Case Battles Uganda Crisis Oks Huge Spending Measure $25 Million Approved for Euclid Corridor Alan Fram Associated Press

TODAY: Clouds, some sun. YYYYY HOME&NEWSSTAND | $1.50 High 51, low 33. Map, B10. ONLINE: WWW.CLEVELAND.COM GLENVILLE’S HOLIDAY GIFT BIGDAY GUIDE ALUMSLEADOSU SUNDAY OVERMICHIGAN MAGAZINE MARVIN FONG THE PLAIN DEALER OSU quarterback Troy TARBLOODERSTOP MORETHAN$300 Smith, a Glenville alumnus, rushes for 145 yards and IGNATIUSINPLAYOFFS INCOUPONS SUNDAY passes for 241 yards in the 37-21 win. SPORTS INSIDETODAY [[[[[[ NOVEMBER 21, 2004 SUNDAY ARTS: BUSINESS: ‘Lemon law’ TRAVEL: Tracing NBA: Cavs win; 4 suspended Return of the biopic leaves a bitter taste roots on 2 continents in Pistons-Pacers brawl. SPORTS TEAMING UP AGAINST AIDS Congress Case battles Uganda crisis OKs huge spending measure $25 million approved for Euclid Corridor Alan Fram Associated Press

Washington — Republicans whisked a $388 billion spending bill through Congress on Saturday, a mam- moth measure that underscores the dominance of deficit politics by curbing dollars for everything from education to environmental cleanups. The House approved the measure 9/11 PLAN by a bipartisan 344-51 BLOCKED: margin, while Senate House Republi- passage was by 65-30. cans derail leg- The legislation in- islation to cluded $25 million for overhaul the the Euclid Corridor nation’s intelli- project. gence agen- Senate approval cies. A18 took longer because of disputes over provisions dealing with abortions and members of Congress’ access to income tax returns. From its tight domestic spending to the Democratic-backed provisions on VANESSA VICK SPECIAL TO THE PLAIN DEALER overtime and other issues that were Case Western Reserve University and its collaborators in Uganda have conducted 17 years of research into two of history’s biggest killers — AIDS and dropped, the bill is a monument to the tuberculosis. The partnership is helping patients like Sarah Lubalande, part of a long-running community health study of TB. GOP’s raw power controlling the White House and Congress. It is an imposing monument, too. n a remote region of East Africa But the persistence, compassion and, for About this series see CONGRESS A20 where AIDS was ravaging millions some, sense of adventure that brought Case Today: Case and Uganda launch historic of people, a handful of researchers Western Reserve University researchers to partnership to research AIDS. See A8. from Cleveland joined a small band the fight has earned them worldwide recog- Monday: Case becomes a world leader in of doctors in Uganda in 1987 to take nition for their accomplishments. They have tuberculosis research through its collaborative on AIDS. published close to 100 studies and generated clinic in Uganda. IThey never imagined that the epidemic more than $100 million in research grants. Tuesday: Emergency AIDS dollars changing the would kill so many or that their struggle In a three-day series starting today, follow face of research in Africa. would continue for nearly two decades. their progress in this scientific endeavor. Online: Follow the series at There is no end in sight for the AIDS crisis. — Regina McEnery www.cleveland.com/ugandaaids

A world of vacation TIM CLARY AFP/GETTY IMAGES time, except in U.S. “The effort is united and the message U.S. workers overworked, overstressed is clear to Mr. Kim Jong Il: Get rid of Paid-leave your nuclear weapons programs,” for dual earners with children jumped time for the joys and demands of home days Average President Bush warns at the summit Long hours threatening from 80.7 in 1977 to 90.9 in 2002. life, counteract unemployment, even be dictated paid-leave in Santiago, Chile. our health, family time R As the year winds down, employees who kind to our waistlines because we Country by law days hoarded vacation days may decide not to wouldn’t be gobbling all those fat-laden Australia 20 25 Alison Grant take them: A study by Expedia.com shows fast foods. China 15 15 Bush warns Plain Dealer Reporter that U.S. workers leave three vacation Kerry Aldridge, 50, eased out of the France 25 25-30 days on the table, on average, up from two time trap when she left a second-shift hos- Germany 24 30 If you’re feeling crispy around the edges in 2003. pital job on a surgery ward where piles of Iran, N. Korea on the job, perhaps you are. R The demands are coming at an early paperwork, staff turnover and a nursing Ireland 20 28 R Americans, the world’s workaholics, put age: The Girl Scouts have a “Stress to Suc- shortage made for overload. The regis- Italy 20 30 in an average of 1,815 hours in 2002, sur- cess” badge, focusing on stress-reducing tered nurse switched to the Lutheran Japan 10 17.5 on weapons passing the Japanese, who logged an aver- techniques for today’s frazzled youth. Home in Westlake, where she coordinates Sweden 25 25-35 Terence Hunt age 1,800 hours. Other industrialized But pressure to get out of the rat race is Medicare and Medicaid assessments of United Kingdom 20 25 countries dip as low as 1,325 (the Nether- also growing. residents. Associated Press United States 0 10.2 lands). Advocates of a slower lifestyle say it “It’s a really caring situation,” she said. R SOURCES: Work to Live; Families Santiago, Chile — Facing nuclear Couples have less free time for families. would lessen the job burnout that is crisp- “I feel like I never want to change jobs.” and Work Institute The average combined weekly work hours ing the edges of so many, provide more see WORKERS A19 THE PLAIN DEALER challenges on two fronts, President Bush warned Saturday that Iran’s suspected weapons program is “a very serious mat- ter,” and he stood united with leaders of Soldier killed in ambush: Asia and Russia in demanding North Insurgents battle American Korea’s return to stalled disarmament Breast-feeding in the Capitol troops in the streets of talks. INSIDE Baghdad. A12 Iran and North Korea, two nations in what Bush has branded an “axis of evil,” Woman nurses baby before testifying on bill about nursing in public SundayArts...... J1 The race for mayor: Sev- dominated the president’s attention Classified ...... N1 Ted Wendling eral candidates are consider- along with trade and economic issues at blouse and fed Liam some hu- rants, stores and other public Deaths...... B7 ing a run for mayor of Cleve- the opening of a 21-nation summit of Plain Dealer Bureau man milk, from its original con- places of accommodation, pre- Driving...... F1 land. Metro Asian-Pacific leaders. Bush tried to ease tainer. Some of the women in the venting businesses such as Wal- Editorials...... H2 Columbus global concerns about the sinking value —Itwasnear room smiled or cooed. Most of Mart and Wyandot Lake water Homes ...... E1 The right stuffing: Experts of the dollar, a drop based in part on in- lunchtime, and the legislators’ the men averted their eyes and park from forbidding their cus- Movies...... J9 give their advice for packing vestors’ fears about the huge U.S. trade and lobbyists’ stomachs were fiddled with their briefcases or tomers from nursing. PDQ...... L1 it away on Thanksgiving. and budget deficits. rumbling. So was 6-month-old their Palm Pilots. This summer, the 6th U.S. Cir- Sports...... C1 PDQ Liam Yeung’s walnut-size Liam’s lunch was the prelude cuit Court of Appeals in Cincin- Fresh from his re-election, Bush met tummy, and he was beginning to to an extraordinary hearing nati ruled that Wal-Mart’s re- Call of the wild: It’s the in rapid succession in his hotel with the fuss. Wednesday on a bill co-spon- fusal to allow women to breast birds that bring men and leaders of Japan, South Korea, China So Liam’s mother, Ahmie, a sored by 11 House members — feed in its stores does not violate their best friends back to and Russia, his partners in the talks small-business owner from none of them men. The bill an Ohio law that prohibits sex Pelee Island each year to with North Korea, which is led by the Cleveland’s Old Brooklyn neigh- would allow women to breast discrimination in public places. hunt, bond and bark at the mercurial dictator Kim Jong Il. borhood, discreetly lifted her feed their children in restau- see NURSING A16 6 74776 18012 1 moon. Sunday Magazine see SUMMIT A10

C M Y K 70001SFA112170001FLA11217300103A1121 END PAGE. DON’T ERASE! A8 The Plain Dealer Sunday, November 21, 2004 TEAMING UP AGAINST AIDS In 2003, an estimated 3 million people in sub-Saharan Africa contracted HIV.

PHOTOGRAPH COURTESY OF DR THOMAS DANIEL The tuberculosis ward at Kampala’s Mulago Hospital, where Case’s early epidemiological studies were conducted. As many as 75 percent of the patients were also co-infected with HIV. A call to arms against Goliath of disease

Regina McEnery their mothers. Uganda. wasn’t trained in research and for isolating the West Nile virus, But there was no place nearby Plain Dealer Reporter But not even the prescient Olness looked at the petite had never managed a laboratory. was in chaos. to cash or deposit checks — a real Cleveland scientists who sent University Hospitals physician Yet Guay couldn’t stop think- In the aftermath of war, the headache if the research facility ampala, Uganda — Guay to Uganda realized they with the unflappable nature and ing about the medical school cavernous 1,000-bed Mulago was to pay its staff. And the Dr. Laura Guay worked were heading into one of the had a hunch that Case’s search course that took her to a mission- Hospital had anemic electricity equipment, sent by boat from her way through the worst pandemics in human his- for an on-site director was about ary hospital in Zaire in 1985, and and at times no running water. Tanzania, could take up to four throng in the dimly tory. Faculty members at Makerere months to arrive. So Case scien- K to end. She knew that Guay was a her desire to return to the conti- lighted Entebbe International By 2004, an estimated 25 mil- University Medical School had tists started bringing supplies hard-working problem solver nent that had captivated her Airport terminal, past the sol- lion people in sub-Saharan Africa fled during Idi Amin’s brutal dic- and household products with with a good sense of humor. since her girlhood days when she diers with AK-47s , where a alone would be living with HIV/ tatorship. Basics like syringes, them during their flights to Guay’s background in pediat- watched the 1960s television se- nurse from Minnesota was wait- AIDS. More than 2.2 million gauze and thermometers were in Uganda. ing to take her to the country’s would be dead from AIDS-related rics was also a plus, Olness ries “Daktari.” short supply. Finding gasoline Patients, however, were not in capital, Kampala. infections. The epidemic would thought. While the Case scien- And when she met Robbins, could be a challenge. short supply. The 29-year-old physician destroy economies, orphan mil- The tiny office for the Case The hospital had been trans- from Cleveland no longer had lions and drop life expectancies. project, across from the TB ward, formed by AIDS. HIV-infected her suitcase full of clothes. But The Case project, cobbled to- Not even the prescient Cleveland didn’t have a telephone, let alone patients flooded the emergency the airline hadn’t lost the other, gether in months and launched a fax machine, so Guay called her room and the maze of barracks- more important, bag, the one she on a shoestring in 1987, has be- scientists who sent Guay to Uganda Cleveland researchers once a like wards. had crammed with syringes, of- come the longest-running aca- week from the home of a Ugan- Nearly three-quarters of the fice supplies, alcohol swabs and demic AIDS collaborations in the realized they were heading into one dan physician. tuberculosis patients were in- enough test tubes to store about developing world. By 1992, while In the office, Guay immedi- fected with HIV. Kaposi’s sar- 50 vials of blood. the epidemic in the rest of the re- of the worst pandemics in history. ately installed metal doors, shut- coma, a cancerous lesion that in Guay, a pediatrician who had gion continued to escalate, Ugan- ters and a metal ceiling to pre- the United States is found almost trained in a state-of-the-art chil- da’s AIDS rates began to decline. vent theft of payroll and supplies. solely in gay men with AIDS, was dren’s hospital, felt as though Fred Robbins saw the tidal The laboratories were also in striking heterosexual men and she’d landed in a war zone. It wave approaching. He knew that tists had plans to tackle HIV/TB, Guay felt inspired. She cottoned disarray. There was nowhere to women. Pregnant women were store the TB skin tests and HIV was 1988, two years since a coup the impoverished continent was behavioral health and AIDS-re- to his idea of a global medical routinely passing HIV to their blood samples used in the re- — Uganda’s third in 16 years — ill-prepared to stop the cycle of lated cancers, the most immedi- community working to eliminate unborn babies. had rocked the East African heterosexual transmission or the search because someone had sto- With no drugs or treatment, ate concern was to set up a study stubborn epidemics like malaria country. Military roadblocks devastating effect that AIDS had len the condensers from the re- children withered from the dis- to track the impact of mother-to- and TB. They had a mutual inter- were part of the landscape. Chil- on infants and unborn children. frigerators. ease. child transmission of AIDS. Ol- est in Africa and children. dren in rags sported rocket It was why Robbins, an icon in Several Case scientists and ad- A week after arriving in Kam- ness would oversee the research. In the end, when she broke the launchers. polio research, led a delegation ministrators joined her during pala, Guay began to feel the “Why don’t you contact Dr. news to her worried parents and But as the car swerved over the to Uganda in 1987 to tour the her first month in Kampala to weight of responsibility after Robbins and Dr. Ellner,” Olness battle-scarred highway, more country’s shattered laboratories postponed her oncology fellow- meet their Ugandan collabora- sparring with Uganda’s top ob- jolting was the pyramid of un- and hospitals, and why he told the third-year medical resi- ship, the decision felt like fate. tors and set up the research. stetrician. Case hoped to make sold coffins being hawked along pushed Case to establish the re- dent. “We need a pediatrician They bought a rusty white VW to inroads into the prevention and the smoky highway. It was one search partnership. willing to move to Uganda.” A medical system navigate Kampala’s dilapidated treatment of pediatric AIDS. To thing to listen to colleagues talk After returning, Robbins as- Guay felt torn as she left Ol- in complete chaos roads, rented a house about 20 launch the project, they needed about the AIDS epidemic sweep- sembled a team that spanned ness’ office. She had already minutes from the medical school to find HIV-infected pregnant ing Africa. It was quite another tuberculosis, malaria, anthropol- lined up a hematology/oncology In 1988, Uganda’s medical sys- and nailed down the best ex- women willing to enroll them- to see the effect of the world’s ogy, oncology and pediatrics. He fellowship in Rochester, N.Y. She tem, famous for discovering the change rates in Uganda’s high- selves and their infants in a long- highest prevalence of HIV/AIDS. also put TB scientist Dr. Jerrold didn’t have a background in HIV, cancer Burkett’s lymphoma and inflation economy. term study. She felt her stomach lurch. Ellner in charge of the AIDS proj- But the day Guay walked into The trip from the airport was ect. the busy prenatal clinic at Mu- taking forever because of the aw- “I’m too old to be the principal lago Hospital, its diminutive di- ful roads. She was grimy and investigator, so you can do it,” rector, Dr. Francis Mmiro, had tired from the 20-hour flight. She the 70-year-old Robbins pro- no idea who she was or what she could hear the rat-a-tat of gunfire posed after walking into Ellner’s was doing there. in the distance. laboratory with two cups of cof- “This is my prenatal clinic, and But she was glad to be here. fee in the spring of 1987. no one will come in and do any- She’d been waiting years for this thing without my permission,” moment. From polio research Mmiro told a startled Guay. Guay had come to Uganda to to confronting AIDS The normally jolly-faced be the on-site director of one of Mmiro belonged to a cadre of the world’s first international By fall, Case had submitted a stoic Ugandan physicians and re- collaborations for AIDS research. grant request to the National In- searchers whose careers had Case Western Reserve University stitutes of Health listing a half- been redefined the day they had School of Medicine formed the dozen AIDS-related studies that traced Africa’s first documented partnership with Uganda’s Mak- the researchers wanted to launch cases of HIV to Rakei, a trading erere University in 1987 after with Ugandan colleagues. center about three hours from data suggested that the AIDS epi- Yet when Guay put in for the Kampala. demic was going to be huge and assignment, the young pediatri- They would later come to view devastating. cian had no idea who Robbins the collaboration with Case as a Case had no school of public was or that in 1954 he had valuable weapon. Their relatives health and no AIDS division, but shared the Nobel Prize for polio and friends were dying or dead still it took the unusual step of vaccine research. from AIDS, and it was impossible pursuing small research grants All the Richmond Heights resi- to find a Ugandan untouched by from the U.S. government. It dent wanted to do, she told pedi- the epidemic. won one of the five $500,000 atrician Dr. Karen Olness, was But for now, the Case scientists grants that the National Insti- work in Africa for a year. “Do you seemed like naive travelers who tutes of AIDS and Infectious Dis- know of any programs avail- had crossed an international eases made to set up AIDS collab- able?” she asked. boundary without the proper pa- orations in developing countries. Guay approached the Rainbow pers. Mmiro looked at Guay and Under the leadership of Dr. Babies & Children’s Hospital spe- asked pointed questions about Fred Robbins, Case’s former cialist because Olness and her the data the scientists needed dean of medicine and Nobel lau- husband, Hakon Torjesen, direc- and who would have access to reate, a small crew of researchers tor of Case’s new Center for In- the records. decided to tackle four issues: ternational Health, were long- Mmiro finally told Guay he R The intertwining of HIV and time refugee camp volunteers. needed time to review the proj- tuberculosis (TB) The two helped restore a health ect. R Behavioral health issues center battered during Uganda’s PHOTOGRAPH COURTESY OF DR. LAURA GUAY After three months of negotia- R AIDS-related cancers long civil war in the 1970s. Ol- Dr. Laura Guay at work in the pediatrics AIDS clinic at Mulago Hospital around 1990. The clinic tions, Guay got permission to R And the heartbreaking number ness was now involved in Case’s was where the Case collaboration launched its pediatrics project studies of maternal-child screen pregnant women for HIV. of children acquiring HIV from new AIDS collaboration in transmission of HIV. see UGANDA A9

C M Y K 7000803A1121 END PAGE. DON’T ERASE! The Plain Dealer Sunday, November 21, 2004 A9 TEAMING UP AGAINST AIDS Only 7 percent of AIDS patients in developing countries have access to life-prolonging AIDS drugs.

UGANDA, from A8 Case researchers

Her staff moved into a room forged partnership next to the hospital’s noisy ob- stetrics ward, where 1,000 babies The great epidemic to study AIDS w ere delivered each month.Case’s early data showed Despite poverty and political instability, Uganda has 17 years of research Dr. Fred Robbins led a that about one in four pregnant delegation to Uganda in 1987 women were infected with HIV, led a successful prevention campaign against AIDS Case projects in Uganda have generated more than $100 million in that spurred but only a few wanted to know and fostered strong relationships with researchers AIDS and tuberculosis grants since the collaboration began in 1987. creation of one of the the results of their test. around the world. Uganda’s longest-standing ANNUAL $9.5 million $8.2 million Guay wasn’t surprised. EXPENDITURES world’s first The weight of discovery could academic partnership has been with Case Western $9 international cost these women their hus- Reserve University. Launched in 1988, when Uganda $8 collabora- bands, their homes and their had the highest AIDS prevalence in the world, the $7 tions for lives. Government officials dis- $6 AIDS suaded doctors from disclosing partnership is still growing strong and Uganda’s $5 research. the diagnosis unless a person AIDS rate is now among the lowest in Africa. $4 Robbins $131,000 selected a had symptoms because they were $3 research team at Case, helped afraid people would commit sui- $2 cide or be ostracized. dollars Millions of obtain a $525,000 grant from Uganda $1 And what could Guay offer the N 100 miles the National Institutes of 0 women in return for full disclo- at a glance SUDAN 1988 19901992 1994 1996 1998 2000 2002 2004 Health, and established a partnership with Makerere sure? AZT, the world’s first AIDS Independence: 1962 drug, had barely made it onto the ZAIRE UGANDA Three key grants University in Kampala and the Capital: Kampala shelves of U.S. pharmacies and Lake 1991: Uganda Ministry of Health. Population: 26.4 million Albert AIDS International Training and Research Program was not available in Uganda. Lake launched ($14 million through 2008) Robbins died last year at 86. By January 1989 the first in- Kampala Kyoga Major projects: Shared the Since gaining Lake 1994: fants to be enrolled in the study Edward Tuberculosis Research Unit established 1954 Nobel Prize for Medicine independence from Great KENYA were born. Within a year Case Lake ($47 million through 2006) and Physiology for his polio Britain, power in Uganda was tracking close to 700 women Victoria 1997: research; former director of has been largely in the Case begins work on Africa’s first AIDS vaccine trial and children. Case first looked at RWANDA the Institute of Medicine in hands of three men. The ($3.3 million one-time grant) infant immune responses to the Washington and former dean first two, Milton Obote TB vaccine and the pregnancy BURUNDI of the Case Western Reserve (1966-1971; 1981-1985) outcomes of HIV-infected moth- AFRICA Map HIV declines in Uganda University School of Medicine. and Idi Amin (1971- ers. Later, scientists would test TANZANIA area AIDS experts believe a public education campaign contributed to 1979), seized absolute drugs to try to prevent mother- drops like those shown below among pregnant women in Uganda’s Dr. Karen Olness, power for themselves 68, is a child transmission of AIDS. urban areas. and plunged the country pediatrics professor with the As AIDS cases multiplied, into chaos. The economy collapsed, as many as HIV PREVALENCE Rainbow Guay became both family doctor 100,000 Ugandans died in a civil war during Obote’s Center for and scientist to the women and second reign, and Amin is believed to have had as 30% International children, treating their ailments many as 300,000 of his opponents Health. She while honoring their wishes not 25% 30.8%30 killed. The third man, Yoweri Museveni and her to be told they had the virus. 20% 11% (1986-present), put an end to the chaos husband, By the fall of 1990, close to 15% of his predecessors. During his time in Hakon one-fifth of the babies enrolled in 25% office he has improved the economy, 10% Torjesen, the project’s first phase had died 2001 figures ended human rights abuses and 5% Case’s before their first birthdays. The are the most director of provided the kind of stable government 0 recent clinic assumed that the deaths the center, approached and society that has made the Case available were from AIDS, but Guay would project possible. Museveni 1988 19901992 1994 1996 1998 2000 Robbins in 1987 about never know for sure because HIV forming the collaboration. A is hard to detect in infancy. year later, Olness helped Those who were diagnosed with Sub-Saharan Africa launch studies that estimated AIDS began dying despite the Global AIDS cases that a quarter of the pregnant clinic’s efforts to treat the infec- The number of people living with HIV. 25 million women in Uganda’s urban tions. areas were infected with HIV. Major areas of research: Cleveland team North America Brain development of HIV- pulled into crisis 1 million infected children; effects of malaria on children with HIV. The Cleveland scientists who joined Guay from time to time Caribbean Janet McGrath, 45, an were an eclectic lot. Some peered 430,000 anthropologi st, was recruited into microscopes; others waded by Robbins to through data. Still others tended Latin America study the to the research project’s AIDS pa- 1.6 million socioecono- tients. They were runners and m ic forces hikers, suburbanites and city driving AIDS. dwellers. When she They had joined forces with a made her goal that at times seemed unat- first visit in tainable given the aftermath of 1988, Uganda’s civil war, the poverty Sub-Saharan Africa has Western Eastern Europe patients were and the Goliath-like strength of 10 percent of the world’s Europe and Central Asia lying on the virus. population but two-thirds of the 580,000 1.3 million hospital floors waiting to see Case’s early data showed strik- HIV population. According to the doctor, and few could ingly high rates of HIV. These East Asia UNAIDS estimates, an estimated North Africa afford an HIV test. statistics collided with the harsh 900,000 22.9 million Africans have died and Middle East Major areas of research: realities of trying to practice of AIDS and some African 480,000 South and Sexually risky behaviors of Western science under Third countries have infection rates Southeast Ugandan women, AIDS World conditions. They struggled approaching 40 percent. Oceania Asia vaccine trial education. to find those willing to pay for 32,000 6.5 million the studies. Supply shortages and equipment failures created un- Dr. James Kazura, 57, is an told delays. SOURCES: Case Western Reserve University School of Medicine; Joint United Nations Programme on HIV/AIDS; CIA World Factboook; http://en.wikipedia.org/wiki/History_of_Uganda oncologist and malaria expert Janet McGrath, a young an- REID BROWN | THE PLAIN DEALER who studied thropologist from Case, had been whether Ka- sent to Uganda to delve into the posi’s sar- behavioral and cultural patterns coma was linked to a that put women at risk for HIV. of time. Guay held her breath ev- thought Guay a little crazy for TB, malaria and preventable can- would stay that long. But re- virus en- As she followed Guay through ery time the lights went out. moving to his country. Guay even cers at a frightening rate. Thou- search had a way of sucking you demic in the one of the clinics, women and Finally, the lab got a computer. wandered around after dark de- sands of children were born with in deeper and deeper until you developing children were stretched out on But it was still a primitive opera- spite the lack of security. HIV or orphaned by AIDS. couldn’t let go. world that the floors waiting to see a doctor. tion when Dr. Brooks Jackson, a But he liked the American The sheer number of cases and The oncology fellowship she Dr. James Kazura had been also gave rise Case pathologist, arrived in 1990 from the start. She went out of the poverty were mind-boggling, had postponed in 1988 had given to adult leu- paired with Uganda’s chief onco- to evaluate the facilities. Robbins her way to socialize with the Guay thought, as the study way to a new interest in AIDS. logist to look closely at the roots kemia. Kazura didn’t find a had recruited Jackson soon after staff. She laughed easily. She was moved forward. After a while, She would return to University of Kaposi’s sarcoma. connection, so the study ended the collaboration began to set up usually the last one out at the the epidemic became almost un- Hospitals for advanced training The night Kazura arrived in in 1991. He is now director of clinical trials on mothers and ba- end of a long day. She would bearable for the researchers. The in infectious diseases. Uganda, the sound of gunfire Case’s Center for Global bies. Jackson took one look at the even steal onto the floors of the statistics now carried names and A year before leaving Uganda, sent him diving to the floor. He Health and Disease. laboratory and felt like he had intensive-care unit at 3 a.m. to faces. The nurses and doctors with the Case collaboration didn’t have the nerve to tell his Major areas of research: stepped back in time. check on her tiny patients. had witnessed the deliveries of growing rapidly, Guay gave up wife that it wasn’t fireworks she Kaposi’s sarcoma. “Laura, you have to take a hundreds of babies, gotten to her job as the on-site director to heard when she called from break,” Bagenda would often tell know their mothers and visited concentrate full time on the pedi- Cleveland Heights. Laboratory methods Dr. Thomas Daniel, 76, spent Guay. their homes, only to watch the atric project. Dr. Thomas Daniel, a TB scien- crude and inefficient a year in Bolivia with the Peace Bagenda and Guay worked babies die. Would the research make a dif- tist from Shaker Heights, had Corps during Lab workers were doing standard side by side for two years, first in It became so draining that ference? It was too soon to tell. spent a year in the mountains of the 1970s, so blood counts manually using a the prenatal clinic and then at Guay added counselors to help Robbins wanted the collabora- Bolivia during the 1970s working Uganda 50-year-old microscope. Ward 11, a ranch-style building her stoic nurses cope with the tion to set up clinical trials with alongside Peace Corps volunteers seemed tame The lab wanted to move be- given to the Case collaboration deaths. and had worked in Haiti. mothers and babies so they could in compari- yond simple HIV-antibody test- about a year after Guay arrived in He went to Uganda hoping to find ways of reducing perinatal son. An infec- Kampala. nail down a rapid, reliable blood ing and begin subtyping HIV. Homeward bound transmission of HIV. But those tious- disease The long process of collecting test for the infection. Most TB Jackson told Guay they needed after three years studies were several years off. physician and analyzing data was painfully patients with HIV couldn’t seem an experienced technologist to After three years, all the Case and tubercu- juxtaposed against the rising Uganda was supposed to be a to produce telltale antibodies so train the technicians in good lab- collaboration could say for sure losis expert, death toll, rattling the steady 12-month detour for Guay, a way physicians were forced to rely on oratory practices. He suggested was that the epidemic was get- Daniel docu- hands of Case’s scientists on the of assuaging a stubborn curiosity more labor-intensive methods to that Case appoint someone to ting worse. The percentage of mented how ineffective blood front lines. about Africa. But it was nearly diagnose TB. oversee the lab. pregnant women coming into the tests were in detecting TB in AIDS patients wasted away three years before she headed Daniel also helped Guay de- Jackson knew the lab had prenatal clinic infected with HIV people with HIV, but efforts to from diarrhea. They contracted home. She never thought she velop a system to track the thou- miles to go, but he saw the in- had grown from one in four to find a more reliable test eluded sands of specimens stored in the credible possibilities. nearly one in three. him. Daniel retired from Case laboratory’s subzero freezers. The laboratory grew more so- In 1994, the collaboration in 1994. The samples reflected tidbits phisticated and Jackson began shifted its focus more toward TB, Major areas of research: of data on Case’s expanding pa- his own projects, the first a Epilogue by then the biggest infection TB immunology. tient study base that Guay and search for the elusive antibody preying on Ugandans with AIDS. her technicians recorded pains- test that could diagnose HIV in Dr. Laura Guay and her colleague Brooks Jackson A $19 million federal grant takingly by hand in a giant log. infants. He also started develop- left Cleveland in 1996 for Johns Hopkins Univer- would put the Case group on the It was through this massive ing clinical trials that would sity School of Medicine. Determined to find a road to international dominance Footnote catalog of stored blood that Case prove to be a turning point in the cheaper, more effective way of reducing the rate in the field. Kaiser Family Foundation was able to document the rates prevention of mother-child of pediatric AIDS, Jackson and Guay launched a But for Guay, it was about the in California awarded reporter and progression of HIV infection. transmission of HIV in the devel- large, groundbreaking study of the AIDS drug children. It would always be Regina McEnery a travel The laboratory operation was oping world. nevirapine that was found to cut transmission of about the children. grant to help research this crude. Weeks of inventory could Danstan Bagenda, the Ugan- HIV from mother to child by 50 percent. The project. be destroyed in a flash if the dan biostatistician working on study, led by Jackson, proved to be a major To reach this Plain Dealer reporter: freezer lost power for any length Case’s pediatric project, always Guay turning point in the battle against AIDS. [email protected], 216-999-5338

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