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Medical hero of AIDS epidemic remains a down-to-earth doctor

THE work is still the same for Gui Xi'en, the doctor who fought 10 years ago to expose the AIDS epidemic crisis in China's villages. He enjoys working in a community rather than a clinic and returns to the village where he first found the infection. Chang Ai-lin reports.

A noisy cab speeds along a dark country road on a muggy Friday night in July this year. Dr Gui Xi'en, 72, sits on the cramped back seat with a satchel on his shoulder and suitcase on his lap. He is on his way to Shangcai, an AIDS-ravaged county in central China's Henan Province.

As the cab approaches the county seat, Gui directs it to a small hotel. He plans to stay the night and quietly goes to the villages on Saturday.

Ten years after he first exposed their deadly secret in 1999, Gui, who blew the whistle on China's "AIDS villages," is still sneaking into rural communities in Shangcai, offering counseling to those dying from the epidemic.

"I came secretly before, because they (local officials) were not nice to me. I still come secretly now, because they are too nice to me," says Gui.

"If they knew I was here, they would come to see me and invite me for lunch or dinner. I think that is unnecessary and I don't like it."

From being driven out of the villages to being treated as an "important guest," Gui's experiences reflect the changing of Chinese official attitude toward the HIV/AIDS plague, which is believed to be the most serious public health problem confronting new China since 1949.

An infectious disease specialist with Zhongnan Hospital at Wuhan University in Hubei Province, Gui first visited Wenlou, a village of Shangcai, in July 1999 as a favor to a fellow doctor there.

HIV/AIDS was the last thing he expected to find. Some villagers suffered from constant fever and diarrhea. People died every month, with their bodies covered in sores and dark, wine-colored blotches. Panic had seized the village.

Gui took 11 blood samples from the villagers and found 10 were HIV positive. He immediately informed the local health authorities and urged them to take action. But their response was to refuse him further entry to the villages.

Two months later, during a long holiday when he calculated that officials would let their guard down, he sneaked back into Wenlou with his three students. After three days of house calls, Gui returned to Wuhan with 159 blood samples. The result was shocking - 90 of them were HIV positive.

Gui realized that he had stumbled on a full-blown AIDS epidemic, something he had only read about in medical journals.

The tragedy originally was caused by a local unchecked blood selling and collecting industry in the early 1990s.

With detailed data and analysis, Gui wrote a letter to Beijing. With the central government involved, local authorities could no longer hide the lethal infection. But they looked on Gui even more unfavorably.

On June 8, 2001, Gui went to Wenlou alone. He took medicines for the villagers. The county government sent police to expel him. Gui escaped with the help of villagers, who hid him from the police and moved him to a safer place by motorcycle in the middle of the night.

Faced with smears and obstructions, the mild-mannered doctor wrote a letter to the county authorities in an uncharacteristically strong tone: "One day the tragedy will be written into history and those responsible will be condemned by history."

Today the health clinics Gui visits in the AIDS villages provide free HIV testing and anti-retroviral treatments, and charity homes shelter AIDS-caused orphans and the elderly whose caretakers have died of AIDS.

Nationwide, the government has been providing free anti-retroviral treatments to rural HIV/AIDS patients since 2004, and to urban sufferers with financial difficulties.

The government has also provided free HIV screening, free therapy to block mother-to-infant transmission, free infant HIV testing and financial assistance for children who lost their parents to the epidemic.

In the summer of 2004, Premier Wen Jiabao visited Gui at his home, and thanked him for his efforts in the epidemic prevention. In 2007 and again in 2008, Wen invited Gui to join him on visits to HIV/AIDS villages and AIDS-related orphans.

Chinese media called Gui a medical hero, who has helped improve the country's public health policy and benefit hundreds of thousands of people. But Gui is far more comfortable talking about the villagers than discussing his role in revealing the epidemic. "I just did what a doctor should do," he says.

On a recent Saturday morning, when Gui arrived at a bus stop outside Houyang village, Zhao Qiang (not his real name), a villager with HIV, is already there waiting for him.

"He is honest, kind and gentle, and always ready to help. Whenever we called and asked him to come to the village, he would come," says Zhao, whose wife and six-year-old son are also infected with HIV.

After picking him up, Zhao takes Gui by his motor-pedicab directly to his home, where HIV carriers and AIDS patients are waiting.

"I cannot take him to the village clinic. There would be too many people coming to see him. He might not be able to leave today," Zhao says.

As Gui sees his patients at Zhao's dilapidated house, Cheng Dong (not his real name) waits anxiously at the Shangcai County Hospital.

Cheng's cousin with AIDS is in hospital. Cheng calls Gui and asks him to come. He also wants Gui's help in getting his daughter enrolled in a good local high school.

Cheng sees nothing inappropriate in his requests. He is sure Gui will help. Cheng was among the first 10 HIV-positive villagers Gui diagnosed 10 years ago, and Gui has continued to give him medical and financial help since.

"He is a marvelous man," Cheng says. "He was unpopular here in the past. Since Premier Wen (Jiabao) visited him, everything has changed. But he does not change. He is still the Dr Gui I know."

Despite his age, Gui still works full time and spends most weekends and holidays visiting poor peasants, a routine he formed almost 50 years ago.

In 1960, Gui, a medical school graduate aged 23, volunteered to work in the remote hinterlands of Qinghai Province on the Qinghai-Tibet Plateau, answering the government's call for young intellectuals to work and settle in frontiers.

During his 16 years in Qinghai, he focused on curbing infectious diseases and endemics, like measles, typhoid and plague. But as medical staff were scarce, he was also surgeon, laboratory analyst, anesthetist and pharmacist.

He once amputated the seriously injured arm of a herdsman. "The man said I saved his life and was grateful to me. But I felt sorry for him, because a proficient surgeon with good facilities might have been able to save his arm."

Gui recalls visiting and treating the herders' families. "I didn't need Tibetan translators at that time because I spent so much time with them that I could speak Tibetan fairly well."

The bleak and wild plateau also served as a refuge that kept Gui from the turbulence of the "cultural revolution" (1966-76).

Gui was born to well-educated parents, both US-trained scholars. His father graduated from Princeton University with a doctorate in physics. His half-Chinese, half-Dutch mother graduated from Columbia University. They returned to China in the 1920s.

During the "cultural revolution," many Chinese with "complicated family backgrounds" or relatives overseas suffered from persecution.

Despite his "problematic" genealogy, he could still go to villages and pastoral regions and offer medical help to herdsmen. "I was on good terms with local people so I didn't suffer much," he says.

The experience taught Gui that doctors had to work in their communities, rather than wait in clinics for patients, a lesson he passes to his students. "Infectious diseases are not only medical problems, but also social problems. We must reach out to the people in need."

The same afternoon, Gui meets Cheng Dong and his cousin in Shangcai County Hospital. He reads the girl's medical records and offers advice to resident physicians. He also discusses with Cheng about his daughter's schooling.

As he is about to leave, a girl approaches him. "Dr Gui, could you please have a look at my mother? She doesn't feel well and has not eaten much for a week," she pleads. Without hesitation, Gui follows the girl to her mother's ward.

At about 4pm, Gui has to leave for Zhumadian City to catch a train back to Wuhan. He apologizes to the families of patients who are still waiting to see him and promises to return.

On the bus to Zhumadian, he looks drawn. "Once I was able to see about 30 to 40 patients on a day like this," he says. "I am really inefficient now."

It's a comment that belies his apparent strong sense of urgency. He describes himself as an "old farm ox," aware that its life is almost at an end and therefore ploughs diligently on.

He quietly recalls a colleague, a year senior, who died suddenly a week ago while eating at a restaurant. Gui attended the funeral the day before he left for Shangcai.

"His family was heartbroken at his sudden death. But I admire him. I think this is a good way to leave, without suffering much and burdening other people," he says.

"To people of my age, this (death) is a natural thing," he says with a slight smile. "That's why I hope I can still do something. I may not have much time left."


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