Thursday, August 15, 2013

Biosocial Phenomena

Today, after a round of our usual kitchen garden monitoring and evaluation, we asked the Tujitolee support group if they had any questions for us. As we sat in the cool breeze of our shaded area, the group briefly discussed in Kiswahili. Then a woman named Genevieve slowly turned to us and softly asked us if there are people in the United States living positively with HIV/AIDS. She said, “In your country are there people living like us? Are they open; are they talking about it like us? We thought this was only an African disease. It will encourage us living positively in Kenya to share our stories and know we have counterparts across continents living like us.” I am always a little surprised when I hear that people think HIV is a burden unique to Africa. If only they could realize that this is a global epidemic and have a sense of solidarity with those living positively in developing and developed countries alike. Genevieve’s powerful and inspiring words immediately brought to mind another quote that I had just recently read. As if to address questions like Genevieve’s, in her book The Coming Plague, Laurie Garrett puts it this way:

Rapid globalization of human niches requires that human beings everywhere on the planet go beyond viewing their neighborhoods, provinces, countries, or hemispheres as the sum total of their personal ecospheres. Microbes, and their vectors, recognize none of the artificial boundaries erected by human beings. Theirs is a world of natural limitations: temperature, pH, ultraviolet light, the presence of vulnerable hosts, and mobile vectors.

Like most things in the natural world, bacteria and viruses pay no heed to lines drawn on a map. They do not care if you’re white or black, wealthy or poor, Catholic or agnostic. These disparities are but social fabrications with biological manifestations. What I mean by this is that Mycobacterium tuberculosis, for example, does not choose its victim based on skin color or religion. Instead, factors like race, socioeconomics, and drug or alcohol abuse create inequalities that drastically increase the likelihood of infection. In short, these social disparities provide environments in which diseases like tuberculosis are able to flourish. HIV/AIDS can be found anywhere and no matter where you are, it is certainly devastating. But depending on where you are, certain inequalities—like access to treatment and nutrition—make HIV a very different experience. When assessing basic healthcare inequalities around the world, we are not only looking at the availability of efficient care and treatment, but we must also take into account the opportunities available for education and economic empowerment.

WOPLAH has provided an amazing opportunity for us to learn these lessons firsthand. We did not have to fly twenty hours to study and work with people suffering from HIV/AIDS; we would have barely needed to drive twenty minutes from our cozy Colorado campus. We came to Kenya to study the complex interplay between certain social factors unique to Africa and HIV/AIDS. For example, at one of the very first support groups we visited as a GROW team we posed a difficult question: “When you were first diagnosed HIV-positive, did you face any backlash within your own family?” One woman, who was involved in a polygamist marriage, said that she is the only wife living positively and is therefore ostracized within her own family. This example of stigmatization within a tribal marriage is not something we would find back home.

Thinking about health and social justice in a Kenyan setting has challenged us to keep in mind that infectious diseases are what Paul Farmer calls a “biosocial phenomenon.” We are systematically learning that there are many more factors at play than biological factors like CD4 count. WOPLAH’s three main objectives, youth empowerment, health and reproductive education, and income generation, provide a wonderful template for addressing both the biological and social aspects of HIV/AIDS. One WOPLAH project that immediately comes to mind when thinking about this complex relationship is the jiggers campaign. When we visit infected children and adults, the biological ramifications of these parasites are awfully apparent in the form of very swollen and malformed feet. When we begin to talk to these unlucky individuals, we find out that because of jiggers, kids are staying home from school and falling behind with their education, and parents are not as able to support their families. This example demonstrates both the social and biological aspects of infectious disease.    

The GROW team is currently struggling with ideas on how the jiggers campaign can expand and become more sustainable in the future. In 2014, WOPLAH will cease purchasing shoes for beneficiaries, believing that families will begin to buy their own after having witnessed firsthand the positive effects of wearing shoes. I wonder though, since every person we have talked to thus far has listed school fees and food as their primary financial difficulties, whether they would actually allocate the money for shoes when there appears to be other priorities. The dilemma here is figuring out how to prioritize certain repercussions of poverty. Jiggers are a visibly heart-wrenching and serious issue these families face, but if they are still struggling to feed themselves, can we expect them to prioritize shoes over food?

Our internal debate over the future of the jiggers campaign is no new quandary to nonprofits and health providers working in developing countries. As we explore social disparities and their biological manifestations, we are constantly challenging ourselves to think from both a medical and social standpoint. Every GROW team has indubitably faced this same problem masked in a different interaction between infection and sociology. The approach we take when considering health inequity around the globe must be a constantly evolving one based on the dynamics of local variation. GlobeMed has created a unique opportunity for this to occur by placing young, open-minded, and passionate health advocates all over the world. It is our job as the burgeoning generation to utilize an analytical and systemic mind to approach the widening gap between those who have access to efficient healthcare and those who must make do with the meager resources they are given.                


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