In a region where virtually all movement of freight takes place via road, trucking companies and their frontline truck drivers are all-but the literal spine of sub-Saharan Africa’s economy. Tens of thousands of trucks take to the region’s roads, day in, day out, transporting goods, products, and personnel from A to B, facilitating economic growth and prosperity. For the often unseen and forgotten men and women who spend long hours, days and even weeks traversing roads and national borders, however, life behind the wheel can be a lonely and stressful place where poor health is an accepted occupational hazard.
Due to a lack of access to healthy food and exercise whilst on the road, truck drivers reportedly suffer from well above average rates of heart-disease and diabetes. On top of this, lack of sleep, combined with the stresses of facing traffic and adverse driving conditions, has led to endemic rates of hypertension and increased chances of being involved in fatal accidents on the region’s notoriously chaotic roads. Lorry driving and healthy living are uncommon bedfellows in any country – in this regard, Southern and Eastern Africa are no exception. But while truck drivers are under no illusions that their job is one that comes at a price to their health and safety, a far deadlier silent killer lurks in the region – one that has stalked drivers and their communities for over 20 years with heart-breaking ramifications.
Historically speaking, mobile workers and groups have often acted as inadvertent carriers of disease and infection, particularly sexually transmitted infections. It was true of sailors and soldiers travelling the open ocean in search of new worlds and treasure centuries ago, and it is true today of roving long-haul lorry drivers. The nomadic and isolated nature of their lifestyles can inevitably mean that contact between truck drivers and sex workers is common. With rates of HIV infection amongst sex workers being so high, combined with a lack of education surrounding the disease, an HIV/AIDS epidemic broke out at the turn of the century that threatened to engulf the sector. The outbreak was ruinous for truck drivers, and by extension their families, the wider community, and the transport companies who employ them.
Once the problem and its terrifying scale first came to light, it quickly became apparent that action was urgently needed, as Paul Matthew, North Star’s Director in Southern Africa, remembers clearly:
“The focus on healthcare for truck drivers really came to the fore 20 years ago. I came from the road freight sector myself, and way back in the early days, around 1998 to 1999, we found that there was a large and sudden decline in truck drivers, and soon after we realised that it was a problem directly related to HIV.
There was a real crisis at the time. Drivers would refuse to disclose their HIV status to management because they were scared they’d lose their jobs. That really got me thinking about how do we look after truck drivers, and how we can make them look at us as a neutral party, rather than management? The idea to deliver healthcare from the side of the road came to us shortly after, which in-turn led to a visit from the UN in 2001-2 to find out more about our work and what we were doing in terms of healthcare for truck drivers. At the time, they were experiencing a similar problem with their relief drivers. With their support and initial funding, North Star Alliance was born.”
The success of North Star Alliance, an NGO committed to providing quality healthcare services and education to hard-to-reach people across Southern and Eastern Africa, is a powerful and innovative example of how public-private sector partnerships can be utilised to solve the greatest challenges facing disadvantaged communities in developing countries. Since the organisation was established in 2007, when its first clinic opened its doors in Malawi, North Star Alliance has helped play a pioneering role in curbing the spread of HIV in even the most high-risk communities. From its network of ‘Blue Boxes’ – blue-painted former shipping containers that have been converted into cutting-edge semi-mobile clinics, equipped to WHO standards with equipment, staff, and medicines – Paul Matthew and his 200-strong team of professional nurses and counsellors have been able to deliver a portfolio of high-quality healthcare services in trucking ‘hotspots’ such as border posts, transit towns, and ports – areas where large numbers of truck drivers stop to rest and offload cargo, where sex work and informal trade flourish.
From the roads and transport corridors connecting South Africa to Swaziland, Kenya to Tanzania, and then Uganda, Zambia, Zimbabwe, Botswana, and Mozambique, North Star’s distinctive Blue Boxes have become a familiar and reassuring sight to those who live their lives on the open road. Easy to produce, easy to set up in the communities that house them, and cheap to deploy, the number of mobile clinics that can now be found on roadsides, truck-stops and informal settlements has grown rapidly. Today, North Star has grown its clinic network to more than 40 – a number which, in Paul’s words, is only the beginning.
The strategic placement of North Star Alliance’s semi-mobile clinics in such locations is essential in the war against the spread of HIV infection because, as Paul and his team soon found, offering healthcare services to truck drivers alone wouldn’t be sufficient to get a handle on the crisis:
“We quickly realised that we needed to balance our work with truck drivers with sex workers as well. Then, after working with the sex workers, we were led to work with wider communities,” explained Paul. He continued: “Drivers create these hotspots along major transport corridors where they make up these informal rest areas where they will park off. Informal settlements tend to start up around it because the truck drivers have the money to buy goods and services.”
North Star Alliance has sought to build relationships with the communities that they serve. It is telling that while lorry drivers are still fearful of the repercussions for their livelihoods if they are diagnosed with HIV, and that whilst the stigma surrounding the disease has diminished it is still ever-present, they trust North Star Alliance and its staff, as do sex workers and other vulnerable community members. Through combining empathy and understanding with common sense and pragmatism, Paul’s mobile clinic model has been a resounding success. Over the past decade, close to quarter of a million truck drivers, sex workers, and other vulnerable members of the community have flocked to North Star’s Roadside Wellness Clinics seeking primary healthcare, HIV counselling, ART and PrEP testing and antiretroviral (ARV) treatment, and blood and urine tests, in addition to screening for malaria and tuberculosis, and health education and advice. On top of this, in excess of 16 million condoms have been provided to those that need them, and invaluable education to isolated communities where in some instances fear, denial, and misinformation still reign.
Having matured into a multinational organisation with international capabilities and reach, North Star Alliance appears to be on the cusp of becoming household name in its field. With an array of international public and private sector partners, its unbending commitment to its core values (integrity, quality, entrepreneurial spirit and its ‘People Matter’ outlook), and plans to further expand its Blue Box network to assist mining sector workers, it might come as something of a surprise that storm clouds are looming which could greatly hinder the organisation’s capabilities and ambition.
Paul elaborated on this, saying: “As a result of the global economic crisis, NGOs the world over are experiencing funding problems, as donations have diminished substantially. In light of the global recession and increased corporatisation and competition, as well as reduced government funding, the non-profit sector in Southern Africa currently faces many challenges.
In the current climate, our main obstacle is that of securing funding. As our work is critical to a great many people across Africa, one of our dedicated goals going forward is to optimise our funding base.”
This being so, the organisation has gone to great lengths to gather further support and commitment to funding from the business community, both at home and further afield. In a world where protectionism and toxic nationalism has increasingly taken root in the most surprising of places, you’d be forgiven for thinking that such support might be difficult to find, but this simply isn’t the case. As the wiser heads are all too aware, ongoing efforts to halt the rapid spread of HIV/AIDS – a disease that since its emergence is believed to have killed more people than the two World Wars – is one which each country must participate in if the global epidemic is to be overcome.
Organisations like North Star Alliance are on the frontline of the gruelling fight against this horrific disease, and over the coming year Paul is quietly confident that, with continued support from public-private sector partners, he and his team will be able to expand on their achievements so far.
Concluding the interview on this point, Paul said: “With the aim to grow our organisation to the next level, we have developed three main strategic goals: increasing access to healthcare, guaranteeing the quality of our services, and strengthening our data management and learning. In addition, we set internal strategic goals to optimise our funding base, strengthen our governance, enhance our leadership, and maximise the engagement and overall alignment of our global team.
As we move through 2017, North Star Alliance is confident in our direction, and resolutely working towards realising our mission. Together, as friends, colleagues, partners, and supporters, we can grow North Star to its full potential – bringing essential health services to the people who need it most.”
To find out more about the work of North Star Alliance and pledge your support, visit http://www.northstar-alliance.org