Thursday, February 16, 2012

A Divided World

A close friend, colleague of many years who is also a health worker dedicated to improving health for rural people in Uganda recently sent me this story on his recent trip to Northern Uganda. It is a moving call to us all.
Setting off from Mbarara in southern Uganda, I am off to Kitgum and Gulu. This area is the heartland of the Acholi, a people who have suffered disastrously in the past twenty years from war, famine and displacement and now the scourge of HIV/AIDS. It seems the right place for a social medicine course.
The bus scheduled to depart at 8.00 am from the bus depot in Kampala is only 30 minutes late. A young man enters the bus calling on everyone to pray. He prays, ‘Since we can do nothing without you, oh God, guide the journey and let us reach safely’. I wonder if this is going to be a journey of special challenges or problems or if the driver is perhaps not competent! I also consider that maybe the travelers believe that only God that can truly take care of them. I start to think about this divided world we live in today.
One constant reality makes me very uncomfortable – the ongoing awareness of HIV / AIDS. As I enter the Northern homeland via the Gulu-bound bus, I sit on a seat beside a youthful woman holding a small baby. Settling down after the prayer, I notice the woman by my side. Every 10 minutes she talks to her baby, telling him not to cry, to sleep well and about his medicines. Then in the midst of her admonitions to her baby, she turns to me and discloses that she is living with HIV / AIDS and her baby is on multivitamins and antibiotics. Her baby looks to be around six months of age. Armed with her Bible, she spends the journey reassuring the baby, breast feeding and making comments about the poor economic situation of Northern Uganda. She continues with her stories to me without asking me questions or even supplementing her statements. I start to think she has lots of problems and I know there are many more people like her.

As the bus traversed the savannas, shrubs and planted forests along the way, I noticed that God has been gracious enough to Uganda. With a variety of vegetation, wildlife and the beautiful Karuma Falls one could not have asked for more. But then from within, I felt a lack of comprehension. Why was my neighbor talking only to herself? Can she no longer trust? Why did the 30 year old man feel the need to pray for the bus? Is it because he has seen too many road accidents? Why do I see a beautiful country, but a struggling population? Why is my seat mate not changing the diapers for her baby when she seems aware they have been soiled? I almost shouted WHY? Then I remember that my elder brother calls me a philosopher – maybe I need to think about this.
The journey takes six and a half hours. Finally we arrive in Gulu town and I need to locate my social medicine course mates. When I call one of the students, he advises me to take a boda – boda (a Uganda name for motorcycle hire) at three thousand shillings to Lacor Hospital. At the bus park, a volunteer guide advises me I can save money by using a taxi at one thousand shillings which will also save me from dust. Sure enough, the fifteen minute ride to Lacor is the most dusty ride I have experienced in along while. What disturbs me more is thinking about all the dust getting into the hospital and the patients. The patients are people, Ugandans like me. Once again I thought it was time to shout WHY? As I pondered the situation, I was consoled by the realization that after all we live in a divided World. Yes, the World we live in is divided and cracks are appearing in the divides.
I decide to share this story. In the cracks of our divided World, HIV/AIDS finds weaknesses and vulnerabilities to build on. Women do not own their bodies. Women work hard on the land, but do not own it. Women may own nothing. What about their babies? Maybe sometimes, women own their babies. As I interfaced with my social medicine course, I recalled men as well as women struggled in poverty. I realized that Uganda too was divided. In the cracks lie poverty, food insecurity, malnutrition, poor access to education and health care, gender based violence and child neglect. In the cracks lies hopelessness and dependency with most people feeling that only God can help them. At the deep end of the swamp of despair, lies hunger and starvation.
Alas, we live in a divided World. It is only with resilience, hope, solidarity and social cohesion that the cracks will begin to be mended. Professionals: social medicine scientists, family medicine doctors, primary health care practitioners and global health policy enablers have the means to begin to help to heal the cracks created by our differences. There is still much more talk than action.
With humility, but with a much greater inner drive now after my trip to the north, I call for solidarity of all global health professionals to begin to confront the structural effects of the social inequality that exists worldwide. If the current and emerging global health problems and diseases are ever to be meaningfully addressed, we need to start with the cracks that divide us now.



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