'Accept me': Organization offers haven for outcasts near Ukraine front
Whenever warm days come to Kramatorsk, near the eastern Ukrainian front, the Svitanok organization leaves its door wide open, offering advice or a cup of tea to the city's social outcasts.
People living with HIV, those recovering from drug addiction, sex workers — all are welcome to seek medical guidance and respite from stigma and solace as Russian troops advance toward Kramatorsk.
The refuge they find at Svitanok is vital during the war, when marginalized communities often feel left behind and face heightened insecurity and stigma.
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NHK
4 days ago
- NHK
UN report: Lack of US funding will cause 4 milion additional AIDS deaths by 2029
The United Nations has warned that a permanent halt in US funding is expected to result in 4 million additional deaths from AIDS-related causes by 2029. The General Assembly met on Thursday to study a UN progress report on the fight against HIV/AIDS. The report says the US has been a leader in the global response to HIV for more than two decades, contributing more than 70 percent of donor funding. But it notes that the administration of US President Donald Trump has paused the contributions since the end of January. UN Deputy Secretary-General Amina Mohammed told the meeting that the cost of the reduction is stark. She said closures of clinics and other disruptions to HIV services are putting adolescent girls and young women at especially greater risk, and that more babies are being born with HIV. Mohammed said if US funding is permanently halted, the UN projects 4 million additional deaths and over 6 million new HIV infections by 2029. She called on countries to reverse the funding declines, saying they must not allow themselves to "shatter the possibility of achieving the 2030 goal to end AIDS as a public health threat." The UN report says nearly a quarter of the 39.9 million people living with HIV globally are not receiving life-saving treatment. It says one person is dying from HIV-related causes every minute.
Yomiuri Shimbun
6 days ago
- Yomiuri Shimbun
Some Advice from LGBTQ Elders as Worldpride Kicks off Amid Fears
Matt McClain/The Washington Post People dance during a WorldPride Welcome Party at Berhta in Northeast Washington on Saturday. They were born too late to have witnessed Stonewall, lived through darkest days of the HIV/AIDS epidemic or have memories of a time when it was illegal for same-sex couples to marry anywhere in the country. Still, four 20-somethings from a small private college in south-central Pennsylvania got out of bed before sunrise and spent a few hours on a bus to D.C. so they could make it to the U.S. Supreme Court for a gathering that would take them back in time. They would listen as longtime LGBTQ advocates, who had come together to celebrate the 100th anniversary of gay pioneer Frank E. Kameny's birth, spoke about struggle and the progress it has wrought. They would hold candles and look on as those advocates marched in loops in the high court's shadow holding large signs – black lettering on white poster board that recalled the very first gay rights demonstration in the nation's capital 60 years ago. The posters declared such things as 'Gay is good' and 'Homosexuals ask for the right to the pursuit of happiness.' Tatiana Gonzales, 22, watched in awe, an electric candle in each hand, a 'trans lives matter' shirt peeking out from beneath their black hoodie. Gonzales would later describe the experience as transformative, how the candles in their own hands felt more like a passed torch – a reminder that their generation must pick up the work started long before to ensure that progress is not undone. 'Wow,' Gonzales recalled thinking, 'these are really the people that helped make this happen. These are really the people who fought for us to have these rights.' As D.C. decks itself in rainbows and welcomes WorldPride, one of the largest international observances of Pride Month, many LGBTQ people say that they are finding inspiration not by imagining a brighter future – but instead by revisiting a more hostile past. After years of buoyant celebrations of advancements and greater acceptance for members of the LGBTQ community over the last two decades, for many, Pride is taking place this year in the shadow of mounting legal and cultural attacks: books featuring LGBTQ+ characters have been removed from school libraries and curriculums; hate crimes are on the rise; the federal government has barred transgender people from the military and girls' sports; HIV prevention programs and gender-affirming health care have been slashed; drag shows have been banned at the Kennedy Center; and state legislatures around the country have introduced more than 500 anti-LGBTQ+ bills. The young people assembled outside the Supreme Court that day kept coming back to one word: 'Scary.' They feel fearful of political and social attacks on LGBTQ people, they said, and they worry about the safety of their friends, family and even themselves. 'There's a very real shot that we won't have those rights that we've just kind of had for the majority of our lives,' said Elspeth Hunter, 20. 'It's so scary.' In the D.C. area, LGBTQ trailblazers who formed secret societies in the '60s, marched in the '70s, read aloud the names of AIDS patients of the '80s and '90s, and staged kiss-ins and mass weddings in the aughts have also been reflecting on the nature of progress: how it is won and how it is protected. How they hope the next generation is listening – and preparing – to carry it into the future. Finding 'familia' at Pride José Gutierrez, 63, knows what it feels like to watch the government turn its back on LGBTQ people. When he was in his 20s, Gutierrez said, he kept a personal phone book with the names and numbers of all the people he knew. In the worst throes of the HIV/AIDS epidemic, he said, he would open that book nearly every month to cross out the names of those who had died. The grief felt inescapable, unending. 'I wish that new generations knew what that was like,' he said. 'Those were difficult times because we didn't have any medications, we didn't have services, and people that were infected with HIV/AIDS, some of them, not everybody, but some, would prefer to commit suicide.' In 1993, Gutierrez was invited to attend the March on Washington for Lesbian, Gay and Bi Equal Rights and Liberation as a representative from Atlanta and a member of the Latino community. When he arrived, he said, he could hardly believe what he was witnessing: A million people in the streets. ACT UP protesters carrying coffins through the city to protest the government's inaction in response to the epidemic. A giant memorial quilt unfurled across the National Mall that included panels from every state and 28 countries. Gutierrez was asked to read aloud the names of Latino people who had died of the disease. Recalling that moment still makes him weep. Gutierrez moved to Washington soon after, inspired to continue working to support those who were HIV-positive and immigrants and Latinos in the LGBTQ community. He's advocated for better bilingual health care and education about the HIV/AIDS epidemic and worked to create distinct spaces for LGBTQ Latinos in the District. In 2000, he founded the Latino GLBT History Project. Seven years later, he organized the first D.C. Latino Pride. On Saturday, Gutierrez will ride at the front of the Pride parade as an honoree and co-chair of this year's WorldPride march – an event he said is as much a protest as it is a celebration. 'We're protesting because we need visibility for many reasons. The first is: We have, against our community, the LGBTQ community and especially the transgender community, so much violence and hate,' Gutierrez said. 'We also need to celebrate our lives, our rights, even though we are now having a lot of issues, just to be with thousands and thousands of people around the world in a safe space.' 'Familia, like we call it in Spanish,' he added. At Pride, 'we're in familia.' The pendulum keeps swinging Eva Freund isn't coming to the parade. She doesn't like crowds or loud noises and, is still recovering from a fall last year in which she broke her femur. But at 87, Freund is one of the earliest members of the District's first gay rights group, the Mattachine Society of Washington, and still makes herself – and her beliefs – known everywhere she goes. In the retirement community where she lives with her wife, Elke Martin, Freund's front door stands out in the long, winding hall. Rainbow flags dot the wall, the door frame and the flower pot from which a long, winding pothos vine crawls. A sticker declares her home a 'hate free zone,' and a rainbow plate says, 'Love always wins.' An ornate marriage contract, framed and signed by Freund and Martin, hangs in the hallway surrounded by photos. Even the mezuzah at the entryway is painted as a rainbow. On a recent day, as Freund made her way upstairs, a young man stopped and thanked her for speaking out at a recent event. 'Hey, kudos to you for saying what everyone was thinking,' the man said. Freund smiled. She had asked a visiting politician what meaningful actions they planned to take to protect marginalized people – she was tired of the talk and the 'do-nothing Democrats,' she said. 'I just appreciate you standing up and saying what you said yesterday; I know that's nothing new to you,' he added. 'But especially in that setting where everybody's there and everybody's kind of like, 'Did she really just say that?' And, like, 'Yeah. She did.' ' When Freund began identifying as a lesbian in the 1960s, being gay was all but illegal in public spaces. Workers suspected of being gay were fired from their jobs in the federal government. LGBTQ people were routinely rounded up and arrested at bars or in parks amid police raids. Even the American Psychiatric Association at the time classified homosexuality as a mental illness. In her youth, Freund demonstrated for women's rights and gay liberation. She carried signs with other trailblazers like Paul Kuntzler and Lilli Vincenz, calling for federal reforms and the removal of homosexuality from the APA's list of mental illness diagnoses. She was defiant in the face of police, who, when Freund was at a D.C. lesbian bar with her friends in the early '60s, raided the joint, asking each patron to hand over their IDs. 'I never saw myself as an activist. I saw myself as a curmudgeon,' Freund said. 'I wouldn't be necessarily someone who wanted to lead marches or organize marches, because I know that change comes incrementally. Unless you have a really bloody revolution, change does not come in a big fell swoop. And people's minds get changed incrementally.' But, she admits, she has seen a whole lot of change: Friends, who for years hid who they were, able to come out. Her marriage to Martin, her partner of more than 30 years. Legal protection against discrimination – in Virginia, where she lives, it's illegal to deny housing or employment to anyone based on sexual orientation or gender identity. She doesn't take it for granted. Freund has recently found herself thinking about the period after the Civil War – a period of reconstruction and freedom, for some, but also a devastating backlash that brought with it systemic segregation and discrimination against Black Americans. 'When the pendulum swings,' she said, 'the folks who are in power lose power, and they can't stand it. So when they get back in power they have to chip, chip, chip, chip away' at whatever progress was made. 'The question,' she went on, 'is how much damage can they accomplish in all that chipping?' Freund does what she can in her own little slice of the world to keep that chipping at bay. That means trying to help young people understand the history that came before them – how to persevere in the face of hatred and discrimination – and being out, proud and visible. Each night when Freund goes down to the community dining room to eat with her wife, she said, the two of them walk in together, past tables of people, holding hands. The last survivor of the 1965 march Kuntzler, the sole surviving participant of the District's first gay rights march in 1965, has remained active in the ways he knows how. The 82-year-old, who still rides his bike to get around the city, is a regular at anti-Donald Trump demonstrations, having attended the 2017 Women's March on Washington, where he held up a sign that read 'Donald Trump Is the Ugly American' (a nod to the 1958 novel 'The Ugly American'). He later walked in the March for Science and the People's Climate March. In April, Kuntzler marked Trump's second term by attending the 'Hands Off!' rally on the National Mall with a homemade sign: 'Trumpism is fascism.' Later that month, he joined supporters at a reenactment of the 1965 protest for gay rights in front of the White House. As he walked in circles outside the tall White House fence, Kuntzler held up a placard much like the one he made more than half a century ago. It read: 'Fifteen Million U.S. Homosexuals Protest Federal Treatment.' The figure he cited – 15 million – was an estimate based on the statistic that about 10 percent of the population at the time was probably gay. Decades later, Kuntzler marvels at the passage of time and the progress it has brought. Gay and lesbian politicians hold office in Congress and state legislatures around the country; the former U.S. secretary of transportation, Pete Buttigieg, is openly gay, married and a dad. Kuntzler and his partner of more than 40 years, Stephen Brent Miller, became legal domestic partners in a civil ceremony in 2002 – two years before Massachusetts became the first U.S. state to legalize same-sex marriage. 'Well, I think probably the national gay community, LGBT, probably have made more progress than any other group in America. I mean, the change has been astonishing,' Kuntzler said. 'We couldn't conceive of the idea back in the '60s that there would be laws to protect us from discrimination, that there would be openly gay elected officials. … The whole idea of marriage equality was something we couldn't conceive of.' Kuntzler ran Kameny's campaign for Congress in 1971 – a historic first in several ways: Kameny was the first openly gay man to seek congressional office and he did so in the District of Columbia's first election for its nonvoting delegate seat. Kuntzler had planned to attend Kameny's centennial demonstration, but rainy weather kept him home. Kuntzler was heartened, however, to hear that so many young people had attended. He hopes they'll also come to a public exhibit he's featured in and leads tours of: the Rainbow History Project's display in Freedom Plaza on 'Pickets, Protests, and Parades: The History of Gay Pride in Washington.' Vincent Slatt, the curator, said he built the exhibit to be more than a look back at history. Slatt said he hopes it serves as inspiration – and instruction. 'At that first picket in 1965, it was 10 people outside the White House. By the 1993 March on Washington, it was a million people. What we have grown here, in Washington, D.C., is a movement,' Slatt said. 'This exhibit is not about old people and what old people do or did. … These were all young people who got off their asses and fought, and sometimes they won and sometimes they lost. But over 60 years, we've won a lot more than we've lost.'
Yomiuri Shimbun
19-05-2025
- Yomiuri Shimbun
U.S. Funding Halted Africa's HIV Crisis. Trump's Cuts Have Forced a Reckoning.
Ilan Godfrey/For The Washington Post Shonewe Thembelihle does a general checkup in March for Maphindi Mtsetfwa at the Miracle Campus in Sidvokodvo, Eswatini. SIDVOKODVO, Eswatini – When American taxpayer money started flowing here 18 years ago, this country was the epicenter of the global HIV/AIDS crisis, with the world's highest prevalence rate, and so much death that 1 in 10 households was headed by a child. U.S. aid unleashed a flood of lifesaving antiretroviral pediatric drugs. It funded doctors and data systems. It helped build an ultramodern medical facility in the center of the country, known as the Miracle Campus, that provided free care behind an entrance sign saying: 'From the American people.' To the nurses and doctors who arrived during that dire phase, this was America at its most ambitious – a superpower vowing to help solve the health crises of the developing world. In Eswatini, U.S. money helped extend the average life expectancy by more than 10 years. But now a project that once embodied America's largesse has exposed the pitfalls of that approach, as some aid and government workers in Eswatini fear it has left the country ill-prepared to take care of its own. Even after the HIV/AIDS emergency eased, U.S. aid kept flowing at high volumes. America took steps to pass responsibility to African countries but kept its hands on crucial tasks. 'We shouldn't expect the U.S. to take care of a chronic disease to infinity,' said Echo VanderWal, executive director of the Luke Commission, the charity that runs the Miracle Campus. Eswatini, formerly known as Swaziland, is a New Jersey-size country of lush green hills wedged between Mozambique and South Africa. Relative to the country's population of 1.26 million, the U.S. investment here had been significant: roughly $800 million since 2007, according to government records. Most of that money came as part of a single program, the President's Emergency Plan for AIDS Relief (PEPFAR), launched by President George W. Bush, who said America had a duty to 'make this world better.' Among health workers as well as Eswatini government officials, there is widespread consensus that the U.S. earned tremendous goodwill with its investment here and helped turn the tide against the epidemic. Those officials and workers also criticize the abrupt nature of the Trump administration's foreign aid cuts as reckless. But now that the status quo has been disrupted, Eswatini must grapple with uncomfortable questions about what comes next, whether a post-U.S. health system might be more sustainable or more dangerous. 'The American government had stepped up and been holding our hand for a long time,' said Lizzie Nkosi, a former health minister. 'That is not something we can easily lose.' In Eswatini, the Miracle Campus is at the center of that reckoning. Founded by an American husband and wife – Echo VanderWal, a physician assistant, and Harry VanderWal, a doctor – the Miracle Campus had become a celebrated emblem of U.S. generosity. Almost every employee carried an iPad, and surgeons used messaging apps to provide real-time updates on procedures. The hospital had 3D printers to customize medical equipment and drones that could transport medicine to rural villages. But beyond the modern equipment, there was another reason people had sought out the campus, according to interviews with patients and health-care workers: the woes of Eswatini's own public health system. The national hospitals struggled to stock medicine and supplies, and government-appointed investigators had accused officials of mismanaging the national drug supply, citing poor oversight and alleged corruption. Even as Eswatini's economy grew, the country was increasingly relying on U.S. charity for the day-to-day care of its people. By 2023, after years of growing demand, the Miracle Campus was handling 24,000 patients a month – more than a quarter of the national load, according to data compiled by the Luke Commission based on government data. The Health Ministry did not respond to a request for comment. The VanderWals, today in their early 50s, had never questioned their faith-based motto to treat all seeking care. But two years before President Donald Trump's decision, Harry asked his wife: Are we part of the problem? 'We were carrying such a big portion of the national load,' Echo said. She called it 'unsustainable.' One of the pharmacists at the Miracle Campus, Thembelihle Zondo, went so far as to say his country would have been further ahead if aid had been cut off years ago. 'The government would have just pulled up their socks, taken ownership to say, 'No one is going to help us, so we need to do this on our own.'' U.S. officials had been working with Eswatini to gradually hand off more responsibility, with the goal of winding down some of the funding by 2030. Wendy Benzerga, who was the U.S. Agency for International Development country director in Eswatini from 2015 to 2020, said that 'a lot more could have been done' to begin the transition earlier. 'But aid becomes this big machine,' said Benzerga, who emphasized that she was speaking in a personal capacity, not on behalf of the U.S. government. 'And it's comfortable for everyone.' The Washington Post did not uncover evidence that U.S. funding was misused, and the government-appointed investigators did not indicate that American aid money was involved in the alleged corruption. The State Department, in a statement, said PEPFAR 'has been impactful, saving millions of lives and helping bring the HIV numbers under control.' 'Secretary [Marco] Rubio has stated that PEPFAR is an important and life-saving program that will continue,' the statement said. 'He has also said that PEPFAR, like all assistance programs, should be reduced over time if they are impactful in achieving their mission.' Now that shift has arrived without any preparation. In early February, with U.S. funding withdrawn, the Miracle Campus installed an entrance gate with a sign asking most patients to go elsewhere. It shuttered the maternity ward, halted preventive care, and stopped treating diabetes and hypertension. It had to lay off almost half of its 700 workers. It couldn't even pay its utility bills. The last trickle of patients come for HIV/AIDS medication refills, or for specialty surgeries performed by doctors who agreed to work without pay until funds were available. Echo, the facility's executive director, says she sometimes believes that the campus's near-total shutdown is in Eswatini's best interests. 'I hate to say it, but I think it had to happen,' she said. But on other days, she sobs as she walks through the empty wards, or when she gets text messages from former patients who say they have no other place to go for reliable health care. She still asks the same question that caused her to keep the doors wide open in the first place: What happens without us? 'Finest health care in the country' They had first traveled to Eswatini in 2004, a trial to see if people like them might be able to help. Echo, raised in Idaho, had obtained her first passport specifically to make the trip. Harry, from North Carolina, had never traveled farther than Canada. They had four young children, some savings from flipping houses, a deep Christian faith and a sense they were ready for a risk. As they saw it, this was part of what it meant to be an American – not hesitating to offer help, whether to a neighbor or someone overseas. 'As Americans, we want to run in and fix things,' Harry said. Hours off the plane, they saw people dying of HIV/AIDS. And by 2006, weeks after Harry finished his residency, they had moved for good. They rented an apartment and started crisscrossing the nation with medical supplies stuffed in the back of trucks. One of the main objectives, in those years before widespread drug availability, was chillingly modest: delaying orphanhood. By 2010, the VanderWals had their first contract with the U.S. Agency for International Development – for performing adult circumcisions that reduce the risk of HIV/AIDS. The contract sum was modest, $180,000, but Echo remembers feeling they had 'broken the barrier' into the world of foreign aid. Three years later, they bought farmland near a river. Initially they just used the land's old dairy barn to store their medical supplies. But the money kept coming – ultimately, $40 million from USAID, according to government data. They used those funds for doctors, equipment and, later, solar panels and other technology. They leaned on private charitable donations, mostly from the U.S. and Canada, as they kept building out the campus. What took form, spread across 200 acres, defied the stereotypes of a health facility in a developing country. They constructed an auditorium for team meetings and church-themed musical shows. They added an in-house 'farm team' that grew maize and other ingredients for hospital meals. They added a 'wood team' that made canes and crutches, and fabricated parts for buildings. If the Luke Commission 'hadn't been there for Eswatini, I think most people would have been dead by now,' said Colani Nkambule, a security guard who works at the campus and lost both of his parents to HIV/AIDS in the early 2000s. 'They provided the finest health care in the country,' said Barbara Staley, an American Catholic missionary who has worked on and off in Eswatini since 2004. But as demand skyrocketed, they also made personal decisions they admit were reckless. During the coronavirus pandemic, they took out a loan against the value of their home to help cover operational costs. Amid national drug shortages, they used a line of credit to buy medicine from South Africa. In 2023, they drained their retirement savings to help pay employees. 'Whatever was in the bank account, it's gone,' Harry said. They eventually realized they had gone too far to keep the campus running – and by 2024, they were scaling back some services and using charitable donations to pay debts. Those moves also meant they relied on U.S. aid more than ever for their day-to-day operations. By the time of the Trump administration's decision, they had no margin for error. According to the Luke Commission's 2023 financial statement, 33 percent of its revenue came from USAID. The campus's fate has now become Eswatini's top political battle, dominating local front pages and serving as a proxy for broader questions about how the kingdom moves on from the era of big U.S. aid. While almost everybody agrees that it's foolish for the campus to sit nearly empty, the debate centers on whether Eswatini should offer a sustained financial lifeline – and whether the charity running the campus should come under government control. Nkosi, a senator who served as health minister until 2023, said the Luke Commission had been offered a financial deal two years ago on the condition that the government could approve the chairman of the board. 'They flatly refused,' Nkosi said. Echo and Harry said they never received a formal offer, and instead wanted financial support without submitting to a government takeover. A parliamentary report from last year detailed how the back-and-forth negotiations had created 'bad blood' between the Health Ministry and the Luke Commission. In many ways, Echo and Harry are no longer outsiders: They are citizens of Eswatini and refer to the country's monarch, Mswati III, as 'our king.' They raised their children here. They dress for formal occasions in traditional Swazi wraparound fabrics. But they say they don't feel ready to make their hospital part of a national health system that can't stock its own drugs. Doing that, Echo says, 'would be the biggest mistake we'd make in our lives.' No clear exit strategy When Velephi Okello heard about Trump's decision to slash foreign aid, she thought to herself, 'Fasten your seat belts.' As director of health services at Eswatini's Health Ministry, she had been imagining this moment for years – while sitting in on meetings with U.S. officials where they talked about PEPFAR's future, and about passing off more and more work to local partners. She had helped the country take major steps in self-sufficiency – buying its own antiretroviral drugs, for instance, rather than relying on international donations. 'We thought that the PEPFAR funds would take us to 2030, slowly and gently,' she said. Before the Trump shutdown, the U.S. had retained responsibility for crucial tasks in Eswatini's day-to-day health care – not just by funding the Miracle Campus but by paying workers who were performing testing and working in communities. Of the USAID money flowing into the country, global nongovernmental organizations like Pact and the Elizabeth Glaser Pediatric AIDS Foundation had been among the biggest historical recipients. An assessment published in late March from UNAIDS, a United Nations program devoted to fighting the disease, said there has already been a 'significant decline' in HIV case identification in Eswatini and described a risk of supply 'stockouts' in three to six months. Nkosi, the former health minister, said that Eswatini still has one of the highest HIV rates in the world and that removing foreign support means restoking the emergency. 'That is just logic,' she said. Okello said Eswatini is past the stage where the U.S. decision might 'collapse the health system.' She noted that years before U.S. support arrived, the country had declared a national emergency, launched local education programs and created a national response council. And Eswatini was the first country in Africa to reach a landmark global AIDS target, known as 95-95-95, referring to the percentages of people who know their HIV status, are undergoing therapy and have successfully suppressed the virus. But after the withdrawal of U.S. aid, many in Eswatini are angry – not at America but at their own government. Patients across the country, as well as doctors at government hospitals, say that while Eswatini has mounted a strong response to HIV/AIDS, it has allowed deepening problems in its overall health system. Patients tell similar stories: of going to hospitals for basic drugs and being told the essentials aren't in stock. The government says it is taking the problem seriously, and three years ago commissioned an internal investigation that examined years of health and drug-procurement records. The final investigation, which was not made public but was obtained by The Washington Post, laid out a scheme in which officials systematically buy drugs the country doesn't need or are about to expire. The scheme enriches suppliers, the report says, who make direct payments to complicit bureaucrats, who have accepted trips abroad and used cash to purchase luxury cars. People living in Eswatini do not connect the king to the drug shortages. But political dissidents abroad say his system of patronage, as well as his lavish lifestyle – with 16 wives and a fleet of luxury cars – fosters a culture of corruption. 'You've got one person who is accountable to nobody but himself,' said Ignatius Dlamini, a political activist based in South Africa who chairs a group called United Eswatini Diaspora. Eswatini's Health Ministry declined to respond to a list of questions about drug shortages and alleged corruption. It also did not respond to questions about the Luke Commission. 'It's a dire situation,' said Zakhele Dlamini, director of the forensic company that led the investigation. 'People are living in hell because there are no drugs – hence the Luke Commission and other private clinics that are the go-to for trying to survive.' Six weeks after the U.S. aid was halted, the security guard at the Miracle Campus entrance had turned away patients with broken bones, people in tears, even his own relatives. One nurse had sold off cattle to help manage bills; another had downsized apartments. The employees were accruing backpay, but Echo worried that as the uncertainty dragged on, the entire Miracle Campus could come unglued. So she called a morning meeting – 300 people crowding into an auditorium, with Harry in the background as a grandchild tugged at his knee. She acknowledged that she didn't have many updates, that U.S. money still wasn't coming, and spoke again and again about 'how painful' this has been. But her speech, as it went on, took on the feel of a pep talk – both for her staff and herself. She said the facility still had a future, one that wouldn't rely so heavily 'on what people decide in another country.' The meeting ended with a prayer, and the staff spent the rest of the day refilling antiretroviral prescriptions and performing a skin graft for a 6-year-old girl bitten by a venomous snake. Echo and Harry retreated to an upstairs conference room, spending one full day, then another, huddling with advisers and strategizing about their future. Eventually, they sketched out a vision of a smaller Miracle Campus, about one-sixth of its size at its peak, that relies more on private donations. They also decided, for the first time, to start charging patients who could afford it. Harry said he still viewed America as having a 'spirit of compassion.' But as much as Americans rush in to solve problems, he said, they've never been very good at getting out. 'There wasn't a clear exit strategy,' he said. They'd built the most advanced medical campus in Eswatini, but now it was just idled equipment and pretty landscaping. The sun had set. The staff had gone home. After almost two decades in the aid industry, this is what had come to: Harry and Echo, late at night, trying to figure out how to start over.
