Canada and the world have lost a great medical researcher, and a remarkable man. In my life – and I’ve had a long one – I’ve met only a handful of people I admired as much as I did Frank Plummer. This is my tribute to him.
By Joan Baxter
February 6, 2020. When I heard this week that Dr. Frank Plummer had died, the loss hit hard, although I hadn’t seen him in two decades and knew him for only a couple of years when my family and I were living in Kenya.
That Frank had died suddenly while in Nairobi to deliver a keynote speech at the annual meeting at the collaborative centre for research and training in HIV/AIDS/STIs at the University of Nairobi – his old stomping grounds – made his passing somehow even more poignant.
It was in Nairobi in the mid-1990s that I met Frank, a fellow Canadian. Through our kids and mutual friends, we met the Plummer family, and would get together at parties or for weekend outings in the Kenyan countryside.
At first, I had no idea how renowned he and his work were, although he had been in Nairobi for more than a decade doing research on HIV/AIDS. It was through our mutual friends – not Frank himself – that I learned just who he was, a globally and highly respected microbiologist whose work had made world headlines in 1993.
At the time, I was working as a science writer for an international research organization headquartered in the Kenyan capital, and was eager for some writing projects that involved more creativity than did the mostly technical reports and academic articles that took up my working days.
Then one day in 1995, Frank asked me if I would consider writing a book about him and his work on HIV/AIDS. He said a European publisher had approached him and asked if he would be willing to pen an autobiography. He told me he wasn’t interested in doing that. Not then. He was too busy.
I was flattered and honoured that Frank would entrust me with a book about the research that he and his Kenyan and Canadian colleagues were doing on HIV. So I spent every moment I could find on weekends and evenings over the next few weeks interviewing him and his colleagues, studying the medical literature that he passed on to me. I also followed him in his daily research routine in Nairobi, and to the hospital where he and his colleagues did their lab work.
Frank was particularly keen that I capture his views on medical research and AIDS, and very critical about the vast amounts of money spent on finding treatments rather than on understanding the syndrome and preventing AIDS.
Using all this material, I wrote a book outline and proposal, which Frank sent off to the publisher. It was turned down. The publisher wanted the book in the first person, and Frank said he wasn’t ready to do that.
So the book proposal and all the documentation including the interview transcripts, went into my files – some on computer, and others in a faded filing box that sits on a shelf with other precious documents that I have collected over the decades.
I did take some of the notes and write a letter about him, which was aired by CBC Morningside in 1996 and printed in Peter Gzowski’s 1997 book, The Morningside Years. I also devoted a chapter to Frank and his work in my 2000 book, A Serious Pair of Shoes – An African Journal.
After my family left Kenya and moved to Mali, and Frank and his family moved back to Canada, we lost touch.
But I continued to follow his remarkable career in Canada, where he headed the National Microbiology Laboratory in Winnipeg. In 2006 he was awarded the Order of Canada. His list of achievements could fill a book or two. And that work he and his colleagues did in Kenya was just the launching pads for many breakthroughs on HIV/AIDS and vaccines for other infectious diseases.
I didn’t know that he struggled with alcoholism until December 2019, when the CBC’s Carol Off interviewed him on As It Happens, and he spoke about having undergone experimental brain surgery to fight alcohol addiction.
In his honour – and because I feel so privileged to have had the good fortune to meet him, spend time with him, interview him, and watch him at work – I am posting here some of those notes and writings from those early days.
I’ll start with the day I spent with Frank in Pumwani, one of Nairobi’s more impoverished areas (and there are plenty of those), which I documented in my book in 2000. At that time, Frank was 43 years old.
A day in the working life of Frank Plummer in Nairobi
The morning Frank took me to Pumwani, I was ashamed to admit that I hadn’t been there before, that I had almost no first‑hand experience in the city’s teeming, sprawling slums where about a million people lived ‑ perhaps a third or even a half of Nairobi’s population at that time.
Frank, on the other hand, obviously felt quite at home in the shantytowns that most expats preferred to forget about. Frank worked in Pumwani as a medical researcher, when he wasn’t at the hospital overseeing laboratory work, or back home in Manitoba trying to drum up more funding for research that might lead to prevention of AIDS, or attending international conferences to gain support for the same cause. Pumwani was, after all, a veritable laboratory for the infectious diseases he studied.
As he eased his Nissan Patrol into those alleyways, Frank told me Pumwani was one of the city’s oldest slums, settled in the 1920s when the British housed their labourers there. He called it a “rough place,” even for those who lived there.
I won’t try to pretend that I wasn’t disturbed by the riotous squalor, the crowds, the claustrophobic slumminess of Pumwani. I was more than disturbed; I was appalled. I’d been living a very cosseted life in Nairobi that had spared me much of the reality.
There was a strong smell of sewage; I had the impression that all 15,000 inhabitants of this small ghetto had gathered in the one alley we were trying to negotiate that cloudy morning. Everyone was trying to sell something ‑ old shoes, old curtains, old bed sheets, old brassieres. The only things that didn’t look old, used or cast off were the mountains of fresh mangoes and tomatoes on the roadside market. The alley was thick with hawkers and makeshift stalls. Behind those stalls were the houses, wattle‑and‑daub structures that needed to lean on each other to remain standing. Behind those, there were mountains of rubbish that not even the resourceful people who lived here could re‑use or recycle.
I wound up my window. right to the top. I was terrified of thieves.
I glanced over at Frank, who was busy winding his window down, sticking his head out and leaning out of the vehicle like a farmer on a tractor in rural Canada about to have a wag with the neighbours.
“Excuse me,” he called to the horde of young men blocking our path and armed with their wares, stacks of second‑hand blue jeans.
“I’m afraid I have to get through,” he said, sounding every bit the gentleman that he was. The hawkers seemed to appreciate his good manners. They were, I suppose, unusual in a so-called Big Man in a Big Car in their part of town. They took up the call in Kiswahili, warning everyone ahead that a car was coming through. The path cleared. We pulled into a littered yard in front of a small bungalow badly in need of a coat of whitewash.
“This is Majengo Clinic,” Frank said. “Majengo means slum in Kiswahili. This is where we do our work with the malaya, or sex workers. We have 1,800 registered patients here. They’re all malaya. They’re not like prostitutes who work the bars downtown at night. The malaya work only in the daytime, selling sex to men who are on their way to work or passing by. They close up shop at dusk, when it’s time to cook for their children or their husbands. Some of them are married or at least living with a man who may not even know they do this for income. They have houses, usually just one room with two beds – one for themselves and their children or steady boyfriend at night, one for their daytime clients. They have four or five clients a day. They charge twenty shillings for sex with a condom, thirty without.”
I was busy taking notes, as my mind ground away on the arithmetic. Twenty shillings for sex. That worked out to less than half a Canadian dollar. It wasn’t just life that was undervalued there.
Frank led the way into the clinic that was separated from the bedlam of the Pumwani market by a low wire fence. An amazing lack of security, in that city where security was typically measured by the diameter of the bars on windows and the height of walls around compounds. Frank had been working there for more than a decade, heading up a research project on sexually transmitted diseases. The research project was a joint effort of the Universities of Manitoba and Nairobi.
Originally he came to study chancroid, a sexually transmitted disease that causes genital ulcers. It’s rare in North America, common in this part of the world. But an epidemic of chancroid in Manitoba in the 1970s sparked interest in the disease at his university in Winnipeg. So Frank moved into a clinic in Pumwani, working with malaya. In 1985, not a single case of AIDS had been documented, not officially. But that year, on the off chance that HIV had made it into Nairobi slums, the research team decided to test their women patients at Majengo Clinic ‑ just in case. The blood samples were sent off to the United States for testing and it was months before they came back.
“I remember the day,” Frank said. “It was May. We opened up the envelope and learned that two‑thirds of our patients were already HIV‑positive. We couldn’t believe it. After that,” he said with a shrug and a wry smile, “there wasn’t much choice but to work with AIDS.”
Inside Majengo Clinic, Frank introduced me to the nurses, who were busy with files, and to a few women sitting quietly on a bench in the foyer that doubled as an office and waiting room. The nurses said how glad they were he had come. They had a patient in the treatment room and wanted his advice on what to do for her.
Frank led the way into the cramped but tidy treatment room where two Kenyan doctors were examining the patient. She was young, not yet thirty. She wore flip‑flops and a low‑waisted brown dress of polyester. She was having trouble standing and leaned against the bed.
Frank and his Kenyan colleagues exchanged observations, noting that she had lost coordination in her right arm and leg. When they gently urged her to try to take a step, her right leg dragged behind her. The young doctors, Joshua Kimani and Ephantus Njagi, moved in to help her keep her balance while nudging her for answers with gentle questions. Speaking in Kiswahili, they asked her to try touching her nose with her finger. She tried but couldn’t do it. I turned away.
The doctors switched back to English and told Frank that thrush had appeared on her tongue. They noted the bacterial infection around her eyes. Joshua said she had already been treated for tuberculosis. I glanced at her again, taking in her lifeless eyes. She was hacking up phlegm, using a faded wrapper slung over one shoulder to cover her mouth and wipe her face.
I averted my eyes again and gazed out the window, amazed that the riotous marketeering just a few feet from the open window didn’t seem to bother anyone inside the clinic. I watched a dented van pulling up into the cacophony that was the alley just outside. The van was purple and green, with the words “Christ Crusades” emblazoned in silver letters on the side. There was an enormous plastic fish, also painted silver, on the roof. Deafening music came from loudspeakers inside the fish. The van door slid open to reveal a wall‑to‑wall selection of Christian music cassettes and videos. You could buy just about anything in Pumwani – blue jeans, fruit, sex . . . even faith.
Frank and his two Kenyan colleagues were still discussing the case, deciding that her loss of coordination indicated neurological problems, a sign that she was moving into the final stages of AIDS, the final days or hours of her life. Any further treatment would be far too costly for the project to cover and accomplish very little except to prolong her life and her suffering a few more days. The project paid for the patients’ basic health care, in exchange for monitoring and studying the sexually transmitted diseases among the registered patients. That included the 1,800 sex workers here, 1,600 mothers with children in Eastleigh Clinic nearby, and 1,400 patients in a special treatment clinic downtown.
The doctors escorted the woman out of the office, preparing for the next patient. I asked Joshua Kimani what else the project did for the women, besides paying basic health care as they succumbed to AIDS, taking their blood, and monitoring the rate of transmission of HIV and other sexually transmitted diseases.
He said Majengo Clinic organized community projects to help the women find alternatives to the sex trade. This brought the malaya together in large groups, where they learned how to protect themselves from further infections. Perhaps even more importantly, they learned that together they had a voice and that unity gave them a little power. If all the sex workers in Pumwani refused their services to men who wouldn’t wear a condom, the men would eventually be forced to go for safe sex. By protecting both men and women, the epidemic could be slowed. This was a give‑and‑take project, not, as Frank put it, “safari research” that gave nothing back to the communities in which it worked.
Joshua told me that 95 per cent of the patients in the clinic were HIV‑positive. The remaining 5 per cent were women who had had intense contact with HIV for years ‑ yet remained negative. It was this statistic that had inspired me to take a day of leave and to venture away from my side of town and into Pumwani with Frank. It was also the reason that Frank Plummer’s name and the names of his Kenyan and Canadian colleagues featured large in medical journals and at international AIDS conferences. Those fifty‑eight women with resistance to HIV ‑ a small silver lining in that obscure Nairobi slum ‑ were making and shaping medical history.
In the early 1990s when the research team in Nairobi documented their resistance, those women were the first known cases apparently immune to HIV infection. Kelly MacDonald, another of the research team, who divided her time between Toronto and Nairobi, explained the resistance to me using the simplest terms. With apologies to her for what may well be a seriously deformed lay translation, I took her explanation to mean that resistance to HIV began with human leukocyte antigens, individual cells’ defences that kicked in against infection before HIV could touch the body’s immune system. And this, in turn, seemed to be linked to a certain genetic predisposition, which the researchers were studying in the resistant women.
I asked Frank if he would take me to meet one of the women involved in the project. He agreed, glancing down at my flimsy open sandals, and suggested that next time I remember to wear a more serious pair of shoes. I nodded; I wasn’t going to say out loud that I didn’t foresee any next time.
Frank introduces me to Charity
We picked our way on foot (in my case, on tiptoe) through the crazed confusion of a Kenyan market in full swing, past dizzying displays of second‑hand clothes. We stopped in front of a corner dwelling, a house of clay separated from streams of sewage only by a neatly swept stone porch. Frank said this was where Charity lived and worked. He called out a “hello,” and she pulled aside a printed curtain and ushered us into her house with a gracious smile. We ducked to enter her room. It was dark and cool inside; the room was just big enough for two beds and one chair. Frank greeted her in Kiswahili and introduced me.
She was poised, demure and soft‑spoken, bright‑eyed and beautiful. The room was meticulously swept, clean and ordered. This was not the dwelling of a woman who had given up hope or pride. A stack of freshly washed bowls sat in one corner, under a faded colour print of a city square that looked distinctly like a shot of downtown Beijing. I wondered where she had bought that. Probably in Pumwani, where it seemed you could buy just about anything.
After a few minutes, I realized that I had nothing to ask her, nothing that wouldn’t be injurious and out of line. I waited until she and Frank had finished exchanging pleasantries and news about mutual acquaintances ‑ some malaya, some researchers on the project ‑ and then nodded to let him know that I was ready to leave.
As we made our way back to the clinic, Frank told me Charity was one of the malaya who benefited from a small loan to help her get set up in business ‑ selling second‑hand clothes in Pumwani. It was hard to say if she had abandoned the sex trade altogether.
“There are only so many pieces of clothing that can be sold,” he said. “It would be hard to match the money she could bring in selling sex, which is around ten dollars a week. That’s more than a male labourer makes in Nairobi. Even if she hasn’t abandoned the sex trade altogether, at least now she’s insisting her clients use condoms. Most of our patients do.”
“Yes, but since she’s already HIV‑positive, what difference does it make for her?” I asked.
“That’s one of the other areas of our research,” he said. “We think that the rapid progression of the disease from HIV infection to full‑blown AIDS in Africa may be closely related to the rate of exposure to other sexually transmitted diseases. That’s also why most of the HIV transmission in Africa seems to be heterosexual. So, by reducing the exposure to infections through the use of condoms, it seems that the progression to AIDS is slowed down.”
“Of course,” he added, “as fast as our patients are trained in methods of safe sex or set up in other kinds of business, there are new malaya. Especially during droughts, when crops fail in rural areas, we get a lot of new patients. Often girls, sometimes as young as thirteen, who come to the city looking for a way to get money to pay their own school fees. We have some women patients who have been able to send their children to university on what they made here. One of those is in law school in Dar es Salaam. Anyway, there’s a lot of opportunity here to find out why people get AIDS, find out what the immune system is doing.”
As we climbed back into the Nissan, I glanced around once more at the dank alleys and the cornucopia of colours, smells and sounds in Pumwani. I was perplexed that a Nairobi slum could seem so much richer in life and humanity than the posh, lush neighbourhoods that expatriates and well‑heeled Kenyans tended to inhabit. Neighbourhoods like my own, for example, which was no neighbourhood at all. Not in the true sense of the word.
“It’s pretty exciting,” said Frank in that deadpan way he had of downplaying the importance of this work.
We were driving towards town and Kenyatta Hospital where the project had its laboratories and headquarters. The midday traffic was heavy, suffocating actually, and we were driving through clouds of choking black fumes from ailing diesel engines. I asked him to elaborate a little on what, in particular, he thought was “pretty exciting.”
“Well,” he said, “for a long time we thought that everyone could get HIV and that once you got it, it was forever and you died from it. The paradigm on AIDS is shifting and this work in Kenya is helping to shift it, showing us that not everyone is susceptible to HIV. Once we understand why that is, we should be able to come up with something to treat or prevent AIDS ‑ absolutely.”
Frank according to Frank
That day I spent shadowing Frank to witness the work he and his colleagues were doing was a powerful eye-opener. But if I were to write a book on him, as he had asked me to do, I needed to know a little more about him and his life. So one day we sat down for a long interview.
The transcript of the interview is too long to reproduce here. So I’m reproducing only a little of what I learned from him that day.
Frank (Allan Plummer) was born in Winnipeg in 1952. His father was an educator who had been principal of the Manitoba School for the Deaf. His mother was a kindergarten teacher, something she started in their family home, until kindergartens became part of the education system and she could move into a school.
The family moved to the United States in 1963, just outside Washington, DC. “So I was there when Kennedy was shot,” he told me. “I remember we were in school and everyone was crying.”
“Then, because of worry about the Vietnam War and us being drafted, among other worries, we moved back to Winnipeg.”
In his words, “I was a normal adolescent. I did a lot of bad and stupid things, but survived. School was boring.”
“I went to university with the idea of medicine, because my mother wanted me to. Actually the idea of all those people in white coats going around sticking needles into people didn’t thrill me.”
“I was a normal adolescent. I did a lot of bad and stupid things, but survived. School was boring.” Frank Plummer
Frank said he did well at pre-med, and got into medical school, and “coasted through” that. “I spent most of my student loans playing pinball,” he said. “I played a lot of pinball.”
But in his third year, once he started seeing patients, he finally “got really interested in medicine,” and graduated in 1976. His first internship was in Los Angeles, at a charity hospital. He called it a “baptism by fire.”
“There was a jail ward on the 13th floor, a lock-up ward with people in shackles and armed guards. Nobody cared about the patients unless they were lucky enough to have a good intern. You had to do everything yourself. Each team was just a resident and a couple of interns. You learned a lot of survival skills at LA County — the patients’ and your own. You were on call every third night, and you could work 36 hours straight. I had a rotating internship – that meant you did all the wards, obstetrics etc. I wanted to do internal medicine, which everyone else hated, so I traded all my other wards for internal medicine.”
When he finished his internship in California, he spent three years doing internal medicine at the University of Manitoba, and the head of infectious disease there, Dr. Allan Ronald, then interviewed him and asked him if he wanted to go to Nairobi.
“Before that, I’d been going on a straight line, school, university, pre-med, med school, internship and all that. I hadn’t taken any time off. I thought this would be a good opportunity to see the world a bit. He [Ronald] wanted me to come out on a project that was just starting, to study chancroid [a sexually transmitted infection that causes genital ulcers].”
He spent a year in Nairobi. That was followed by a year back home in Manitoba, before he headed to Atlanta where he spent a year at the Center for Disease Control.
But he greatly missed Kenya, and spent his time “pining away” as he waited to get back there.
In 1984, he returned to the Nairobi, this time to work on a project on ophthalmia, an eye condition of babies born to mothers infected with gonorrhea. That led them to work extensively with sex workers, and eventually, to the decision by HIV/AIDS researcher Joan Kreiss, to test them.
When the results came in June 1985 that showed two-thirds of the sex workers were HIV-positive, Frank told me they really had no choice but to work with AIDS.
Frank’s tribute to his lost colleagues
It was New Year’s Eve 1995, and we had joined the Plummers and two other families in a rustic retreat in the shadow of Mt. Kenya to mark the turning of the year.
I remember that Frank seemed to be in charge of the music; during our interview he did tell me he had always thought he would love being a DJ. Several times that evening, he played Johnny Nash’s version of “I can see clearly now” and some great music by a group I’d never heard of that Frank loved, called The Subdudes (Next chance I had, I bought all their albums.)
I also remember that Frank was extremely subdued that night. He had recently lost five of his closest Kenyan colleagues in a car accident, when they were returning to Nairobi from an international AIDS conference in Kampala, in neighbouring Uganda.
Frank later gave me the piece of paper on which he had written the eulogy for his colleagues, which he read at their funeral.
With his permission, I published it in my book.
Now that Frank is also gone, I find it even more powerful and poignant than I did then. So I am posting it here:
My name is Frank Plummer. I am here to speak on behalf of the Canadian component of our project. Before telling you something about those we are here to honour, I would first like to express something about the closeness of our project and how deeply the loss of these fine people hurts us.
Our project is now sixteen years old. From very modest beginnings and through more than a little adversity, it has been built into a world‑renowned enterprise where leading research, prevention of disease and development of people go hand in hand. People from many countries, of all races, have created a small world where there is no room for racism, sexism or tribalism, where people bound together by ideals, friendship, loyalty and love work side by side to make the world a better place. Together we have created new knowledge, cured and prevented disease and taught others to do the same. In doing so, we have touched the lives of millions and in a real way, we have changed the world. Twenty‑six of us went to Kampala to tell the world about our work. Five of us did not come back, leaving a terrible hole in our midst. The five who were torn from us so tragically and senselessly last Thursday will be long remembered for their role in our enterprise. Their families, our project, this country and the world are poorer in their absence, but we should take comfort in knowing they were each an important part of a great thing.
Several lines of this eulogy could have been written for Frank Plummer himself. I’ve taken the liberty of revising the last one in tribute to him:
“His family, his work, his country and the world are poorer in his absence, but we should take comfort in knowing that he was such an important part of a great thing.”