Dr. Alex Coutinho: Hero behind HIV/AIDS fight

SUNDAY VISION

When HIV puzzled the world, a young graduate doctor stepped in; treating, training and traversing the world for answers. Thirty years later, Dr. Alex Coutinho is one of Uganda’s leading experts on HIV/ AIDS and infectious diseases. But the winner of the second Hideyo Noguchi award has come a long way.

By Stephen Ssenkaaba

He emerged from his office at 7:20am, simply dressed: Pink shirt, striped tie and grey trousers, with metallic rim glasses over his forehead. “Who has come from the New Vision? he asked. I raised my hand. “I will be with you shortly,” he said.

His office door swallowed him almost immediately. He appeared about 10 minutes later to say: “Let’s go; you will interview me from my car. I have another appointment…”

I met Dr. Alex Coutinho in Mulago, at the Infectious Diseases Institute (IDI) where he is the director.

He recently won the second Hideyo Noguchi Prize for Africa, a Japanese government award to individuals for their outstanding work in medical research and stopping infectious diseases in Africa.

Dr. Coutinho was recognised for “stepping up access to life-saving drugs for people infected with HIV” in and beyond Uganda.

Before our meeting, I thought of Dr. Coutinho simply as some expatriate physician. Newspaper mug-shots suggested a well-built, tough-looking man.

In real life though, he is a short man with grey curly hair. There is a daunting sense of urgency about him, manifested in his hurried answers to questions.

Sometimes it is a dry ‘yes’ or ‘no,’ leaving you scampering for the next question. From Mulago to Crested Towers, I only managed a few questions and then he was soon off for his next meeting.

Facing the HIV/AIDS giant

Dr. Coutinho was among the first doctors to confront HIV/AIDS when it first presented as a strange disease in the early 1980s. Since his graduation from Makerere University Medical School in 1983, he has trained medical students and participated in ground breaking research.

As executive director at The AIDS Support Organisation (TASO), he helped scale up treatment and other services for people living with HIV.

He championed the Abstinence, Be Faithful and use a Condom (ABC) strategy in schools and the scaling up of safe male circumcision.

He has brokered partnerships into vaccine research and promoted Prevention of Mother-to-Child Transmission of HIV and the recently adopted Option B-plus strategy for HIV-positive expectant mothers.

He serves on national and international boards and remains widely consulted on issues of HIV and infectious diseases. His work has earned him a place among one of the 20 most influential Ugandans in the fight against HIV/AIDS.

The IDI avials over 10,000 people with Anti-Retroviral Therapy and other life-saving drugs, 9,000 of which receive care at the IDI clinic, and an additional 6,000 are attended to in the institute’s outreach project in and outside Kampala.

Over the last 10 years, 200 papers have been published by IDI on HIV and infectious diseases. The institute is currently supporting the Government and districts to provide treatment to people at health centre III and IV levels.

These milestones have come at a huge price in a country where stigma against the affected and infected remains a big challenge. The continued loss of competent doctors also remains a stumbling block to the good work going on.

That is probably why Dr. Coutinho is not blinded by the individual and national achievements in the struggle against AIDS. “Many orphaned children still need our support; HIV/AIDS continues to kill up to 20% of our people and many needy people in rural areas cannot get the much needed health care,” he told me. Will HIV ever be wiped out? “No, not even with the invention of a vaccine. It will not reverse the existing cases.”

The award has then come at a right time, when so much remains to be done. Indeed, Dr. Coutinho has already laid out a plan to utilise the $1m (sh2.5b) prize money to improve health service delivery.

“I would like to set up a leadership training centre somewhere — probably Kajansi — to train rural-based health workers in health management. The centre will meet the expenses and also provide reading materials, low-cost computers and internet to the candidates.

“We will also sponsor doctors and nurses from the countryside to advance their studies in key areas like tropical medicine and hygiene, obstetrics, maternal and child health at bachelors and masters levels.” This, he said, will be done in partnership with the existing universities in the country.

Dr. Coutinho with his mother and siblings

Carrying the Coutinho legacy

Dr. Coutinho’s is an old story, woven around the fabric of Biso — a tiny village on the fringes of Hoima and Masindi districts in western Uganda. It was here that the good doctor was born, in 1959, to Martha Carmelina Coutinho, a young nurse of Goan-Portuguese descent. “I never got to see much of my dad,” he recalled.

With an elder brother, Godfrey and a younger sister, Felistas, they lived a humble village life fetching water from the spring well and drinking goat milk. His mother moved to Entebbe and later to Jinja where she worked as a midwife in Jinja Hospital before opening a private clinic on Oboja Street in Jinja.

In the modest two-bedroom house at the Jinja hospital staff quarters, Dr. Coutinho first experienced the medical world. “I used to see my mum at work. The way she dealt with her patients taught me to always empathise with the sick.”

His first attempt at service though, was as an altar boy at his local parish in St. Fatima Church.

He was a prefect at Victoria Nile Primary School and a cheeky playmate back home. He was a competitive lad “who always gave his brother and myself a good match whenever we went out riding our bicycles on the shores of Lake Victoria,” Dr. Simon Kagugube, a childhood friend of the Coutinhos recalls.

He became a head boy at St. Mary’s College Kisubi where he later emerged as best O and A’ level student in East Africa in the 1970s. He was a student leader (minister) at Makerere University’s Nkrumah Hall and later emerged top of his medical class.

“My academic record still stands,” he boasted. And yet, he was never a bookworm. “You never saw him locked up in a room reading away,” says his cousin Emmanuel who describes the doctor as a hands-on man who will even engage in cooking at family gatherings.

Responding to the news of the award, Dr. Robert Steven Owor who was also at St. Mary’s College Kisubi, wrote online: “He is one of the brightest scientific minds Uganda has had in the past 40 years. Coutinho had an incredible reading speed, comprehension rate, razor sharp memory and was equally gifted in the arts and sciences.”

Hardworking family

The Coutinhos were always a hardworking people. Antonio Sebastiano Coutinho, Dr. Coutinho’s maternal grandfather, arrived in Uganda around 1910 from Portuguese colonised Goa in India, in pursuit of his elder brother Vito, who had travelled to Uganda and started a business in Fort Portal.

“His parents sent him to find his brother and take him home,” says Martha Carmelina, Dr Coutinho’s mother and one of Antonio’s daughters. Instead, the two joined in business and forgot about returning to Goa.

The two brothers got a misunderstanding and separated. Antonio went to Bundibugyo near the Congo border where he started trading in various commodities before reuniting with his brother. Here, he also met and married Theresa Byaitaka — a Mubiito princess who was the mother of his eight children, including Dr. Coutinho’s mother.

Antonio moved to Kasenyi near Lake Albert where he started a successful business selling smoked fish, beef and other foodstuffs.

“He supplied companies with bundles of dried meat, fish and maize; and was able to build a house for his family and educate all eight of us,” said Carmelina.

All Coutinho’s children grew up into responsible citizens and have produced notable children — doctors, like Alex, Godfrey and Sheila Coutinho, nurses like Sara and Margaret Kigundu, engineers like Emmanuel and social workers like Felistas, among others.

Today, Carmelina leads a quiet life in a decent home set up by her children in Njeru near Jinja. Confined to a wheelchair, the ageing mother glowingly decribed her son: “He has always been very clever.”

Away from hospital wards, Dr. Coutinho is a proud father of three children — Neil, Jeremy and Karen. He is the champion of the Hima Cement Golf Captain’s Prize. He speaks Luganda, Lusoga, Runyakitara and English.

His wife, Sheila, is involved in social work while their daughter uses drama to raise awareness on HIV/AIDS. Sometimes, it looks like life for this man has just begun.