Saturday, August 13, 2011

On Diseases and Disparities and my Moment of Utter Despair

I recently attended a public health residency/conference in the laid back friendly city of Minneapolis. It was a vibrant affair, full of sharp minded types with big hearts oriented towards social change. Social change, at its most basic definition in public health, is the transformation of communities (and therefore societies), through the engagement in scholarly research that is applicable in the form of effective policy and prevention programs. So here we were, all bright eyed bushy tailed idealists in a lot of ways, sitting through session after session of stimulating discourse. 

One would think that since public health is one of my many passions, I would be happy, excited and energized! Yet as I went from session to session sipping on my skim milk caramel latte from Starbucks, I felt like a balloon with a pin hole leak, and air seeping out imperceptibly but feeling heavier and heavier. Now I will have you know that my caramel latte alone is usually enough to put a spring in my step no matter how the world may conspire to ‘bring me down’. But it was just not having the usual effect on me. 

My AHA! moment collided head on with a feeling so overwhelmingly bleak I can only describe it as a moment of utter despair. It suddenly dawned on me that my source of wistful sadness was due to the fact that while we were dissecting the disparities of health in America, looking at the at HIV/AIDS, diabetes, hypertension, cardiovascular disease and obesity on in the African American community, the Hispanic community and the native American community, my own community in Zimbabwe did not even have basic public health infrastructure. In this country, the USA, a sophisticated public health infrastructure is in place: there is infectious disease surveillance, chronic, occupational, genetic and environmental epidemiology. In my own community back home these departments may exist in name only, but they are not fully functional   units that take care of these various aspects of population health both rural and urban. For example, one of my papers was looking at how DDT may cause breast cancer, congenital abnormalities in fetuses and sterility in both men and women after chronic long term exposure to high doses in the USA. I immediately thought of the thousands of men women and children who are exposed to high levels of DDT on the African continent due to indoor residual spraying for malaria. A substance that was banned here in 1970 is in use in Africa and while our beloved governments and the esteemed ministers of health all wonder the globe attending meeting after meeting. I wonder how many of them are concerned about the health impact of DDT, asbestos, which causes lung cancer and lead paint, which causes neurological deficits? Granted DDT has saved many lives but I wonder how many more will be adversely affected in the future.

As we discussed the fine tuning of surveillance systems so that there become more efficient at picking up disease outbreaks in order to implement containment measures before they reach epidemic proportions, I kept wondering about why we, in Zimbabwe couldn’t set up a surveillance system that involves a network of cell phones which are used by rural hospital staff to text a central district location all the new cases of say, cholera, so that if there was any sign of an outbreak then containment and treatment could take place before hundreds of people died. Then I remembered that in order to do that you would need money, a health ministry that cared and of course a doctor at every rural hospital or clinic. That is when the despair really set in. Along with it was the frustration of having acquired so much knowledge over the years, hopeful that one day I would go back to Zimbabwe and ‘give back’, I am finding myself less and less hopeful as I grow older. My desire has always been to serve my country and put my knowledge to use for the benefit of those who need it most. Now I am looking forward to a time when my girls are older and I can get a job that tackles health disparities in America….while my own Zimbabwe continues to tackle the issue of not enough doctors, doctors who charge an arm and a leg, making obscene profits on the backs of the poor, disease outbreaks that kill hundreds in a week due to lack of medication and IV fluids, oh, and chemicals that will give children cancer and cause men and women to become sterile…

It gets worse: On the evening following my darkest hour I felt compelled to switch my caramel latte for something more analgesic. I sat over dinner alone in a quiet corner of the restaurant with a bottle of Merlot, the contents of which were dwindling alarmingly fast. I was greeted out of my maudlin reverie by a brother from Somalia, who was also at the conference. He happily pulled up a chair and I felt my heart sinking even further into a drunken darkness. I really wanted to be alone, but my ever smiling African hospitality would never have allowed me to follow my inclination to ask him to kindly leave me alone. Besides he had broad shoulders and I figured he was strong enough for me to unburden my sorrows over my homeland. After my long slurred monologue, the brother decided I was too deep for his festive mood and he got up. His parting words to me were:
 “I don’t know why you are here crying over Zimbabwe healthcare. Your country is great place and I wouldn’t mind living there. If you cry over Zimbabwe with government, what must I do about Somalia with no government and millions of starving beoble?”

On that note he left me, feeling scolded, and I signaled to the waiter for my bill and another bottle of Merlot. To go.

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