Unsung Victims of Dollar Diplomacy

By Vincent Rollet

FOLLOWING MALAWI'S DECISION to drop ties with Taiwan in favor of China, an important issue is emerging: What will happen to people living with HIV/AIDS who receive treatment and care from a joint Malawi-Taiwan program in Mzuzu City in the country's north?

The impact on Malawians could be devastating. Several other agricultural, health and cultural projects involving Taiwan will also have to be canceled at the expense of the local population.

In 2000, a Taiwanese medical mission began to work in the only referral hospital in Northern Malawi province, which is home to 4 million people who have limited access to modern facilities.

Given a nationwide lack of medical staff -- a problem that Medecins Sans Frontieres has cited time and again -- the presence of the 20 regular medical staff from Taiwan is very welcome; the team provides around 40 percent of in-hospital care in Mzuzu.

To support the fight against HIV/AIDS in Malawi -- where about 1 million people are living with HIV/AIDS and where 15 percent of people aged 15 to 49 are infected -- the Taiwanese team, in cooperation with Mzuzu Hospital, launched a program that has allowed around 7,900 patients to receive antiretroviral treatment.

The joint program includes a therapeutic follow-up, which relies on a monitoring electronic system that was developed by the Taiwanese team and that is internationally recognized (The Lancet, Vol. 365, Issue 9469, April 23, 2005).

If, in the name of non-dual recognition, the Taiwanese medical mission has to leave Malawi, the consequences for these patients could be disastrous.

If the team leaves Mzuzu Hospital, the capacity to provide treatment to people living with HIV/AIDS will decrease sharply and will not be replaced by other Malawian health professionals, despite the fact that the mission has made a point of including local health professionals in the program.

Provision of care, distribution of antiretroviral drugs and monitoring of HIV patients will also decrease.

People living with HIV/AIDS will directly suffer from this development and the risk of resistance to drugs will be increased because of the interruption to their treatment.

There is a possibility that the Taiwanese will be replaced by a Chinese medical team.

In theory this could work, but in reality the new team would have to spend time building trust with local people to understand the sociopolitical situation and to gather sufficient expertise on the local experience of HIV/AIDS. This process would take some time. So, once again, the quality of care, drug distribution and follow-up would be seriously disrupted.

For the sake of the health of Malawians living in the northern part of the country -- and particularly for those who are living with HIV/AIDS -- it is a far better option that the Taiwanese team continue its work at Mzuzu Hospital.

The continued provision of adequate health services to the region will rely on the wisdom of the three governments involved.

Taiwan has to accept the need to continue supporting its medical team at the AIDS clinic even now that Malawi has made China a diplomatic ally.

This would offer conspicuous evidence that Taiwan does not play politics over health.

China, as a responsible state committed to the promotion of sustainable development, should let the Taiwanese team continue pursuing its work, which is important for the development of a country that has high rates of HIV/AIDS.

New health projects could be developed by China in other regions where health access remains limited.

Finally, the Malawian government should understand that if it supports the departure of the Taiwanese medical team, the main victims in this diplomatic shift would be its own people, notably people living with HIV/AIDS in the north.

The question is this: Is it acceptable for a democratic country to sacrifice its own population for political gain?

The health of people living with HIV/AIDS and of people in the northern region of Malawi in general directly depends on the interlinked responses of the three governments.

If any one of them places politics before health, it must be aware that lives will be put in great danger.

Vincent Rollet is a doctoral candidate in the Department of International Relations at the Institute of Political Science in Paris.

"Taiwan has to accept the need to continue supporting its medical team at the AIDS clinic even now that Malawi has made China a diplomatic ally."

Oh really?