Four women emaciated by AIDS, perilously close to death and abandoned by the state health care system cling tenaciously to life at a remote clinic where doctors give them one last fighting chance.
The women, sent home to die by doctors at a state hospital, arrived critically ill. Their immune systems barely registered in tests and their blood was brimming with the virus that causes the disease.
"These are people who were already in the coffin but forgot to fall down," said Dr. Hugo Templeman, the Dutch physician who founded the Ndlovu Medical Center a dozen years ago in this remote and dusty crossroads in the South African countryside.
Remarkably, Templeman said about 85 percent of those admitted to the clinic's small ward in critical condition not only survive but recover. Over months of treatment with anti-retroviral cocktails the viral load drops dramatically and the immune system revives. The patients are not cured, but are restored to the manageable status of HIV positive.
"This is all about hope," said Templeman.
Here among treeless, rock-strewn hills and the abject poverty of dusty, rural townships a hundred miles (160 kilometers) northeast of Pretoria, the Ndlovu Medical Center offers a blueprint on how to bring a successful AIDS treatment and awareness campaign to remote corners of the African bush.
It also offers something rare in South Africa: a hopeful AIDS program in a country where the president has questioned the link between the virus and the disease and the health minister has been pilloried for questioning the effectiveness of anti-retroviral drugs and instead promoting garlic and African potatoes.
"Many people still think that HIV-positive is a death sentence, it is the end of their lives," said Dudu Nkosi, 28, who was sent home to die by a state hospital in 2003. At the time, she weighed just 61 pounds (28 kilograms) and her immune system had collapsed.
Today she counsels patients at Ndlovu. She helps them overcome the shock of discovering they are HIV-positive and to commit to a lifetime of treatment and monitoring, reports AP.
"Being HIV positive is not the end of the world. The patients believe me when I say this because they know I survived," said Nkosi.
The clinic has its own laboratory for monitoring treatment and adherence. It has its own X-ray machines, pharmacy and a remarkably successful maternity program designed to prevent mother-to-child HIV transmission. Teams provide testing, counseling and treatment to farmworkers on their farms and others take HIV education to schools and remote townships. Some go to patients' homes to count pills and ensure treatment programs are followed.
Templeman and the clinic also carry out research on AIDS treatment with the University of Utrecht in The Netherlands.
Roads leading to the clinic are littered with hand-painted signs with slogans promoting safe sex, HIV testing and adherence to treatment and monitoring.
"We still have two or three deaths a week in the waiting room," said Templeman, adding that the AIDS stigma makes many wait too long to seek help.