By Otto Nagengast ’17
In 2001, Dr. Mitch Besser arrived at the University of Cape Town, in Cape Town, South Africa, to help build programs that aimed to prevent mother-to-child transmission of HIV. Around one child in the United States and one child in Europe is born with HIV each day. In Asia, around 60 children are born with HIV a day. In Africa, more than 600 children are born with HIV every day. Dr. Besser saw women come in to the hospital and receive the wonderful news that they were pregnant. But their joy gave way to despair as they received utterly tragic news—they were also HIV-positive. Dr. Besser says that that the high rate of mother-to-child transmission of HIV in South Africa is caused by two factors. First, many of the expecting mothers are so demoralized by the stigma of being HIV-positive that they never come back to get treatment. Often, the women never share their diagnosis with anyone, for fear of the harsh social judgment that comes with it, so anyone who could help them cannot. Second, there is a lack of medical staff to provide full care or adequately educate the women about their options. The women leave the hospital felling totally alone and helpless.
Africa has 25 percent of the global disease burden but only three percent of the world’s medical staff. Dr. Besser knew that the solution to the high rate of mother-to-child transmission of HIV could not rely on more doctors and nurses. After graduating from Harvard Medical School, Dr. Besser worked for three years in the South Pacific nation of Chuuk, a country with 45,000 people spread over an archipelago of countless islands. Dr. Besser was the only obstetrician in the entire country. There was no way that he could provide enough care for the women of Chuuk, so he trained others to perform some procedures like ultrasounds, thereby extending care to many more women.
In Cape Town, Dr. Besser had “the spark of a solution” one day. He began training mothers who had previously been diagnosed with HIV before giving birth to act as mentors to other women who recently found out that they were pregnant and HIV-positive. This program later became mothers2mothers. In 2001, mothers2mothers operated in just one hospital. By 2015, mothers2mothers had expanded to 11 countries, employing 10,000 women mentors. They have more than two million clients a year, and one in five HIV-positive mothers in the world are part of the program.
The three goals of mothers2mothers are the prevention of mother-to-child transmission of HIV, healthy mothers and children, and the empowerment of women mentors. Dr. Besser says, “It’s important for us to remember that the pyramid is upside down…the people at the bottom are actually at the top…we work for our women mentors.” David Torres, Dr. Besser’s close friend and Director of Business Development at mothers2mothers, as well as a 1984 graduate of Middlebury, says, “That’s the secret sauce of mothers2mothers: the empowerment of mentor mothers.” Women who are HIV-positive are often cruelly marginalized if their community learns about their condition. Mothers2mothers gives these women the chance to be contributing members of their community by becoming mentors. They can push-back on the stigma that comes with being HIV-positive and regain the respect of their communities.
Despite Dr. Besser’s success with mothers2mothers, he is the first to admit that his projects were not always as successful. One day he plans to write a book about his life. Its title, he says, will be Recipes for Humble Pie. His most recent project, AgeWell, aimed to use the mothers2mothers model among elderly folks. More able elderly individuals will help their less able peers to continue to have active and fulfilling lives. But just a year after it was rolled out in South Africa, the project was ended due to a lack of funds. Dr. Besser and his team, however, transformed the idea into a for-profit model and are bringing it to the U.S.
Throughout his career, Dr. Besser tried and failed many times. But the key was that he failed forward—he learned from his mistakes. “If you’re not failing, you’re not trying hard enough,” Dr. Besser says. “I don’t think it’s brilliance,” he reflects, “I think it’s just the persistence to keep going…It comes down to finding that passion and taking it forward.”
Here is the full video of Dr. Besser’s talk: