain and trauma. This program operates at the heart of our vision to treat the whole person, empowering the team to live out The Luke Commission’s mission to serve others as if they were our father, mother, brother, sister, or child. Through Base Camp and other training programs, we can care for our staff, so they are better equipped to care for others.

As the world observes World AIDS Day, let Eswatini be a reminder that even in the face of seemingly insurmountable challenges, compassionate care can pave the way from crisis to hope. The HIV pandemic is not over, but the spirit of Eswatini suggests that with continued dedication, we can indeed see the end in sight.

Harry VanderWal, a medical doctor, and Echo VanderWal, a physician assistant, are founders and executive directors of The Luke Commission, which serves the most isolated and underserved people of Eswatini with free, comprehensive, compassionate health care.

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