Wednesday, September 4, 2013

One Day

Days later, as I sit in my New Orleans home, it is hard to imagine that I ever was in Mumias. What were chapatti, ugali, and boiled greens has now been replaced with fried oysters, poboys, and crawfish etouffee. What used to be mulish cows and goats roaming our front yard is now the domesticated cats and dogs I call my pets. In short, much has changed about my surroundings. Kenya, and probably all of Africa, is a vastly different setting than my hometown in the United States. Different environments, different socioeconomic factors at play, different cultural norms, and different health care struggles.  According to the CDC, the leading cause of death in Kenya is actually HIV/AIDS, attributing to 38% of deaths nationwide. In the United States, the leading cause of death is heart disease, often credited to the voracious appetite of Americans and the high stress of civilized life. Kenyans are plagued by infectious disease like malaria and tuberculosis that thrive in the climate and poverty of Africa. Americans, on the other hand, are plagued by diseases caused by lifestyle choices like obesity, diabetes, and lung cancer. There is a phrase that both GlobeMed and WOPLAH love to tout: ‘health is a human right.’ Are we, as Americans, taking this right for granted?
Tuberculosis for example, now the disease of developing nations, used to be an urban plague. Due to sanitation advancements, educational reforms, and the growth of medicine, infectious diseases like TB are no longer able to prey on urban dwellers. In essence, thanks to the affluence of an industrialized nation, we were able to beat theses diseases down to the shadows. And in their place we have cultivated a slew of lifestyle diseases. Many people are all too willing to point fingers at developing nations and blame cultural practices for the proliferation of disease. For instance, when HIV first hit Haiti, multiple medical publications in the United States blamed romanticized notions of voodoo for its rampant spread.  This exaggeration of personal agency leads the assignment of blame without any movement to address the phenomena that propagate powerlessness. It is easy to say that voodoo rituals play an important role in the spread of HIV/AIDS in Haiti. It is less easy to say that lack of education and proper medical care play an important role in the spread of HIV because these factors have connotations of global, not personal responsibility.   
Days before I left for the GROW internship, I had already gotten used to hearing how dangerous this trip would be and how brave I was for going to Africa. But I found one interaction to be particularly startling. A physician practicing in the U.S. told me to be extra careful not to contract HIV. I went home that night and did research on the transmission of HIV through nonsexual interactions. All the sources I had found said that, outside of sharing needles, HIV is not easily spread via nonsexual contact. So did he know this, or did he just have questions surrounding my moral turpitude? To me this represents an example of the “the geography of blame.” We have all heard about the HIV/AIDS crisis throughout Africa (Africa usually being used as a blanket term, referring to no particular country in general). But the HIV rate in Kenya is comparable to the rates found amongst poor urban Americans. This challenges the notion of HIV as a virus unique to ‘third-world’ nations. Would people have been as worried about my health if I had traveled to the projects of Boston or New York? The tendency to assign cultural blame, exaggerate personal agency, and propagate stereotypes is counter productive at least. The fact is that HIV is a global pandemic and there is a great need for global solutions.
Working with WOPLAH this summer has provided me with a unique opportunity to study the treatment and management of HIV both in Kenya, and now in my own backyard. One of my biggest goals this year is for GlobeMed at CC to become active within the HIV positive community of Colorado Springs. I also hope to find a local partner that will educate us on the ongoing programs that address the needs of those living with HIV/AIDS in Colorado. I wasn’t in Mumias when HIV first made its impact and so it would be impossible for me to identify any social factors that lent to proliferation of HIV in the community. However after six weeks, I do feel confident in pointing to distinct cultural elements that make the fight against HIV/AIDS in Mumias so influential for me. The one that stands out the most for me is the amazing sense of community. On one of our last days of the internship, we sat down with Edwin to discuss some of the strengths and weaknesses of the GROW team, of WOPLAH and of Edwin. As one of his strengths, Edwin listed the support of his families and friends. As Edwin had just demonstrated for us, the importance of family in Mumias cannot be stated enough. One of the support groups we visited in that last week, The Sky is the Limit, has a similar devotion to the idea of community. The support group was named after the potential a community can reach when HIV positive and HIV negative community members band together. Many of WOPLAH’s programs are aimed at supporting the ‘infected and affected.’ To me this shows a strong sense of solidarity. At first I was confused to see HIV negative people in a HIV support group, but now I see how important that incorporation is. HIV can have powerful emotional and economic impacts on a family, and those family members were also in need.
While we were there, I also noted on the burgeoning role of women in the Mumias society. When I was assigned the task of creating an informational pamphlet on clean water, Edwin instructed me to include a section of gender equity. At the time, I had no idea how the two were related. As I researched for the pamphlet, I learned that gender equity in the gathering and treatment of water was a global movement. Women in the developing world are often forced to travel miles for a source of water. This task alone can take up hours of he day. If men were to help with this acquisition of water, women would have more time for self-improvement. Edwin’s insistence that this information go into the pamphlet represented to me the ongoing movement of female empowerment in Mumias.  The clinic Edwin works out of, Maternal and Child Health (MCH), also offers birth control and viricidal methods to women, putting the responsibility and power in their hands. I was surprised at first to learn that MCH provided IUDs to women and found it to be very progressive. These types of measures help empower women in the community with visible effects. The vast majority of support group members and community health workers that we met were truly inspired and determined women.                  
This internship with WOPLAH served for me as a powerful lesson about the types of social movements that occur when a population bands together for the shared purpose of achieving health. Throughout support groups we heard again and again about the importance of shedding self-stigma and the empowering effects of education. We also saw a dynamic willingness to adapt in Mumias. For example, WOPLAH now advocates against traditional polygamous marriage as a way to impede the spread of HIV. While we were there we also saw a large movement away from traditional male circumcision, which involves the same knife being used on up to fifty boys. In fact, MCH hosted a voluntary medical male circumcision day and around 80 teenagers and men from the community came to be safely circumcised. Large strides like these against the spread of HIV/AIDS are what make WOPLAH so inspiringly farsighted. One day I will return to Mumias, maybe as a physician or as a doctorate of public health always carrying with me the lessons I learned from the Ambassadors, and I will find little to no HIV, less poverty, a liberated community, and the next generation of Ambassadors with even bigger dreams. I will find the achievements of WOPLAH in every successful support group, every empowered community health worker, and every child that grew up learning the importance of reproductive health. 

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