Sunday, May 18, 2008

Honora's home

I have reported below on observations by my friend, Dr. Honora Englander, as she traveled in Africa on medical missions. She just arrived home and had these observations. The pictures are hers as well.

Dear friends and family,
I sit writing from the Entebbe airport waiting for my departure. Slowly, I am beginning that transition back to a different world. I am surrounded by white people for the first time in five weeks, there are others with laptop computers, and there is no chaos, no clouds of smoke, and the seat next to me is empty (a stark contrast from my most recent bus cross-Uganda bus ride with a large woman cloaked in several robes, her child, and half of her luggage all in my lap!). I am sad to be leaving, having said goodbye to dear friends over the past few days. I will also miss the energy, the heat, and vivid color of life here. At the same time, I am grateful to return to comfort, ease, and every-day security of home that travel has made me appreciate more than ever before.

Sunday morning, eight of us departed for the village of Mifumi in eastern Uganda. The plan was to provide medical care at the IDP camp and at the Mifumi Health Center, a remote center that was founded to support survivors of domestic abuse, but whose role has expanded to provide primary medical care to the surrounding communities. The night before our departure, the Kenyans and I were guests at a lovely dinner hosted by a Fulbright fellow from the National Library of Medicine (part of the NIH) who is living in Kampala. She told us about the health center's recent efforts to promote regional malaria education and shared innovative posters she's developed to teach the general public about causes and prevention of malaria. In simple pictorials, the posters describe malaria signs and symptoms, highlight the role of nets, and debunk village myths that mangoes cause malaria.

We set off eager to see a different part of Uganda, and looking forward to a breather from the hectic city life. Along our journey way we stopped to watch a Manchester United match – an absolute must for the men in the group (most East African men are absolute fanatics for English soccer) – so when we arrived in Mifumi it was after dark. Power was out, beds were scarce, and mosquito nets were nowhere to be found. The grasses surrounding the complex were tall and the place was teeming with mosquitoes, the irony of which escaped none of us. Beautiful posters were ubiquitous, but even at the health center, nothing put into practice. A bit disheartened, I overheard the often repeated and sometimes troubling, sometimes heartwarming phrase – "TIA - This is Africa." We passed the evening under the untouched night sky, used all the bug repellent I had carried in one night, and I listened as students shared stories visits to their "upcountry," ancestral lands.

The next morning, we toured the health center with a lovely volunteer name Ben. Part way through the tour, Ben told us that he is "living positively with HIV" and volunteers with the clinic to help and empower others like him to do so. Humble, dedicated, and sincere, it is people like Ben who make some of the greatest contribution towards reducing stigma around HIV. The few resources at the center were a surprise, even despite my limited expectations. There was a pharmacy that dispensed approximately 40 different drugs, a lab that could perform a total of ten studies, a surgical suite (still under construction) and consultant rooms. After brief introductions, we paired up in teams to see the growing line of patients who had come to see the doctors from Kampala who were visiting the clinic.

The first patient we saw was a soft-spoken and subservient young woman whose husband had been treated for syphilis several days prior. Her husband stood squarely behind her and did most of the talking. As we asked a few basic questions – namely how the husband's diagnosis was made and if either had been tested for HIV – two young women appeared. The nurse introduced them as the man's two other wives. While I watched and listened to the translation from Swahili and English to the local language, I realized that one of the women – though barely showing under her clothes – was pregnant. For those of you not in medicine, congenital syphilis can be associated with severe birth defects and grave consequences. So, together with the students and interpreter we counseled the family, treated all four, and recommended HIV testing, and hoped that the pregnant wife would seek further antenatal care. And so, the day began…

The countryside was beautiful, and I appreciated the chance to stay in the village and see an example of how so many of the patients cared for in urban referral hospitals live. The main mode of transport was by foot or bicycle (didn't see a single car or truck apart from ours the entire time) and the villagers were friendly and outgoing. As anyone who has traveled in Africa knows, the sight of a westerner is enough to elicit bunches of children running from their homes with cries of excitement, and Mifumi was no exception. In Mifumi, women still kneel when they greet men, and the basics of clean water, shelter, and healthcare are far from assured. As it turned out, on our way into the village we learned that the IDPs had left the camp. We were told that in the days preceding, they were given two options – to return home or be relocated to permanent camps in western Uganda. So all that remained were cleared fields along the road with abandoned tent sites marked by stones.

My last day in Kampala had elements of the warmth, kindness, corruption and chaos that echoed throughout the trip. Most notably, it was marked by an unexpected and seemingly crooked phone call I received the day prior, suggesting that I might be "detained" in the country. A few weeks prior when I was at the border visiting a friend, I was approached by two people claiming to be immigration officials (or imposters – hard to tell) who stopped me, claiming that I had a "suspicious face." (Who can argue with that, right?!) At the time, it seemed they were looking for a bribe, and I got out of the situation without bribing or any real inconvenience, as the two guys backed off once the driver of my car called his own boss, who I was told happened to be someone high up in the government who was also the boss of these immigration officials… The details didn't make full sense to me at the time, but I was safe on my way to Kampala and didn't give it much additional thought until the phone call the night before my planned departure. The call was not scary – just unsettling – and unsure of who to turn to for advice, I decided the US embassy was my best bet. So, early the next morning I was off to the US Embassy in Kampala, and like so many of my recent experiences showed me my own country in new light. As an American woman thousands of miles from home, the moment I walked into the gated complex, I crossed into a haven of security and trust. I was met with good counsel, respect, and kindness. And I confess, I even got tearful when "America the Beautiful" came on overhead while I was in the waiting room! I left feeling reassured and informed, and with a deeper understanding of the cloak of safety that I am afforded simply by my nationality.

In the past, as I imagine will be true this time, returning to the US has left me with much to reconcile about the disparate realities of the way we live here and there, about the scale and burden of disease worldwide, and about of costs and benefits of living a culture with so much excess, so much abundance. On a personal level it is much simpler for me, and I leave feeling deeply touched, enriched, and indebted to my African friends and colleagues for their warmth and generosity.


Anonymous said...

Thank you for this story. I never thought that I would work in Africa. I was comfortable in a laboratory, where breakthroughs seemed possible with each experiment or observation. But the breakthrough in my comprehension of the qualities of life happened when a colleague called and asked if I wanted to join a team for a few months in the Congo. Twenty months later, my understanding of human disease was transformed completely. It defines the way I think about human suffering and human strength. I try to remember it each time I look in a patient's eyes today.

Unknown said...

Dear Kenyan reader,
Paul sent me your email asking to discuss further some of the ideas and questions that I raised in my emails. I am happy to talk with you further, and thank you for your interest. Please let me know the best way for us to be in touch,