Beeping as Metaphor

Throughout Africa, many people will call from one mobile phone to another and deliberately hang up before the call is answered . . . but just long enough to have call missed and a number/name appear. This phenomena is called "beeping" or "flashing".

Beeping itself is free. It usually can be interpreted as a request for the beeped to call the beeper back, thus placing the financial burden of the call on the person beeped (due to most mobiles in Africa being based on prepaid rather than monthly charges). However, beeping can also have more subtle meanings. While seemingly nonspecific, contextually it can send a very specific message such as "I am outside waiting" or "'Thinking of you."

It can be remarkable what is able to be conveyed when you are forced to keep it simple--A ring tone can proxy for freedom of speech, a text message can rally a protest, and a beep can start an affair. It is said that necessity is the mother of invention, but human curiosity and finding new ways to flirt certainly help to move things along. . .

What's God got to do with it?

Just as you can not ignore culture and ethnicity when confronting AIDS in Africa, it would be a mistake to dismiss the role of religion. Religion permeates so much in this arena, from missionary hospitals to PEPFAR policies to patient and provider beliefs and behavior.

Religion does not necessarily need to be a divisive force. A friend of mine, Jennifer Gross, worked at a Christian faith-founded hospital while in the Peace Corps though she was not Christian. And I happen to work with a Catholic faith-based organization, Reach Out Mbuya, while not being Catholic.

Photo: The motto for Kiwoko Hospital where Ms. Gross worked. A hospital in the middle of nowhere originally founded by missionaries. Interesting fact: Hospital has baby incubators run off solar power. Taken February 2005.

Modern Medicine Man

Chance, African spirits, or some other force crossed my paths with an American psychologist, Jamie Fish, who is working with and studying traditional healers in Uganda. Ms. Fish invited me, quite literally, into the forest to teach and learn with these healers. Curious, I did so and spent an enlightening time participant-observing their classes and reciprocated by answering their questions about HIV/AIDS.

Traditional healers significantly outnumber medical doctors in Uganda--a common phenomena in much of the developing world. To many, they are the frontline health care worker. How then do we incorporate them (or they incorporate us) into the care of the sick?

A pragmatic stance would be "Use what works." The rub with traditional medicine has long been proving it works. But the scientific method and traditional medicine need not be in opposition and, in fact, can be quite, ahem, complimentary. For example, the US has the National Center for Complementary and Alternative Medicine which uses scientific rigour to evaluate these types of therapies. And, one of the current best treatments for malaria, Artemesinin, is derived from a Chinese plant used by traditional healers for centuries.
Photo: Botany class at PROMETRA Traditional Medicine Training, Research, Treatment, and Demonstration Centre, Buyijja, Uganda, March 2006.

Why Did I Die?

One of our patients died yesterday. She did not die of AIDS or from a side effect of the HIV medicines she was taking. Instead, this is a young woman who had become pregnant with a child she did not want. She tried to self-abort her pregnancy (abortions are illegal in Uganda) and something went horribly wrong. She collapsed and died on her way to a local hospital.

This is not meant to be a pro-choice post. Or pro-women even. But to ask again the question as to how a person comes to such a place and end. And, of course, what can be done about it? The modest goods which might come from this sadness is to think more deeply about the context in which health care (HIV care in this case) must exist in to thrive, rather than to be so brutally and wastefully stunted.