One Life at a Time: An American Doctor's Memoir of AIDS in Botswana

by Daniel Baxter

When Dr. Daniel Baxter arrived in Botswana in 2002, he was confident of the purity of his mission to help people with AIDS, armed with what he thought were immutable truths about life—and himself—that had been forged on his AIDS ward in New York City ten years earlier. But Baxter’s good intentions were quickly overwhelmed by the reality of AIDS in Africa, his misguided altruism engulfed by the sea of need around him. Lifted up by Botswana’s remarkable and forgiving people, Baxter soldiered on, his memorable encounters with those living with AIDS, and their unfathomable woes assuaged by their oft-repeated “But God is good,” profoundly changing the way he thought about his role as a doctor.

Now, after caring for innumerable AIDS patients for eight years in Botswana, Baxter has written an urgent, quietly philosophical account of his journey into the early twenty-first century’s new heart of AIDS in Africa, where legions desperately struggled to be among the spared and not the doomed. Part memoir, part travelogue, part chronicle of the zaniness of Botswana (one of the questions on his driver’s license application was “Are you or have you ever been an imbecile?”), and part witness to suffering unknown to most Americans, his testimony is an unforgettable tribute to the many people he cared for.

Join Baxter on his life-changing journey in Botswana, as he recounts the stories of people like Ralph, a deteriorating AIDS and cancer patient who nonetheless always wore a smile, or Precious, a woman found sick and abandoned in the capital’s slum, or “No Fear,” a rude man in Baxter’s gym whose descent he halted. After many years on the front lines of the African pandemic, Baxter realized that “one life at a time” was the only way to fight AIDS.

Genres: Memoir, Africa, Nonfiction, Medicine, Botswana

312 pages, Hardcover

Published June 26, 2018

Reviews

[Erin · Rating 3 out of 5]

Dr Daniel Baxter takes his readers inside the hospitals, clinics, and the bureaucracy that exists internationally in AIDS healthcare. Separated into four sections, Baxter focuses on his time in Botswana, a Southern African nation that is comprised of 2.25 million people and has one of the highest rates of HIV in the world. At times, I did find that the narrative was discouraging as Dr. Baxter retells the stories of several patients that he came into contact with while working in both Botswana and New York City. Sometimes told in a very cynical cool tone, I didn't really feel connected to the author, but I appreciated that Baxter provides blunt honesty when it comes to the many blunders he made along the way and that he can recognize his Western ignorance.

All in all, I find myself at a 3 star rating because I felt that as personable as Baxter attempted to make his memoir, I found myself often bogged down by all the medical jargon and details of specific treatments.


Thanks to NetGalley for an advanced e-arc in exchange for an honest review.

[Lorraine Tosiello · Rating 3 out of 5]

For those interested in the care of African patients with HIV, this will be a very interesting read. Dr. Baxter writes in with a clear, compassionate style, sometimes charming, sometimes obstinate, sometimes frustrated and sometimes just bemused. The most compelling parts of the book are the heartfelt narratives of people with AIDS in Botswana just at the inception of the delivery of adequate treatment. As the book was published in 2018, it would have been helpful to a 21st century audience to be reminded not only of the individual but of the societal impact of AIDS. But then, the book's focus is "One Life at a Time." This philosophy falls short in the latter part of the book, when the doctor is a teaching attending at a poorly supported government facility. The lack of any actions to improve the system, when Botswana by this time was becoming a more affluent nation, is problematic and made the narrative uncomfortable for me. And then, the author short changes himself because the work of teaching moved his impact to much more than just the immediate lives in front of him. So, Bravo, Dr. Baxter!

[Kathleen Gray · Rating 4 out of 5]

A worthy read about a slice of the world we don't read much about and a disease that's slipped down in the news media. Baxter had been an infectious disease specialist for years when he decided to go to Botswana. Seemed like a good decision but then he discovered (and it should not have been the surprise it was) that practicing medicine and dealing with AIDS is far different in Africa than it is in the US. His second tour seems more successful but he's still overwhelmed. There's a certain amount of first world-third world conflict (naturally) but it's the patients who will stay with you. Thanks to Edelweiss for the ARC.

[Zoë · Rating 3 out of 5]

I was disappointed in this book and the author. His perspective is egocentric and it pained me to read the descriptions of Botswana which were less than glowing. He did have an epiphany of sorts, which he truly wants to share with readers to redeem himself, but it comes too late in the book to have much impact. I would have preferred to see his ideas about suffering gradually evolve thorough out the book and see the significance of those revelations for his patients and himself disclosed incrementally.
It is, however, a detailed description of how the AIDS epidemic was fought valiantly in a remote country without access to all the tools, equipment and medicines available elsewhere.

[Pat · Rating 4 out of 5]

A book about reality checks and humble lessons. Life is not fair. Assumptions can kill and learning is constant even for a supposed authority in a field as fraught as AIDS treatment and survival. I liked that this doctor did not shy away from revealing at least some of his learning experiences and mistakes. And the tone remains respectful of the place and time he is in even when his emotions are not so flattering to himself. The patients are people first and that of course is the real lesson of the whole book.

[B · Rating 4 out of 5]

An eye-opening memoir of an American doctor and his life in the trenches of the AIDS epidemic in Botswana from 2002 until 2015. The accounts of equipment not working, medicines running out, and flat out not enough care for the many people suffering of AIDS and other ensuing medical problems plus the personal stories of some of the sufferers would haunt anyone reading this book. Sadly, the situation is even worse in nearby African countries.

[Cheryl · Rating 3 out of 5]

I had a love hate relationship with this book. Because I had wanted to be a missionary doctor in Africa, I wanted to love it. But I found it was great for me to read at night to make me drowsy for bed :(

[Samantha Nuerminger · Rating 4 out of 5]

Important insight into systemic neglect due to societal stigmas in the US and Botswana with the AIDS epidemic while supplementing information on cultural differences.

[Cheewai Lai · Rating 5 out of 5]

I lived in Gaborone 1998 - 2001 and again 2004 - 2010. I shared some of his experience serving in a government department.

[Sai Nageswar · Rating 5 out of 5]

Heart touching. This book is inspiring and gives us insight into helplessness and struggles of controlling an epidemic.

[Jade · Rating 4 out of 5]

I have recently been thinking a lot about how we don’t really talk about HIV and AIDS that much anymore. As a kid born in the late 70’s I remember the dark days of the 80’s when people were dying in numbers from the disease and we assumed it would become a Black Death type plague, the early 90’s when our beloved Freddie Mercury died, his illness a secret until his death. And then the ARV medication cocktails started to work, and people stopped dying... The billboards disappeared and we started to worry more about HPV-related cancers, Ebola, Zika, and the re-emergence of certain vaccine-preventable viruses like measles.

Remember when reports told us that AIDS would wipe out Africa? Was it all scaremongering, or was it really on the brink of a continent wide pandemic? I certainly never really took too much time to do more than some topical research on the subject, just assumed that we had managed to solve the crisis with the drugs that had become the norm in the US. As I have been digging a little deeper into the subject recently, One Life At A Time by Daniel Baxter popped on my radar, and I feel it provides a very enlightening narrative into a small part of Africa and the AIDS epidemic, through Baxter’s personal experience in Botswana.

Baxter worked as an AIDS doctor in NYC during the worst US era of the illness, the 80’s, and left for Botswana on a slight whim in 2002, excited to bring his expertise and care to the Batswana, where at the time a big portion of the population was assumed to be infected with the virus (24%). Through his two stays in Botswana (6 years and then 2 years with a 4 year hiatus between) Baxter recounts how he arrived in Botswana assuming certain things and instead learnt many lessons, some heartbreaking, some embarrassing, and some just really important along the way.

Africa is a continent, a huge continent, comprised of many countries, and this memoir only describes the AIDS situation in Botswana from the early 2000’s onwards, so while other countries similar in population and government might have had the same processes in place I think it’s important to have a distinct view of all, just as we would when talking about different European countries. More importantly we should draw a comparison with other countries where the attitudes towards prevention and care have been different, or were different at the time (South Africa for example), to see how important the collaboration between the Botswana government, population and outside agencies was/is.

There are times during his first stay in Botswana (6 years) when I felt that the narrative gets a little jumbled up, Baxter’s memories and facts all colliding together, and I found it hard to fasten myself to a timeline or even a character or edifice that I would reencounter again down the road. This isn’t a bad thing, just that sometimes the stories were combined in a way that makes it a little hard to get through, because you have to go back a few lines or pages and read them over again. The second part of the book, when Baxter goes back to Botswana for another stint after 4 years in NYC, is less haphazard, written with more focus, and a lot easier to follow in general.

All in all I thought One Life At A Time was a great story of how an American doctor lands in a country he does not know at all, and learns so much more than he ever imagined he would. While Baxter brings his expertise to help the people of Botswana combat the epidemic of AIDS in the country, he receives so much more in return, including a lot of humility and a much wider view of the world. I feel like I learned so much more about Botswana than I ever knew before, and am now interested in learning much, much more. Last of all, I think it’s very important to mention that Baxter never portrays himself as a savior - he just continued to do the work he had been doing in the 80’s and 90’s in NYC in Botswana, and is very vocal about how much he learned about himself when he was there. One Life At A Time is a brilliant insight into the AIDS epidemic in general, how hard work and collaboration (we can include Dubya -in this part too - PEPFAR helped make a huge difference in how HIV positive patients in Africa received care), can turn despair into hope. I’m looking forward to reading Baxter’s other books now too.

One Life At A Time will be published on June 12, 2018 by Skyhorse Publishing. Thanks to Netgalley and the publisher for the advance copy!