The Art in Our Lives

After spending a great deal of time and some money buying knickknacks and traveler's kitsch, I decided to largely stop and instead just buy local art. You can probably think of some explicit reasons why this may be a good thing: 1. Supports local artist. 2. Supports the arts. 3.Unique "souvenir".

Some may not think there is much room for art in RLSs. Few would argue that life essentials (food, water, shelter, security) should not be prioritized, but life moves dynamically and asynchronously. Picasso's quote after seeing the ~17,000 year old cave paintings of Lascaux, "We have invented nothing", is instructive, i.e. art is universal and ancient, and it can allow us a moment of higher reflection in the midst of the mundane and even tragic.

Photo: Painting by Sudanese artist, Abusharia Ahmed, currently residing in Kampala, Uganda.

Is This World Flat?

I have returned to Africa (and to blogging). Some light reading during my down time is The World is Flat by Thomas Friedman. This book makes an interesting argument that the world has been “flattened” through technology so that more individuals from around the world can take part in the global economy than ever. However, one of the fundamental requirements for flattening is the internet. As I try to blog from a continent with shamefully low bandwidth, it seems obvious that Africa has been left out of the flattening.

Attempts are being pursued to bring more bandwidth to Africa, but are still years away. So, most of the continent, while increasingly filled with connected individuals eager to be part of the internet age, is forced to crawl along at monotonous speeds.

What can I do?

A difficult question for anyone to answer, and perhaps also for someone to ask in the first place, is “What can I do?” Someone who answered that question quite well is my friend, William Harlan. He is editor-in-chief of Blue Ridge Outdoors and an ultramarathoner. Leveraging his skills, interests, and passions, he helped found www.runforafrica.org, a wonderful example of grass-roots connecting with high flyers connecting to the work on the ground. Check it out, sign up, get more fit in the process, and answer that challenging question posed above for yourself.

The Making of a Better Person

Spending time in the poor countries of our world may make one a better person, but I am not sure it necessarily makes you a happier one. There are simply innumerable ways to lose varying levels of innocence here at a rapid rate (e.g. experiencing death, poverty, injustice, repression firsthand) which can lead to guilt, disillusionment, bewilderment, and, at the end of the pot-holed road, despair. Resilience then becomes such a vital characteristic to possess and grow in this land.

A strange counter to this weariness of wordly souls may be the following phenomena: It could be that it is the relativeness of poverty, not the absolute level, that determines a person's health and social outlook. Will then a middle-class non-black Westerner (called mzungu in Luganda) suddenly thrust into a position of relative wealth and power in Africa reap the physical and psychic benefits of an increase in social position? Or (as has been reported at some of the seedier bars of Africa) will this unearned status elevation lead to a life of gluttony and corruption with the requisite associated unhealthy behaviors? Case studies requested.

Big Pharma, Cynicism, and Truth

The 3rd International Film Festival of Uganda is ongoing in Kampala right now. I was fortunate enough to see The Constant Gardener this past weekend (for free!). A good movie about a corrupt pharmaceutical company (Big Pharma) running a dangerous drug trial on coerced Africans. Fiction, right? Can we just praise and dismiss this as an emotive, skilled, but ultimately cynical act of story-telling by a liberal, bleeding heart filmaker?

I actually hate conspiracy theories, but I'll be damned if I didn't read the following in the Washington Post the very next day: Pfizer faulted over drug trials in Nigeria. Pfizer happens to be the world's largest drug company if you're keeping track of such things. And, I'll be damned if I didn't meet a bunch of representatives from a contract-research organization (CRO) yesterday searching out sites in Africa for clinical trials of new tuberculosis drugs. It is almost enough to turn a pragmatic idealist into a paranoid cynic.

Photo: Kibera, an urban slum in Nairobi, Kenya where many scenes from The Constant Gardener took place. It is home to ~1 million persons living in rather depressing conditions. Taken 2001.

The Cultural Contradictions of International Research

Research in the developing world is quicksand, firewalls, and floods occasionally punctuated by light skies and cool winds. One thorny issue, suppressed to varying levels of depth in researchers' psyches, is the problem of ethics. Ethics not just in the sense of does Drug A's potential benefit outweigh its potential risk, but the foggier and subtler ethics involving cultural difference, the motivations, explicit and buried, of researchers and their collaborators, and the fundamental, overt power discrepancies between the North and the South.

Some folks talk of the 3 M's of global health: Missionaries, Mercenaries, and Misfits (a fourth M has also been proposed--Meddlers). Useful caricatures to a certain extent, but we certainly live in a more ambigious reality where many who work in RLS (resource-limited settings) have a mix of these characteristics--some of which may be in conflict. And the evolution/devolution from one M to another is a constant source of intrigue, talk, and concern.

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.

Lake Victoria Triathlon

I "competed" in a triathlon for the first time last week as part of a team (I ran and please ignore the fact that we came in next to last). Lake Victoria is under significant environmental pressure, as are many water sources throughout the world. Running through the back roads of Africa, dirt paths, lush valleys, fascinated children, et al., reminds me of my runner friend Will Harlan, editor-in-chief of Blue Ridge Outdoors, and his wife, Emily Diznoff, a family physician and my magnificent friend since medical school. Together, they have been consistent, thoughtful friends of the environment for many years.

Are you PeerSMART?

Some friends have asked what the heck I actually do in Uganda. Every day I have a different answer. But, one thing I am helping do is jump start a peer educator program, called PeerSMART (Peer Supporter and Mentor for AntiRetroviral Therapy). The premise is that people living with HIV/AIDS (PLWHA) on ART will benefit from having some of their peers as frontline service providers to promote drug adherence and monitor for illness and medication side effects. These peers may then help ameliorate the large health care provider deficits found throughout the developing world.
Photo: Inaugural PeerSMART class of the Rakai Health Sciences Program. Taken March 2006.