An Uphill Battle

January 31, 2005
To the top: Duke medical student James Floyd, left, with members of AIDS Climb team at Uhuru peak, 5,895 meters

 To the top: Duke medical student James Floyd, left, with members of AIDS Climb team at Uhuru peak, 5,895 meters; climbers, below, scale Barranco Wall on day four of seven. Chris Hildreth

Climbers scale Barranco Wall on day four of seven

 On the morning of June 17, 2004, minutes after sunrise, a fifty-one-year-old HIV-positive Tanzanian man named John Mwita stood at the peak of Mt. Kilimanjaro. Mwita was one of fifteen participants in the "AIDS Climb for Kilimanjaro," a fund-raiser founded by James Floyd '00 that raises money for Duke's regional partners, Amani Children's Home and KIWAKKUKI, both dedicated to stopping the spread of AIDS in northern Tanzania. Amani, founded by Valerie Johnson '02, is home to more than sixty children orphaned by AIDS. KIWAKKUKI, a grassroots organization that provides care and counseling to the sick, is assisted in its efforts by fellows in the Hart Leadership Program from Duke.

Floyd arrived at the peak minutes later. He was nauseous and exhausted. He'd spent the previous five days serving as doctor for the climb, making sure Mwita and the other two HIV-positive climbers weren't developing respiratory problems at the higher altitudes. Now, though, it was Floyd who appeared to be sick. He staggered the last ten yards to a sign announcing the elevation (5,585 meters), and, once there, collapsed supine beside the path.

A third-year medical student, Floyd had only months earlier discovered the Duke presence in Tanzania. At the time, he was just getting interested in global health. He'd been reading Tracy Kidder's Mountains Beyond Mountains, about an infectious-diseases specialist named Paul Farmer '82 and, as Floyd puts it, "his human-rights approach to medicine."

Floyd was inspired. He read Farmer's books, too--the ones by Farmer--and his journal articles and research papers, and even sought him out at a "Physicians for Human Rights" conference in Chicago, where, for the first time, Floyd got to shake his hero's hand. Farmer's message--that so many of the world's poor were dying of treatable diseases precisely because they were poor--began to tug at Floyd's conscience. "I felt this obligation, as someone who will soon be a physician, to assist those who most require our help."

Soon, Floyd learned about the work Nathan Thielman and John Bartlett, infectious-diseases specialists and professors of medicine at Duke, were doing in Moshi. They told him about the service ties they'd recently developed in the region, and, before long, Floyd had conceived of a way he could contribute. If he couldn't treat patients, if he couldn't deliver life-saving drugs to the poor in Tanzania--at least not yet--he would raise money for those who could.

He says it occurred to him that so many Duke efforts concentrated in a land of little wealth and great need were positioned to do just that. Because, of course, just miles away there was the mountain--the tallest free-standing mountain in the world, the "Roof of Africa," the "Mountain of Greatness," the "Shining Mountain," or, in the language of the Chagga, the oldest inhabitants of its foothills, "Something Which Cannot Be Conquered"--calling out for the obvious: conquering.

And so AIDS Climb was born. The Duke fellows and alumni in Moshi would climb the largest mountain on the continent to fund the fight against the biggest killer on the continent. Joining them would be three HIV-infected volunteers at KIWAKKUKI, four teenage orphans from Amani Children's Home, four trail guides, one cook, forty-five porters, and I.

When I first met Mwita, a volunteer at KIWAKKUKI, I asked him if he'd ever been to the top before. He laughed and shook his head as if he'd never heard of a more ridiculous notion. It is too cold and too expensive, he said, and, besides, he could see it just fine from here. He was only climbing now, he added, for HIV. The others said more or less the same thing. A woman named Romana told me she wanted to be the first HIV-positive Tanzanian to reach the peak. She wasn't sure whether that woman already existed, she said, but she had never heard of her.

Neither had I. All along I had assumed that among the many feats recorded on Kili's slopes--the Brazilian who'd run right up to the summit in twenty-four hours, the English brothers who'd cycled up surviving on Mars bars, the German who'd walked backwards the entire way--there was the story of an HIV-positive Tanzanian. But I had never actually read this anywhere. So I asked one of the guides if he knew of any who had made it. "So many people have HIV," he said, "I am sure some have reached the top. You just do not hear about them because they don't want you to know who they are."

Here was a perfect example of the "stigma" I'd been hearing about. Experts were always blaming it as a hindrance to their treatment efforts. The ostracizing of people who were HIV-positive by a community that regards the disease as punishment for promiscuity had long made Africans, especially women, think twice about presenting themselves for testing or treatment. But here, too, was a chance to change that.

As Mwita stood at the top, he looked out over Moshi. People couldn't see him from there, he said. But they'd see him later that week in the paper. And maybe, he hoped, they would read the story.