“You should try the cheese and chocolate,” she said. “Cheese
and chocolate?!” A confused facial expression accompanied my response. The local
Stone Town woman smiled warmly under her ornate hijab and instilled confidence
in this Zanzibar pizza chef – she was
a regular. I couldn’t decide between the savory tomato, meat, and cheese or the
sweet nutella, chocolate, and banana. She’d made my decision for me. “Don’t
worry,” she said as she walked off with her pizza in hand, “you’ll try it
anyway - this one’s on me.”
--
The first few times I traveled in sub-Saharan Africa, it was
only natural to be confronted with how different this was from my world. There
were people living in conditions like I’d never seen, receiving healthcare in
clinics and hospitals considered substandard in Texas, and those with cultural
practices and beliefs that seemed so odd. I was confronted with these
differences each day, smelling the air, hearing the sounds, feeling the heat,
stomaching the tastes. But following a more prolonged stay, becoming more
comfortable with the setting, and after wading past the differences, I’ve started
to appreciate all of the similarities. Why is the focus so frequently on our
differences?
In American politics, we focus on what distinguishes one
candidate from another, bringing us to the polarized place in which we find
ourselves. In religion, one hears the call to prayer and sees the dress and
thinks about the divergence of Muslims from Christians. In healthcare,
physicians are trained to observe or judge patients based on differences in
culture, gender, generation, or sexual preferences. And in current events, the
media highlights the many challenges our dissimilarities have brought us.
Perhaps if our global village started to focus on our similarities, our mutual
reliance on a healthy economy and environment, and our collective desire for
basic necessities, we would avoid much of the needless conflict we see
ourselves in today.
When Ebola first set foot in the U.S., we were already 8 months
and about 4,000 cases into the current epidemic. It was already 10 times larger
than any prior Ebola outbreak. And then the West took notice. We were different
from Liberians, until we were in the same boat. Ebola was a world away, until
prevalent international travel put us on the same globe. Then we started a
furious search for a drug or a vaccine. Lower resource countries don’t have the
market power to create the demand to inspire solutions to many tropical
diseases. Instead we wait for vocal advocates such as Bill Gates, Bill Clinton,
or Margaret Chan to push donors into these arenas to find an answer.
The silver lining of this experience with Ebola ought to be
a resurgence of civil debate on how we spend our abundant resources, with
renewed focus on the societal good.
The last two weeks I spent learning predominantly about
Palliative Care and HIV/AIDS care in Uganda. Our week at Hospice Africa Uganda
involved learning about the expansion of oral liquid morphine access for pain
control in terminally ill patients, followed by home visits to those receiving
home hospice services. Our home visits involved two women dying of cervical
cancer, dealing with pelvic pain and urinary incontinence. They simply wanted
pain relief and urinary care to die with dignity and in peace. Much like patients in the U.S.
These patients many times get confused by difficult drug
regimens, despite only having ibuprofen and morphine for pain control. Primary
care doctors, nurses, and clinical officers at times are not trained to refer
to Palliative Care at the appropriate time. There is also a shortage in these
providers to competently prescribe this powerful drug, which lowers the amount
of patients who can benefit from it. And Hospice Africa Uganda is on the brink
of a severe funding shortage, with 70% of their funding coming from external
donors, much of that being cut in the near future, leaving inadequate funding
from the government to keep the service up and running as it is now. They are
the only producer of oral liquid morphine for all of Uganda. All of this – poor
funding, health worker shortages, patient education challenges – we deal with
in the U.S.
The HIV/AIDS epidemic is showing signs of improvement. The
number of new cases each year is dipping, but due to a lack of functioning
health facilities and a severe shortage of health workers, many are still
diagnosed late, dying of largely preventable causes. Mulago Hospital, the
national referral hospital for Uganda is overcrowded and under-staffed, but
still the best place to handle complex cases. There, we rounded on patients
with advanced lymphoma, visceral leishmaniasis, advanced lung cancer, and
toxoplasmosis. The chemotherapy or proper treatment is largely unavailable or
too expensive, and thus these patients rely on family to take them home and
care for them, without the help of the public health system. Despite seeing
this for a couple months now, it doesn’t make it easier. In the U.S., we too still
have many without basic health insurance and poor access to primary care
services, thus they present late in their disease, which can lead to worse
morbidity or even mortality, and is more costly on society.
When I return home from traveling and studying this time,
I’m sure I’ll be asked about the differences. But in addition to telling of these,
I plan to speak of the many similarities, and how we are in this together.
Whether we plan to bring the current Ebola outbreak to an end, or to control
tropical ailments with basic public health efforts, or plan to alleviate
poverty in any setting, it may just be in our interest to focus on how similar
we are, rather than taking the easier route of considering us all so different.
--
My cheese and chocolate pizza was ready around the time my
friends caught up to me circulating the nighttime food market on the water’s
edge. We each tried a bite and she was right - it was a hit. So we ordered three
more to finish off our dinner.
