by Bernadette Gillis

On average Ryan Phelps, MD’03, sees about 14 HIV patients a day, most of them children in the Swaziland clinic where he works.

In December one of those children
didn’t return, and for the first time in his short career Phelps learned what it’s like to be the last doctor who sees a patient.

“I realized that I was the only doctor standing between that baby and death,” says Phelps. “I couldn’t help but think that perhaps I didn’t do exactly the right thing to save his life.”

Looking back, Phelps knows there was probably little he could have done. Still, he is determined to do whatever he can to save as many children as possible from
dying unnecessary deaths.

“I think about all the children who don’t make it to our clinic and silently die,” he says. “HIV—pediatric HIV in particular—has been aggressive in southern Africa, but (with treatment) these children can live long healthy lives.”

A pediatrician, Phelps is part of the first group of doctors to travel to Africa with the Pediatric AIDS Corps. The Baylor College of Medicine’s Baylor International Pediatric AIDS Initiative (BIPAI) created the corps last year to help make up for the shortage of physicians treating HIV-positive pediatric patients in developing countries, particularly in Africa. The Swaziland clinic where Phelps works is just one of several Clinical Centers of Excellence established by BIPAI.

“I think about all the children who don’t make it to our clinic and silently die,” he says. “HIV—pediatric HIV in particular—has been aggressive in southern Africa, but (with treatment) these children can live long healthy lives.”

Phelps says he chose to go to Swaziland inpart because the country, which is slightly smaller than New Jersey, has the highest adult prevalence of HIV in the world. And he knows the children of Swaziland are suffering in large numbers as well. “HIV is a disease that has been affecting children since it began, but we’ve only begun treating children recently.”

Located in Swaziland’s capital Mbabane, the clinic first opened in 2006 and now has nearly 3,500 patients registered. Phelps spends most of his days giving children—and sometimes their parents or caregivers—much-needed antiviral medications. He works with the parents to help them understand that taking medications regularly is the key to keeping children well.

Although he and the 12 other doctors at the clinic cannot save all the patients, Phelps says he truly feels they are making a difference.

“We have between 500 and 600 children and caregivers on antiviral medications,” he says. “It’s extremely fulfilling when you see a patient get better and better.”

Phelps doesn’t spend all of his time at the clinic. He and his colleagues often travel to rural health centers to train health care workers throughout Swaziland. Developing relationships with the rural centers is important, because these centers provide the vast majority of care to HIV patients in Swaziland.

“Our clinic is a simple building,” says Phelps. “We cannot do it without the help of every health center. Hopefully these partnerships will last for many years.”

Training the rural health care workers will benefit the patients as well. “We want to make sure that if the patients can’t travel to our clinic, they can still get care and support in a decentralized fashion.”

Phelps has committed to spend a year in Swaziland, but says he will most likely continue to work with BIPAI in Africa. Fluent in both Spanish and Portuguese, he wants to help develop treatment programs in Portuguese- speaking African countries, such as Angola or Mozambique.

While warding off homesickness is sometimes a challenge, the Denison, Texas, native uses a blog (www.pediatrician-in-swaziland.blogspot.com) to communicate with his family and friends back home. He grows butternut squash in his garden and frequently hosts barbeques in his backyard.

He has even received a visit from Steve Taylor, T’98, MD’04, a friend who attended Duke medical school with him, and a few more Duke Medicine friends are making plans to visit soon.

But homesickness is a small price to pay, Phelps says. “Sustaining this kind of work requires good friends, rest, and a lot of patience. In the end it’s worth it.”