11/24/06

For a morning, Dr. Jeff Stringer took me under his clinical wing, and we assessed his guard's health, who likely had TB, and may have had an overlying community-acquired superinfection of his left lung. The X-ray was not a true A-P; the patient was rotated left slightly, but it was clear that nearly all of the left lung from the top of the heart down was full of fluid. He was not, however, in great distress. There is more to write about - one clinical officer was there and nearly 50 patients were waiting. During the 30 minutes we were there, the central laboratory on which the entire PEPFAR ARV program relies for CD4 counts and all other laboratory support, lost power no less than 4 times. A massive, room-sized generator with push-button ignition kept failing, perhaps because of bad fuel in the wake of the current diesel shortage. Nevertheless, the system works. These are the problems that concern me, on top of patient care and ensuring the best for my fellow Zambians, but a the same time, in light of my current trajectory as a student, they're not my problem and I tried to let them go, and hoped for the best. My battles will come later.

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One of my happiest images occurred at the Falls. Two, come to think of it. On the Zambian side, there were many Zambians touring, in contrast to years past, when Muzungus dominated the tourist traffic, and on the Zim side, not the Zam side.

On this day in 2005, a Zambian family was there, on the Livingstone side.

I remember a father and two children. I remember the daughter in particular, about 7 or 8 years old, in trousers and a white shirt, with a tidy two-inch 'fro, bright eyes, and all teeth, with gaps, smiling - her face shone with sheer delight. She was soaked through to the skin, dripping, ecstatic, and as happy as only a child whose innocence is intact can be. Since some time has passed in my stay here, her countenance remains with me, and makes me happy and hopeful all at once.

The following is one of the meaty bits that I too seldom get to in my writing. I hope you will read on, kind reader.

I'm at risk of being a cynical, middle-aged fart (laughing), but I've not lost all my wonder at the world we live in. It was absolutely fulfilling to be with my classmates in Cape Town as we drove to the UCT Medical School to meet with the lovely Lwazi. "Are we driving together in a car in Cape Town, South Africa?" I simultaneously asked and remarked, happily. The future Dr. Denney remarked also, glad to see that I still get excited about travel, and inside I was glad too. We were together, Brad Denney, Michelle Downing, Katrina Julian, and Stewart Hill - UASOM 2008, representing.

With a few exceptions a lot of this travel has left me with the feeling of doing chores. Part of that's the lack of money. Part is my poor frame of mind. Part is the disorganization and resultant lack of support from CIDRZ, an unfortunate but wholly understandable side effect of the operation. However, I came here believing that no matter the circumstances, I would make do, and opportunities to connect and learn would present themselves, and these would carry me through. It's a close call at this point, but I have learned, and I have benefited, and I have met nearly all of my undefined, unknown expectations.

The analogy that the Saag-team made in "The Plague that Thunders" was one of comparing the Victoria Falls water flow over the 100 meter precipice of the deeply carved Zambezi to the impact of HIV here in Zambia. (The 26 minute film may be viewed on Mary Fisher's web site here. If you click that link, you will be taken directly to the imbedded QuickTime movie within your browser.) The film makes an analogy between the avalanche of water that pours over Victoria Falls and the daily avalanche of death occurring as a result of HIV in Zambia. There is no more appropriate analogy.

With over 300 deaths per day due to HIV, a scant 18 months ago there was essentially no hope to go against the flow of the viral river that was hammering relentlessly against my fellow Zambians. If you were caught in the masses, your were going down, and that was the way of Zambia, to suffer peacefully, and to pass away, in countless, anonymous numbers - unseen on the news, unheralded on a global scale, and each young death a new wound that ignites new pain over old, reminding the survivors of an immense toll, so horrible that it defies description. The life-price being paid is unspeakable.

But as the film points out, now there is hope. ARVs are free, and if one can overcome the stigma - an underestimated and critically important aspect of successful HIV treatment - and the high threshold of fear, one can be treated and have a new lease on life here in the New Lusaka.

I've been to the Victoria Falls several times over the last eight years, and it is a truly beautiful place. But so is Disneyland.

After several visits, one loses the wonder, one sees the hidden exit signs. The virgin experience, the first high, the first love - the breathtaking awe of God's creation...experience can dull these, despite their core magnificence.

But God has ways of bringing us wisdom, despite ourselves.

When I study something closely, and I study it again, I see things I missed the first time. This is especially true with complex, beautiful things, like an exquisitely played game of chess, or the pupillary reflex, or music that comes from genius...and like the Victoria Falls.

There was something new that I'd never seen at the Falls in Livingstone, or anywhere in the world, for that matter. Fittingly, it was on the Zambian side, a side explored more closely than ever before, accompanied by Eva, Michelle, Aggie, Brad, and Stew-dog. As the water from the Zambezi crashed over the cliff formed by countless water molecules, proving their superiority to mere stone and Earth, like the force of HIV on humanity to date...as the green water turns white, gaining force, crashing, colliding, raining, carving, and pressing on to provide life for millions after settling down in the gorge...a rainforest is created that is luscious green, and home to small antelope, troops of baboons and monkeys. There is a constant precipitation. For the first time here in this constant rainy mist, I saw something new in the water droplets that crashed back upwards, off the rocks in the gorge below, into the air in front of me, and up into the sky over the falls, making "the smoke that thunders."

Soaking in the misty rain, my brown leather coat darkening with wet, as I looked over the cliff, I saw dancing droplets, colored in the rainbow, skipping and weaving upward, dancing vertically, shifting, hanging, moving with the wind, going their own way, gaining momentum from their own, thousands of them, a spectral vision of rainbow colors that at once reminded me, as they have so many generations before, of the promise of God to Noah, that never again will this type of destructive force be used against Man. Rainbow droplets of hope danced upward before me and made rain, bringing new life and renewing something in me. I imagined each droplet that skipped its way up into the atmosphere was a renewed HIV+ soul that was now on treatment, that could live now, that was allowed now, to hope, because the world finally decided that millions of lives were worth saving.

This vision convinced me also of the hope I preach, that I've seen, and that I believe in - that when we decide as a global nation to do something about the now treatable HIV diagnosis, people can live. It's a simple idea, but for some reason it takes a great deal of effort to get people to buy into it, sometimes. I thought it was interesting that I had never seen this before at the Falls, and that I only noticed it after treatment was initiated in Lusaka.

With each person successfully treated for HIV, an individual receives new life. A family remains intact. An economy remains more whole, and a global society maintains its integrity. In my fantasy vision that is becoming a reality, made as Disney might, those rainbow droplets would follow their dance upward, coalescing, forming a rainbow over the Falls, and instead of seeing the words "The End," in my movie, we would see The Beginning.