Medicine Man

Reverend Angelo D'Agostino, G53

Two local police officers found him lying in a small box on the banks of Kenya's Nairobi River. It was impossible to tell how long Moses had traveled or who he was, since he was discovered with little more than the clothes on his back and the box that carried him. Once they inspected the box, the officers reached into it, removed the boy, and carried him to their police car, which was parked nearby. As the car sped over the rough terrain and the Nairobi River faded into the rearview mirror, Moses embarked on the second leg of his journey. The first leg had brought him to the edge of a river on the other side of the world. The second one brought him into the waiting arms of Reverend Angelo D'Agostino, M49, G53, a Tufts University-trained surgeon who was running an orphanage for HIV+ children living in Sub-Saharan Africa.

Soon after he was delivered to Reverend D'Agostino, Moses was tested for HIV. He was found to be positive, and then the waiting began. Since three out of four newborn babies infected with HIV in Africa turn negative within a year following a positive test and Moses was in good health, Doctor D'Ag (or Fr. D'Ag as he is familiarly called), and his team delayed treating him for HIV. Moses, it turned out, was one of the lucky ones. He turned negative when he was a year old and was adopted by a well-wisher and her family. Today, Moses lives in California with his new family.

But for every happy ending, though, there are countless stories that end tragically. UNAIDS, a collaborative effort of the United Nations and several other organizations, estimated that, as of 2005, there were 12 million orphans whose parents had died of AIDS living in Sub-Saharan Africa, over 1 million of whom live in Kenya. And these numbers increase every day. Many of these orphans are HIV+ and if they are not taken in by family members, Reverend D'Agostino shares, they are either abandoned (which he believes was the case with Moses) or left to roam slums like Kibera, which was featured in the recent film The Constant Gardener.

Yet, some of these children end up somewhere else. It's located a mere 15-minute drive from some of the worst slums in Kenya. It's a place of life and laughter, a place where the broken become whole again. It's where you can find Reverend D'Agostino who, for the past 14 years, has given these orphans something many of them have never had–a family of their own.

Humble Beginnings
In 1991, Reverend Angelo D'Agostino was in Nairobi serving on the board of a large orphanage. At the time, HIV+ children were being abandoned at alarming rates.

"The children were often abandoned at hospitals because their mothers, knowing they were HIV+ and probably going to die, felt that if they took their children home they would die in the midst of slums and their children would be left completely abandoned there," says Reverend D'Agostino. "So, they would leave them at the hospital. The hospital, however, had no means of taking care of them and the children would often die of infection or malnutrition within a few months."

Recognizing that a problem existed, Reverend D'Agostino suggested that the orphanage set up a separate facility to meet the medical needs of HIV+ orphans. The board disagreed with his plan. Reverend D'Agostino then made a decision. He decided to start an orphanage on his own. This work was unprecedented at the time, since there were no facilities serving HIV+ orphans in existence in the country. But the reverend moved forward anyway.

The reverend meeting the first lady of Kenya.

One of his first steps was to meet with Kenya's Minister of Health. The meeting went well and Reverend D'Agostino left with a promise of doctors and nurses for the home. He then found a house to rent for the orphanage and admitted its first three HIV+ orphans. But then something unexpected happened. The doctors and nurses never came. The minister of health, who would become a key figure in the life of the orphanage as the president of Kenya a decade later, left his government post to start his own political party. All was not lost, though. Before he joined the Jesuits and became one of the first psychoanalyst priests in the history of Roman Catholicism, Reverend D'Agostino was a surgeon. He was trained at Tufts (earning his Doctor of Medicine degree from the Tufts School of Medicine in 1949 and a master's degree in Surgery from the university's Graduate School of Arts and Sciences in 1953*) and later served as a surgeon in the United States Air Force. This dense medical background proved critically important in the early days of the home.

"If not for my medical training nothing would have happened [with the home]," recalls Reverend D'Agostino during a recent phone interview. "I appreciated the severity of the problem facing the home and I noted that we had no other resources. I was able to put the lab together and get the proper instruments and people to run them. I was also able to get the social workers to do their part in getting the children set up. The nursing, of course, was very important and I had a hand in selecting and supervising them for a while."

The reverend relied on some of his other skills as well. Since he was essentially starting a non-profit organization from the ground up, he needed to both acquire the funding necessary to sustain the home and also lend a hand when necessary.

"I did a little bit of everything in the beginning," he says. "Hardware, plumbing, whatever. But now our work is bigger. We have maintenance people. We have an extraordinarily good manager who is just fantastically gifted in dealing with children. Now, my role is more like that of an executive director of a nonprofit."

While the orphanage is doing well in the present, Reverend D'Agostino and the home faced other challenges when they were starting out. As the number of children being served increased during the early to late 1990s, so did the number of funerals the reverend presided over. In the beginning, there were two to three funerals a month on the grounds of the home. But, with the advent of antiretroviral drug regimens in 2003, the number of deaths plummeted to the point where today funerals at the home are rare.

A Home for Everyone
The process for children who enter the home has been the same since its inception. Prior to being accepted, each orphan is tested for HIV. If they are positive, their blood work is then analyzed to see if they require medication.

"Whether or not the children start receiving medicine is determined by what the blood tests show," says Reverend D'Agostino. "If they are holding their own with their own resources, then we don't start it right away."

While each child undergoes a different treatment regimen when they come to the home, the reverend has noticed that all the children, regardless of their background, have something in common–their ability to adapt.

"It's extraordinary seeing how quickly the children adapt to the home," he says. "The other children take them in even if they can't speak the same language. Some even come from other countries. For example, we have a little girl from Somalia who was HIV positive like her parents and her clan wanted to kill her. Her grandmother used to have to tie her to a bed when she went out of the home because if she had gotten out they would have killed her. A doctor I knew told me about this girl. She was able to be evacuated by UNICEF and was brought to our orphanage. She could barely walk because she had been tied up all the time. But now she's happy and healthy and speaks English and Swahili. She's a totally different person than when she first came."

Outside the home, unfortunately, things are different for these children.

"There's still a lot of discrimination and stigmatization [of those with HIV] in Kenya," says Reverend D'Agostino. "The girls, even more than the boys, have to put up with it in the schools so they try to keep where they come from quiet. These children are pretty gifted musically and they've made some CD's, videos, and are often on television. Sometimes, the kids they're in school with see them on TV and say things like 'you're from that AIDS home and you have AIDS.' We help them cope with that. This is where my training in psychology comes in."

Reverend Angelo D'Agostino with children from the orphanage.

Planning for the Future
Today, the children's home provides housing, food, and medical care to 96 HIV+ orphans and is part of the larger nonprofit organization that Reverend D'Agostino runs. The organization is called Nyumbani, which in Swahili means "home."

"We have three main projects," he says. "We have the orphanage, but we also have a community-based program named Lea Toto (Swahili for "to raise the child"). In 1998, we decided that because there was something like 150,000 HIV+ orphans in Nairobi alone that we should do something. So, we started a program in which we go into some of the worst slums in the city and take care of these children, most of whom are cared for by their grandparents or some other caregiver. We have eight Lea Toto clinics in the city and have registered over 2,000 children so far and we were recently awarded a $2.5 million contract by USAID to expand the number of patients to 4,000 by 2009."

Children who are registered with the program receive, among other things, basic medical care, counseling and psychological support, spiritual guidance, and HIV transmission prevention education.

The organization's third project is the Nyumbani Village, an initiative which has involved everyone from the Kenyan government to the Vatican.

"The Kenyan government gave us 1,000 acres about three hours from Nairobi to build a village," says Reverend D'Agostino, who counts current Kenyan President Mwai Kibaki, the former Minster of Health, and his wife as strong proponents of the work of Nyumbani.

The financial support to construct the village came primarily from the Vatican and the Italian government.

"The Vatican put out a stamp for HIV+ children about two years ago and the receipts from it came to about half a million euro, which we received," says Reverend D'Agostino. "The Italian government matched this money and with the 1 million euro we received, and with a private donation from the United States, we built the village."

The village consists of 40 houses at the moment, but the goal is to have 100. Like the orphanage, it will house HIV+ orphans but these will be children who are under the care of a grandparent or other caregiver. In addition to the dwellings, the village will feature a clinic, school complex, a guest house, police post, a fifteen hundred person community center, and three vocational training centers which will help train the orphans in a variety of life-preparing paths.

As the Nyumbani website states, the village will help its occupants, "sustain themselves through agriculture, poultry, dairy projects as well as handicrafts and external services. The adolescents will benefit from the knowledge of the elderly occupants, who in turn will benefit from the support of the younger population. Vocational opportunity in the form of training, tools, and start-up financing for trades, cottage industry and agricultural endeavors will be provided with the goal of self-sustaining independence, financial security and stability for residents, particularly maturing young people."

Adds Reverend D'Agostino, "One of the goals of building the village was to help teach these children some gainful occupations. In Sub-Saharan Africa, there is something like 25 million orphans, not all of whom have HIV. Through training, we hope to impact this calamity."

In his current role, it would appear that Reverend D'Agostino has left medicine behind. But, in reality, the field remains a cornerstone of his work.

"I feel like I'm doing a kind of global medicine now," he replies, when asked if he misses the discipline. "In fact, I think I'm doing more medicine now than I did before when I was working in psychiatry with only a few patients. I think of my current work as administrative medicine."

Every 14 Seconds
With the exception of a few trips a year to the United States, Reverend D'Agostino spends most of his time on the grounds of the orphanage, where he has an office. At the end of each day, one that consists of answering e-mails, making fundraising calls, setting up meetings with government officials, and visiting with some of the children, he retires to a compound nearby.

The compound was built for retired Jesuits, especially missionaries from India, and each night Reverend D'Agostino has dinner with those who share his mission of improving the world around them. When dinner ends, the reverend and his fellow Jesuits gather on the patio to watch the sun set over Nairobi's Ngong Hills. In the time it takes for the sun to depart and for darkness to settle in, many more children have become orphans. In fact, it's estimated that every 14 seconds a child is orphaned in Sub-Saharan Africa.

But for the briefest of moments each dusk, as Reverend D'Agostino watches the sun disappear behind the hills, there are no mothers, fathers, or children with HIV. There are no slums. There are no orphans. There are no children floating down a river in a box.

There is only the departing sun, the rolling hills, and the faint laughter of children somewhere in the distance.

Reverend Angelo D'Agostino passed away on November 20th, 2006. More information can be found at http://www.nyumbani.org/dag.htm.

To learn about the Children's Home or any of the other programs run through Nyumbani, go to http://www.nyumbani.org/ or contact Info@Nyumbani.org.

*In 1953, the master's degree in Surgery was bestowed by the Tufts Graduate School of Arts and Sciences.