Wednesday, December 1, 2010

On diseases of Affluence and Diseases of Poverty- Perspectives

It was in January of 1994 in Glasgow Scotland. I was sitting at my desk in my damp cold room, with a space heater on to try and chase away the frigid cold. I was wrapped in a blanket with just my right hand sticking out because I was trying to write a biochemistry assignment. It is extremely difficult to focus on glycogen breakdown in the liver when your own liver and other vital organs are under threat of freezing within your body. I alternated between picking up my pen to write, and picking up a mug of hot tea which was rapidly becoming tepid as it lost its heat to my ice box room.
 Suddenly my phone was ringing and I tried to ignore it. I was loath to get up from my spot and to let the cold air into my blanket. However the incessant ringing got me onto my stockinged feet and went over to the side table to answer it. I barely got my “hallo” out when through the receiver, sobbing as I have only ever heard at the news that someone had died, bombarded my ear.
“OK. It is OK. I am on my way!”
I put the phone back on the cradle and scoured the room for my scarf and gloves. I hurried to the hall way shouting to my roommate that I had to dash out for an emergency.
“In this horrible weather?” she shouted from the kitchen from where warm comforting smells of soup and baking bread were diffusing to the rest of the house.
“Yep! I should be back in a couple of hours. I am just heading to Byres road.”
I pulled my boots on hurriedly hoping my roommate would be too preoccupied with her cooking to pay attention to what I had just said. There was no such luck. Instead she came to the kitchen door and leaned on the door jamb, with a knowing smile on her face. She flicked her blonde hair off her face.
“Off to tend to our neurotic Viking friend, are we?”
I kept my head down and my eyes averted and mumbled something unintelligible about needing something from Safeway. I yelled “see you later” as I closed the door and faced the icy wind, which tore at my scarf and fought for control of my hat. As I hurried down Great Western Road, past Leo’s hairdressing salon (where I braided hair on weekends), towards the underground tube station, I asked myself why it was that my Danish friend always seemed to be falling apart for one reason or another. We had been friends for the two years I had been in Glasgow. We met in a pharmacology class and bonded over our lecture’s indecipherable Scottish brogue. That first time, our eyes had met after he said something that sounded as though he had just burped while talking and we burst out laughing. We spent lots of time together, sometimes alone and most times with other friends. We frequented our favorite pubs together or sometimes took turns cooking and holding dinner parties for our perpetually hungry friends. My friend, whom I shall call Lisa, seemed a very well adjusted young lady who was independent attractive and extremely charming. She came from old money and therefore had a stylishly furnished two bed roomed loft apartment in which she lived alone.  However, unbeknownst to our friends she had a very needy side. I have no idea how it happened, but I became the figurative and sometimes literal crutch that would prop up her limping self and self esteem every now and then. This day was such an occasion and as I trudged through the dirty slush, praying that my boots would remain dry, I realized that the role of crutch was one I was getting very tired of.
I ran up the two flights of stairs to her apartment and rang her door bell. She came to the door clad in sweat pants and a long sleeved baggy shirt, tissue box in hand. She crumbled in my arms, sobbing and uttering incoherent words. This was the worst I had seen her so I started to feel a little alarmed. I assumed my crutch status and helped her into the apartment, kicking the door shut behind us. I led her to a couch and settle her into it, as one would do with a child.
Lisa sat for a full two minutes, sobbing and contorting her face with her eyes closed. Her nose was beet-root red and congested, so that when she started to speak she sounded as though she had a horrible cold. The suspense was unbearable so I asked her what was wrong.
She started to talk as though to herself about how she had been sitting trying to study and she had had a flash back of her first boyfriend on the night he told her it was over because she was too fat. She was crying because that breakup and the parting statement from her first love precipitated what would become a life long struggle with anorexia. This was a new twist to our usual “I feel worthless and want to die” theatrics. I had in passing, read about celebrities battling anorexia and bulimia. However I had never met anyone who had suffered from these two very alien conditions. As she explained how she had started out by binge eating then purging by sticking her fingers down her throat, I felt a revulsion and horror at the idea that one could gorge until their stomach could take no more food, and then voluntarily induce vomiting.
My shock I believe was due to the fact that I had come from a country where food was an everyday obsession. Where would we get it, would we have enough and  whether we could  afford it, were questions constantly on the minds of many Zimbabweans who were thankful if they managed a couple of paltry meals daily. Snacks for the majority had become an unaffordable luxury. Therefore the idea that one could have enough excess food around to gorge oneself and then waste it by throwing up before it was digested was something that I could not get my head around. I tried to empathize, to place myself in Lisa’s shoes and to try to feel what she was feeling. I failed dismally because firstly I really had not experienced the kind of love for a man that would induce self destructive behaviors at its withdrawal. I therefore had no understanding of what it felt like to love in that self sacrificial way. My view of love between men and women was that it was too much stress and offered very little benefit. I was too busy exploring the world to be engaged in what I viewed as frivolity.
While I was focused on trying to empathize, Lisa had retrieved a photograph which she threw onto my lap with one hand while she wiped her nose with the back of another. As she settled back on her couch, I gingerly picked up the picture and got the shock of my life. There before me was an emaciated female sitting on a hospital bed, with an intravenous line running from the top of one hand and into a packet of fluid on a stand. All the bones on her face stood out like rocky outcrops on a craggy mountainside. Stick-like arms protruded from her white singlet and one could see the swollen ball and socket joints where her arms joined her shoulders. There was hardly any hair on her head.  I felt as though someone had punched me in the stomach and I could feel reverse peristaltic movements trying to move the contents of my guts upwards to my mouth. I suppressed the urge to retch but stared at the picture, unable to look away from the skeletal figure before me.
“That’s me.” Lisa announced in a matter of fact tone. ‘I almost died. I stopped eating and eventually I could not eat. I still thought I was fat even at the time that picture was taken.”
Suddenly I felt hot volcanic anger in the pit of my belly. Here I was sitting with a woman who had voluntarily starved herself into a skeleton because she thought, no, believed that she was too fat. At this time Niger in West Africa, was experiencing a drought induced famine and I saw pictures of thousands of human beings just as emaciated as Lisa was in the picture, but for exactly the opposite reasons. The people in Niger were nothing but skin and bone due to the lack of food and its nourishing properties. Lisa was skin and bone due to being surrounded by too much food and therefore having an irrational fear of what it would do to her body. My anger was at the absurdity of it all, the irony, the sick joke.
Anorexia-  a disease of affluence. That anorexia was a disease, I did not doubt, because I imagined how painful it was to go without food and to allow one’s body to consume itself until almost nothing was left. It was a powerful disease of the mind and my anger was directed at the root causes of this disease and the societal pressures under which it flourished. The obsession with weight and being skinny and western constructs and standards of beauty were superb breeding ground for this awful disease in which food becomes an enemy rather than an essential source of sustenance.
I wish I could have been more empathetic back then. I tried, however my life experience and the values from which I operated made it impossible. As I watched her sobbing, her hair in her face I came to the realization that the countless hours I spent listening and clucking in sympathy and soothing and hugging were not doing Lisa or myself any good. She needed professional help.  I left Lisa’s apartment having made a firm decision that I would no longer be the sponge that absorbed all her negative experiences. I left feeling very angry that while I had been there for her all the time, she had never been there for me.
As I trudged home, feeling cold and carrying the picture of anorexic Lisa in my head,I recalled an incident  when one day she stopped at my place, all broken down because her 11 year old cat that was riddled with tumors had finally been put down. That was the same day I had received a phone call from home telling me that my cousin, a childhood playmate, had died of AIDS leaving behind three orphans. I suppose the fact that I was not howling and ripping my clothes of my body in an outward exhibition of grief was interpreted by Lisa as meaning that I was alright. As she finished her story about poor Toby the cat, I interjected with my own tale of woe. The response I got was a perfunctory I am sorry, en route to her launching into how she wanted to fly home for Toby’s burial. I had taken this show of insensitivity in stride, but had never forgotten that incident. Here I was mourning a human being, with no financial means to go home for her burial and my friend was making plans to fly home to Denmark to bury her cat.
As I look back now (with the wisdom of age on my side!!), I realize that while we were both fun loving students who found a basis for a friendship, we came from very different worlds which informed our perspectives on life, our values, our goals and probably even our perceptions of each other. Lisa often commented on how serious I always sounded. She saw me as too preoccupied with the state of the world, my world, Africa and its myriad problems. I often wondered how she could be so consumed by materialism and the superficial things in life, like her body, her number one obsession, clothes, her hair color or a pimple on her chin! I was struck by how petty things could initiate a chain reaction, which usually started with complaints about her parent’s inattention to her needs. It would reach the very predictable climax of sobbing, snotty nose and wringing of her hands. All this would be because her mother did not call her that day. She promised!!  

Now, in 2010, as I go about my daily activities I often find myself looking at my surroundings and identifying diseases of affluence or those due to poverty, depending on one’s cultural perspective. I am a public health professional and I am therefore fascinated by disease patterns in populations. Where I come from being skinny is a sign of disease, here in America, it is a sign of good health and a healthy lifestyle. In Zimbabwe being fat (but not morbidly obese) is a sign of affluence and good living. Here in America obesity is associated with low socioeconomic status, poverty, lack of education and poor lifestyle choices.
In Zimbabwe, fresh garden grown greens (organic!), beans, fresh tomatoes and naturally grazing livestock are cheap whereas here in America, one pays an arm and a leg for organically (naturally) grown produce and grass fed beef. In Zimbabwe back when I was a teenager everyone who was someone, wanted to eat hamburgers and fries, which were expensive relative to the organic produce one grew in one’s own back garden. Therefore rich kids tended to be more overweight than poor kids who ate home cooked meals. Here in the States the cheapest food you can get is at MacDonalds, Kentucky fried chicken and Burger king. Therefore poor people are in general overweight and obese.
It is all about perspectives. The same way an American might go to Zimbabwe and be appalled at the conditions under which some domestic animals live, is the same way I cannot get used to walking through the pet isle in my local grocery store. It is an isle that is totally dedicated to the well being and sustenance of people’s domestic pets, replete with toys and cookies and cute little coats. My frame of reference prevents me from attaining any great level comfort in spending money on a pet when I could cater for the needs of three or four children for the amount I would pay for the upkeep of one domestic animal. Yet I am able to understand the value that domestic animals have for many of my friends and I am able to enjoy watching them interact with the canine and feline members of their families.
It’s all about perspectives. And the world has room for them all and is a more interesting place because of them all!

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