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, by Daniel Baxter
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Product details
File Size: 1742 KB
Print Length: 312 pages
Publisher: Skyhorse (June 26, 2018)
Publication Date: June 26, 2018
Sold by: Amazon Digital Services LLC
Language: English
ASIN: B076QHTB8V
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Amazon Best Sellers Rank:
#1,136,873 Paid in Kindle Store (See Top 100 Paid in Kindle Store)
This is book is very much a memoir, and reads like a detailed stream of consciousness of one doctor who treated many suffering HIV patients in a well known former HIV hospital New York, and then later grew disenchanted treating more minor problems in an outpatient clinic and travels to Botswana when treatments for HIV became available in Botswana. The day to day work in hospitals in Botswana is really descriptive and gives you an idea of what Botswana is like without painting an overly rosy picture.Perhaps similar to people working in hospice and palliative care, the author discovers that witnessing the deaths of a large number of patients actually sensitizes him to the suffering of others, and in the end makes his work in an outpatient clinic more satisfying. Working in Botswana from 2002 to 2008, and then returning for two years in 2013, it is interesting to see how things have, or haven't, changed in Botswana and to read a little bit about other interesting patients and colleagues that the author runs into.The author isn't an expert on the epidemiology of HIV, but does spill some ink describing the roots causes behind the high prevalence of HIV in Botswana, which probably does justice to the Botswana people who are confronting a crisis well-beyond the scale of anything seen in most western countries in terms of huge effects on society at large.The ambivalence that the author regarding his work in the US, the shortfalls in Botswana, and just dealing with greatly suffering patients in general more or less comes to a satisfying conclusion at the end of the book. Although the author takes a more philosophical perspective by saying that he didn't "save" anybody in Botswana, only that treating patient extended their life span so that they can "save" themselves, it would have been interesting to know what he thinks about optimizing HIV care, and general medical care, in Botswana and what sorts of behavior change techniques could be used with patients and general community members to curb the trajectory of the HIV epidemic there.
I have recently been thinking a lot about how we don’t really talk about HIV and AIDS that much anymore. As a kid born in the late 70’s I remember the dark days of the 80’s when people were dying in numbers from the disease and we assumed it would become a Black Death type plague, the early 90’s when our beloved Freddie Mercury died, his illness a secret until his death. And then the ARV medication cocktails started to work, and people stopped dying... The billboards disappeared and we started to worry more about HPV-related cancers, Ebola, Zika, and the re-emergence of certain vaccine-preventable viruses like measles.Remember when reports told us that AIDS would wipe out Africa? Was it all scaremongering, or was it really on the brink of a continent wide pandemic? I certainly never really took too much time to do more than some topical research on the subject, just assumed that we had managed to solve the crisis with the drugs that had become the norm in the US. As I have been digging a little deeper into the subject recently, One Life At A Time by Daniel Baxter popped on my radar, and I feel it provides a very enlightening narrative into a small part of Africa and the AIDS epidemic, through Baxter’s personal experience in Botswana.Baxter worked as an AIDS doctor in NYC during the worst US era of the illness, the 80’s, and left for Botswana on a slight whim in 2002, excited to bring his expertise and care to the Batswana, where at the time a big portion of the population was assumed to be infected with the virus (24%). Through his two stays in Botswana (6 years and then 2 years with a 4 year hiatus between) Baxter recounts how he arrived in Botswana assuming certain things and instead learnt many lessons, some heartbreaking, some embarrassing, and some just really important along the way.Africa is a continent, a huge continent, comprised of many countries, and this memoir only describes the AIDS situation in Botswana from the early 2000’s onwards, so while other countries similar in population and government might have had the same processes in place I think it’s important to have a distinct view of all, just as we would when talking about different European countries. More importantly we should draw a comparison with other countries where the attitudes towards prevention and care have been different, or were different at the time (South Africa for example), to see how important the collaboration between the Botswana government, population and outside agencies was/is.There are times during his first stay in Botswana (6 years) when I felt that the narrative gets a little jumbled up, Baxter’s memories and facts all colliding together, and I found it hard to fasten myself to a timeline or even a character or edifice that I would reencounter again down the road. This isn’t a bad thing, just that sometimes the stories were combined in a way that makes it a little hard to get through, because you have to go back a few lines or pages and read them over again. The second part of the book, when Baxter goes back to Botswana for another stint after 4 years in NYC, is less haphazard, written with more focus, and a lot easier to follow in general.All in all I thought One Life At A Time was a great story of how an American doctor lands in a country he does not know at all, and learns so much more than he ever imagined he would. While Baxter brings his expertise to help the people of Botswana combat the epidemic of AIDS in the country, he receives so much more in return, including a lot of humility and a much wider view of the world. I feel like I learned so much more about Botswana than I ever knew before, and am now interested in learning much, much more. Last of all, I think it’s very important to mention that Baxter never portrays himself as a savior - he just continued to do the work he had been doing in the 80’s and 90’s in NYC in Botswana, and is very vocal about how much he learned about himself when he was there. One Life At A Time is a brilliant insight into the AIDS epidemic in general, how hard work and collaboration (we can include Dubya -in this part too - PEPFAR helped make a huge difference in how HIV positive patients in Africa received care), can turn despair into hope. I’m looking forward to reading Baxter’s other books now too.
A worthy read about a slice of the world we don't read much about and a disease that's slipped down in the news media. Baxter had been an infectious disease specialist for years when he decided to go to Botswana. Seemed like a good decision but then he discovered (and it should not have been the surprise it was) that practicing medicine and dealing with AIDS is far different in Africa than it is in the US. His second tour seems more successful but he's still overwhelmed. There's a certain amount of first world-third world conflict (naturally) but it's the patients who will stay with you. Thanks to Edelweiss for the ARC.
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