Dené Marcello
I always considered lobbying an avaricious act by influential people or corporations seeking to extend their influence. The very definition of lobbying supported this suspicion: attempting to gain influence over a politician or public official regarding a specific issue.” However, the reality of our political climate is that change requires political and financial resources. I must admit, answering “yes” to the “did you engage in lobbying activities during the year” question on our IRS Form 990 coincided with a certain feeling of guilt. Even though there was a cause in front of America’s decision makers that I felt deeply about and knew would make a difference for millions of people without a voice, it was hard for me to justify an investment in lobbyists. But PEPFAR (the President’s Emergency Plan for AIDS Relief) was too important for me, and I realized the guilt I felt was misplaced. PEPFAR has saved over 25 million lives, making it worth answering “yes” on the 990-lobbying question.
Meet Dr. Jon Fielder and Mark and Rabbi Erica Gerson
Jon Fielder graduated summa cum laude from Williams College and with honor from the Baylor College of Medicine. He completed his residency in internal medicine at Johns Hopkins Hospital, where he was named the top intern in his class. Despite opportunities to work anywhere in the US, Jon has served as a medical missionary in Africa for two decades. He and his wife Amanda, a social worker, have three children and live in Kijabe, Kenya, where he is the chief executive of African Mission Healthcare.
Mark Gerson is an investor, businessman, and philanthropist. Mark attended Williams College with Jon, where he also graduated summa cum laude, and went on to Yale Law School. Mark co-founded the Gerson Lehrman Group, and Thuzio, a sports media and events company. His wife, Rabbi Erica Gerson, graduated from Amherst College magna cum laude and received both rabbinical ordination and a Master’s in Religious Education from Hebrew Union College-Jewish Institute of Religion. They have four children and reside in New York City.
Jon and Mark’s friendship developed at Williams College and has only grown over the years. When Jon told Mark he planned to serve in Africa, Mark was unsurprised. “He called me and said, “I’m a Christian, and I’m called to go serve the poor in Africa,” Gerson recalled. “I wasn’t surprised at all.”
When Jon reached Kenya in 2002, the PEPFAR treatment program had not yet started. There were antiretroviral drugs available that could keep HIV from developing into AIDS. Still, these drugs were expensive, and few could afford them. Jon and his colleagues treated the infections resulting from AIDS but could not control the HIV virus ravaging the bodies of their patients.
Inspired by his deep-rooted belief in the Torah’s mandate to cherish and aid strangers, Mark and his brother Rick donated generously to provide life-saving antiretroviral drugs. It was a commitment. These patients had to stay on drug treatment for the rest of their lives.
PEPFAR
In the 1990s, the HIV/AIDS epidemic had a devastating effect on sub-Saharan Africa (SSA). In some of the hardest hit areas, life expectancy dropped by up to 20 years, falling from 60 to 40 years or less, leaving 13 million African children orphaned and communities gutted. This drop in life expectancy had heartbreaking effects on families and communities, along with devastating economic and social implications, negating years of progress in Africa.
President George W. Bush, during his State of the Union address on January 28, 2003, announced the President’s Emergency Plan for AIDS Relief (PEPFAR). It officially launched later that year. Regarded as one of history’s most successful public health initiatives, PEPFAR has saved over twenty-five million lives and supported antiretroviral treatment for nearly twenty million people worldwide. The number of HIV deaths has fallen by 60%, and the new infection rate has been cut in half. The impact is almost miraculous.
My first trip to Kenya
This intervention by the US was the backdrop to my first visit to Kenya in 2007. My pastor at Heritage Christian Church in Westerville, Ohio, wanted to see how we could help those struggling with HIV in Africa. I led a team of about 15 volunteers from our church. We attended community meetings, met people struggling to survive, and talked with families and leaders who desired to help in any way they could.
I think I expected total devastation, and yes, there was extreme poverty that is hard for anyone in the West to imagine. There was sickness, tears, loss, and isolation – but also healing, smiles, life, and community. I saw the hope that was starting to rise from the despair. We visited HIV community groups where individuals who were affected with HIV gathered to encourage, assist, care for and hold one another accountable for taking their antiretroviral drugs. Inconsistent adherence to the treatment plan can lead to drug resistance and failure. These groups were vital to keep parents and children alive.
There was singing, dancing, laughter, and children playing soccer. In some of the fortunate places, including Kijabe, Kenya, where I visited, there was access to the PEPFAR program. With this influx of hope, everyday community life was starting to return. I remember one community meeting very clearly. We were in a small rural church that held about 150 people. The HIV group arrived dressed in vibrant African colors and sang and danced as they entered the church. You could hear the laughter and drumbeats, filling the air with celebration. I remember this community group so clearly because I met a couple planning to marry there. I was surprised. How will HIV affect this couple? How are they going to have children? What will this mean to the next generation? At the time, I had no answers to these questions. I remember being happy for them. They had found each other in a highly challenging time, and they would not be alone as they continued to fight HIV and its impact on their lives.
What next? African Mission Healthcare
With the introduction of PEPFAR, donations specifically for antiretroviral treatments were no longer required, but other forms of support remained critical. In 2010, Mark Gerson, his wife Erica Gerson, and Dr. Jon Fielder founded African Mission Healthcare (AMH). AMH provides resources and strategically partners with mission hospitals across sub-Saharan Africa to treat patients today, train doctors for tomorrow and transform hospitals for the future. As of 2023, African Mission Healthcare has supported 1.2M direct patient visits, trained 26,480 African health professionals, and invested $22M in hospital infrastructure and equipment.
But much more needs to be done. More than 288 million Africans suffer needlessly from surgically treatable conditions. The continent requires 50 times the surgical personnel currently available. In 2021, there were 860,000 new HIV infections and 420,000 HIV-related deaths. HIV infected approximately 130,000 newborns in sub-Saharan Africa. There has been limited progress in reducing HIV transmission between mother and child over the past five years, even though this is almost 100% preventable. So why is this number not decreasing?
This transmission continues primarily because mothers are not receiving quality care early and often. They do not have access to effective healthcare. Research and the experience of on-the-ground health workers point to the lack of quality maternal health services as a significant barrier to women entering care earlier and remaining in care for the duration of pregnancy and the postpartum period.
Lobbying, back to it
This is why lobbying is a good word. As mentioned, I did not want to have to say on the 990 form I was completing for African Mission Healthcare that we spent money on a lobbyist or spent time trying to persuade politicians. Lobbying was not what I imagined to be a good use of our board’s generosity. But I was wrong. I am proud to say African Mission Healthcare spends funding on lobbying. Why? Because these women cannot go to Congress to tell their stories. They are poor women caring for families, working in their communities, and trying to survive. Malawi’s GDP perperson is $645, according to the World Bank.
African Mission Healthcare invests directly in making a difference in these women’s lives. We treat HIV, sponsor surgeries, invest in the training of African doctors, build operating rooms, and source equipment. However, we also advocate for continuing and expanding the continent-changing PEPAR program. Yes, we lobbied for PEPFAR. We are guilty.
These funds do not come to African Mission Healthcare. We do not benefit from PEPFAR as an organization, but we certainly see the benefit to the people we serve. The President of AMH likes to say, “We measure ROI not in dollars but in lives changed.” Changing lives is why the dollars spent on advocacy matter.
On August 1, 2023, the US announced Safe Births, Healthy Babies, a commitment to eliminating mother-to-child transmission of HIV (MTCT) and improving the overall quality of maternal healthcare. This initiative will launch in 2024 through PEPFAR and includes a two-year, $40 million commitment to accelerate progress toward eliminating MTCT.
Back to Africa
I have gone to Africa many times since that first visit. There is still extreme poverty and many needs, but I see hope. At least once a year, I return to one of the first clinics I visited in 2007. I speak with women whom I may have met on my first visit. Todat, their HIV infection is controlled. They are community leaders traveling into underserved areas, looking for women who may be HIV positive, providing them with encouragement, support, and access to help. I love to hear the stories of these women. They share how they are healthy, working in their communities, and serving others. With tears in my eyes, I listen to them speak of their grandchildren. Yes, I am guilty of wanting to hear more stories about how the United States has made a positive difference in these women’s lives and the world. I am guilty for lobbying for more of this.
I think of the young couple I met in 2007. I like to think they have children and are supporting their community because someone made a difference in their lives in 2007. They are paying it forward, just as I see these women doing today. I am proud that my country and the organization I serve helped make that happen.