Man of the World: The Further Endeavors of Bill Clinton (36 page)

At the same press conference, Clinton and Magaziner also announced a new $5 million program in Rwanda, where CHAI would support the takeover and renovation of an abandoned rural hospital by Paul Farmer, who had proved at his clinic in the mountains of Haiti that treatment could be effective among the poor in less developed countries (contrary to the assumptions of leading health authorities). Farmer’s relationship with Magaziner—and the former president—had come a long way since he had mocked the Clinton administration’s priorities in a 1999 book on AIDS.

Still a trenchant critic of the wealthy nations’ failure to address the health care needs of the world’s poor, Farmer couldn’t help but point out to reporters that for anyone who had seen a child die of AIDS, $10 million was “too little, too late—but to let that paralyze us as a nation is a huge mistake.” Also present was Stephen Lewis, the U.N. special envoy for AIDS, who described the CHAI plan as “a breakthrough. It always enrages me that children are on the bottom rung of the ladder in international priorities. Now it’s clear that we will have these pediatric formulations.’’

It was the kind of advance that kept Clinton going even when he
felt discouraged by the scale of the pandemic. He often spoke of the continuing AIDS death toll as depressing, and sometimes sounded like Farmer when he scourged the response of Western governments as “pathetic” and “unacceptable.” When audiences applauded CHAI’s efforts at a speech or public appearance, he would always hush them, because so few were still being treated.

Yet he drew encouragement from the progress that CHAI had enabled so far, along with its governmental and nonprofit partners. According to Magaziner, nearly 400,000 people were receiving treatment less than two years after the program began. He expected that number to rise to one million by the end of 2006 and two million by 2008. “Let’s assume we need six million people getting their medicine,” Clinton would say, when asked about the daunting numbers. “If our foundation can account for two million of that, if we can do a third of that by 2008, then we’ve done a heck of a lot there.”

Fluent as he sounded when reciting the statistical data, those numbers alone revealed little about the realities on the ground, where CHAI’s roughly two hundred young staff and volunteers had to surmount cultural stigmas and backward systems every day, without alienating their government partners. In July he planned to visit Africa again, a summer trip that would become an annual pilgrimage to the continent, where he and his entourage would cover seven countries—Lesotho, South Africa, Tanzania, Kenya, Rwanda, and Mozambique—in ten days.

To anyone who went along on Clinton’s Africa trips, the march through clinics, hospital wards, community centers, and presidential palaces could feel dizzying and repetitive. But the annual tour served several important purposes. His appearance on site always provided an enormous lift to foundation staffers, toiling in difficult and distant places with very low budgets. His private meetings with heads of state and cabinet ministers rewarded them and fostered the critical relationship with government in country. His invitations to donors who accompanied him encouraged fresh funding and new networks of support. And his celebrity status attracted media coverage of the foundation’s work, at least sometimes. Among the journalists on the plane in July 2005 were writers for
New York
and
Esquire
magazines and a TV crew from CNN led by Dr. Sanjay Gupta, the cable network’s health correspondent.

Aside from those institutional considerations was the spiritual uplift for Clinton himself, a man motivated above all by human contact. Barnstorming through Africa, from big cities like Nairobi to remote farm villages in Malawi, brought him close to the work he had set in motion, and offered him a vital opportunity to meet the people whose lives he was seeking to improve—or save. In grim hospital wards and tiny rural clinics, he got to see what his foundation had actually done with the millions of dollars given by his friends in Ireland, Canada, Norway, and the United Kingdom.

And Clinton always paid a call on Nelson Mandela in Johannesburg, on or around the great statesman’s birthday, just like a good son.

On the morning of July 18, when Mandela turned eighty-seven, a small motorcade passed through the gates of his walled home in a leafy Jo’burg suburb called Sandton, where the two former presidents were to enjoy a private luncheon. From within the yellow stucco of Mandela’s home his booming, cheerful voice could be heard quite clearly as he walked out to the stone portico to greet the Clinton entourage, which included four aides, six Secret Service agents, a few current and potential foundation donors, and a couple of journalists. The graying Mandela now used a cane and a hearing aid, but his eyes were clear and his mind focused as he greeted each awestruck guest. He made no attempt to hide his own boisterous joy at seeing Clinton again.

That evening, Clinton and his party attended a gala celebration of Mandela’s birthday to raise money for his own foundation. Thousands of South Africans of all races showed up at a huge, wood-paneled civic auditorium to pay homage to the former guerrilla warrior who had led them peacefully out of apartheid. The event featured remarks by Clinton and various African dignitaries, including a speech by Wangari Maathai, the Kenyan environmental leader who had become the first African woman to win the Nobel Peace Prize in 2004.

When Mandela was seated onstage, he beckoned Clinton over to sit next to him. While the speeches and music continued, they could be seen whispering to each other and laughing, like the most intimate friends. Top aides to Madiba would say there were three sides of his relationship with Clinton—as father and son, as longtime friends, and
as peers in statesmanship. Estranged from his own four surviving children after his lengthy imprisonment, the lonely Mandela found empathy and understanding in his American friend. They were so close that in later years, as he grew weaker and his appetite waned, he would eat at Clinton’s urging.

And for Clinton, Mandela had become a spiritual mentor who provided counsel during impeachment, teaching him to liberate his own mind by refusing to reciprocate the hatred of his enemies. The public embrace of this secular saint continued to cloak Clinton in an impervious mantle of legitimacy—especially across Africa.

Later that night, the Clinton party would return to the Saxon Hotel, a luxurious retreat surrounded by woods where Mandela had lived after the Pretoria regime released him from prison. There the former president would linger quite late in the bar, talking and trading stories with anyone who had the stamina to stay up with him.

From Johannesburg, the Clinton party flew to Nairobi, Kenya, where the day’s stops included a health clinic operated by the French charity Doctors Without Borders, whose volunteer doctors used AIDS tests and medicines provided through CHAI; a public elementary school whose fees had been abolished under a program urged by Clinton when he was still president; and a private “bilateral” meeting with Kenyan president Mwai Kibaki at the State House.

Dapper in a tan suit and striped tie, Clinton emerged from that meeting to praise Kibaki, a competent, low-key technocrat who had helped return Kenya to multiparty democracy, implemented the education reform, and welcomed CHAI into his country. The feisty local reporters who awaited him were bursting with questions about the upcoming national election and the perennial complaints of opposition leaders.

“I would tell the opposition to keep on trying,” he said, grinning into a cluster of microphones. “It took my party 12 years to defeat the other side, but eventually we did it, and they can, too.”

Clinton’s evening hours in Nairobi were spent dining on room service with his aides in the Serena Hotel. After dinner he played cards and made telephone calls to the United States while chewing an unlit Cuban cigar and sipping occasionally from a glass of red wine. He talked with Hillary, as he did at least once a day, and with Rep. Donald
Payne, who then chaired the House Subcommittee on African Affairs, to update the New Jersey Democrat on the progress of his AIDS work.

From Nairobi, Clinton flew to Dar-es-Salaam, seaside capital of Tanzania, one of the most rapidly developing nations in East Africa. As his motorcade entered the city, thousands of people lined up along the roadside, cheering, waving, and simply staring—as they did in almost every big African city he visited. He was still immensely popular on the continent, where many remembered him as the first president who had seemed to truly respect and care about Africa.

His first appointment in Dar was at the U.S. embassy to participate in a ceremony marking the upcoming anniversary of the terrorist attack that killed eleven and wounded eighty-five there in August 1998, which had been timed to coincide with a similar truck-bomb attack on the embassy in Nairobi. As a former president, Clinton felt an obligation to provide support whenever possible to the Foreign Service corps, whose members were plainly delighted to see him. He offered brief remarks to the assembled diplomats and workers outside the embassy building, then went upstairs to the ambassador’s office for coffee.

Central to Clinton’s visit to Dar, as the capital is known, was the cultivation of Tanzanian president Benjamin Mkapa, a technocratic politician who was among the first African leaders to embrace CHAI. On this trip, Clinton not only held an hour-plus “bilat” with Mkapa and several of his ministers, but appeared with him at a lengthy outdoor ceremony, attended by many of Mkapa’s supporters and government employees, to announce a new partnership between the Clinton Foundation and the government of Tanzania to provide advanced training in HIV/AIDS clinical care and treatment to “at least 30 medical professionals” in country every year. Prepared for deployment to rural areas and other medically underserved regions, they would be known as “Mkapa Fellows”—a legacy that would continue after the president was replaced by an election in six months.

The meetings were also a chance for Clinton, Magaziner, and local CHAI staff to establish a stronger relationship with Jakaya Kikwete, the Tanzanian vice president and former health minister expected to succeed to the presidency when Mkapa retired. Their aim—with the meetings, the fellowship program, and Clinton’s visit—was to enable the swift scale-up of antiretroviral therapy under the National Care
and Treatment Program that the foundation and the government had developed together in 2003, during CHAI’s earliest days. Clinton nurtured the same kind of relationship in many countries, just as he had so often exercised his charm upon American governors, mayors, and legislators.

African leaders like Kibaki and Mkapa treated Clinton as if he was still the world’s most powerful head of state. Standing proudly beside him, they seemed to feel that his presence reinforced their authority and integrity (sometimes to the dismay of human rights organizations). More importantly, from his perspective, they listened when he urged them to help remove the stigma from their HIV-infected citizens, to expand health services in rural areas, and to cooperate with the United Nations, Western governments, and nongovernmental organizations such as CHAI.

The most affecting moments for Clinton, however, occurred in the communities that were at last beginning to feel the direct impact of his foundation’s efforts. From Dar-es-Salaam, he and his party flew across a small strait of the Indian Ocean to the Zanzibar archipelago, a semiautonomous province off the Tanzanian coast. Until three months earlier, Zanzibar had provided no AIDS treatment at all—a situation that CHAI staff in country attributed to its overwhelmingly Muslim population and conservative culture.

He landed in Stone Town, an ancient Moorish city that had been a center of the spice trade for hundreds of years. The morning destination was an old hospital on the edge of the sea, where dingy, peeling walls and dark, muddy floors contrasted with the bright, clean blue of water and sky. Green scrubs hung on an outdoor clothesline, and pungent odors hinted at inadequate sanitation. Without hesitation, Clinton climbed the stairs to a second-floor ward, followed closely by his aides and security. He shook hands with patients in their beds, talked quietly with their doctors, and inspected the new HIV/AIDS clinic. With fifty-six HIV-positive clients, receiving mostly outpatient treatment, the hospital expected to scale up to serve two thousand before the end of 2005.

He stopped for several minutes to talk with a tall, young, bespectacled doctor in lab whites, operating a large, boxlike machine that re
sembled an old-fashioned computer printer. It was an essential piece of technology obtained for the hospital by the Swedish government through the Clinton Foundation, under a negotiated agreement with the manufacturer, which measured CD4 white blood cell counts—the only way to determine whether the ARV medications are working in each patient.

Not only did Clinton recognize the electronic box; he clearly knew how to read the paper tape that emerged from it, surprising the doctor and everyone else observing them. “I was really impressed,” murmured a young woman from the U.S. Agency for International Development. “He was getting a lot of detailed information.”

In the hotel parking lot, he held an impromptu press conference for the local media and Gupta’s CNN crew. He was splendidly attired in a custom navy blue suit, red striped tie, and black Gucci loafers for a meeting with the island authorities. “I am thrilled to be in Zanzibar for the first time in my life,” he exclaimed with a broad smile. “Just now, I shook hands with an 11-year-old orphan child who knows that he is HIV-positive. His circumstances have changed. He doesn’t have to be stigmatized. And he doesn’t have to resign himself to an early death.”

In places like Zanzibar, where testing positive for HIV carried a disfiguring social stain, Clinton elevated the community’s suffering men, women, and children. With his embrace came the endorsement of local government, as local officials began to follow his lead in promoting science and compassion instead of superstition and stigma.

For months before his visit, CHAI staff had been working in Zanzibar, led by Tanzania country officer Sandra Cress, an American who had seen the job in a business school listing, and Edwin Macharia, a young, American-educated Kenyan who had worked at McKinsey. They had found bureaucratic entanglements at PEPFAR delaying the hospital’s purchase of lab testing equipment. Without tests there could be no treatment. Because CHAI could act swiftly, they arranged training for the hospital staff, and arranged a simple system to gather blood samples for transport via ferry to a private hospital laboratory in Dar-es-Salaam. Rather than wait until testing equipment arrived in Zanzibar, said Cress, who had accompanied Clinton from the capital, “we were able to get people on treatment very quickly, for a minimal investment.”
Now the Zanzibar hospital had its own testing facility and expanded treatment.