11/24/06

Thoughts \ Developed Thoughts \ Rants \ Raves \ Writing

05/06/2005 10:31 -0500 GMT

Here's an email I didn't send.

Light Thoughts

Michelle (et al.)

I am putting the video that Dr. Saag mentioned, "The Plague That Thunders" into my computer bag. Remind me when you see me and you can borrow it to see it. This is the video made last March that Dr. Saag referred to during lunch (made and produced by he and his son Harry.) The title is based on the native name of Victoria Falls. In the Tonga language, Mosi Au Tunya means The Smoke that Thunders - a name that fits the place exquisitely; you will understand when you see the Falls. 

As you approach the area, you get glimpses of the spray from the falls, rising into the air in the distance, like smoke from a huge fire. Maybe you will be walking down a paved, one lane road and have to pause as an army of ants a foot wide and eight feet long crosses your path. Maybe you will stop to look at a family of wart hogs that shows you their tails, straight up in the air as they trot out of the area. You’ll not be in your natural environment; something will be amiss. You will be anticipatory.

Victoria Falls is one of the seven wonders of the world, about to be seen, with your bare naked eyes, on this very day. But you are still far enough away that you don't hear anything. There are exotic birds chirping and what-not, but the mist from the Falls is far away, and there's no noise associated with it. Eventually, as you near the Falls, you begin to hear the falls, rumbling in the background, then roaring as you enter the rainforest that the Falls create. Then a truly thundering sound will wash over you as you stand on edge, soaked by the spray, both as it blasts upward after crashing off of the rocks below, and also as it gently settles back down over you under the force of gravity.

Add to that, this: the beautiful images of - not seemingly - truly untouched Earth into your imagination and you begin to understand what it's like at Victoria Falls. When I imagine heaven, I see Mosi Au Tunya in my mind’s eye.

Since Zambia is so well known for these Falls, I think the name of the video was a natural fit. The natural disaster of AIDS hits Zambia with such unrelenting power and force in Zambia that the Falls provide the only analogy that works, and it works on many levels. Dr. Saag talked about numbers today. To us, these statistics are just smoke in the distance now, as we sit in our Western world, studying abstract behavioral theories and CNS neural tracts. As we approach Zambia this Summer, five weeks from now, the sound of the epidemic will louden. With time spent there, and as you get to know and like the people of Zambia, or Rwanda, or Kenya, as I know you will, the thunder of the epidemic will ring such that, at times, nothing else will be heard. The thunder will drown out every other sound.

Just as everyone who visits the Falls gets soaked, everyone - every single person in Zambia - is affected by HIV. That may sound a little over the top...or over the Falls, if you will…and it may be my personal perspective getting in the way. But I think it's true. I'd like to make two points, then I'll step off my inadvertent soapbox.

First, everyone in Zambia truly is affected by HIV. Every single household...everyone you meet...every individual you interact with - all are suffering the grief that HIV brings to a family, a home, a loved one, a community. Everyone you meet will know of someone personally who has passed away in their 20s or 30s, without exception. Ask around if you don’t believe me. You may think that I exaggerate here, but I know this from first hand knowledge. Even if you think I am off my rocker, consider the numbers. 1 in every 9 or 10 human beings in Zambia, from infant to elderly, are HIV+. This holds true for every urban center in sub-Saharan Africa. One-in-5 to one-in-3 adults are HIV+. And these statistics have been steady for over six years. With households of 10 to 30, I state unequivocally that everyone in Zambia is affected by HIV.

I think my second, forthcoming point needs to be emphasized after you allow the first point to sink in. So think about that the fact that every Zambian you meet is affected by HIV for a moment. Take 60 seconds out of your lives, right now, and simply think about the impact of an HIV+ diagnosis in every household. 60 seconds. After the gravity of that hits home, I think it is important to allow the following concept to coexist with that: Just as an HIV diagnosis does not define an individual, the AIDS epidemic does not define Zambia.  Let me say that again, slightly differently: the AIDS epidemic is not the sole defining characteristic of Zambia; don't miss the beauty - don't let the disease win like that.

Despite the enormous hardships of HIV, Zambia possesses a beauty and splendor that is not found in our Western culture. I hope that you will not let your knowledge of an HIV diagnosis or the effects of this predominate your view of Zambia. HIV is difficult, and in Zambia it can be unbearable, but one of the invaluable lessons I have taken away from living in Lusaka is that an HIV diagnosis does not and must not destroy the dignity of the individual. Don't treat an HIV+ person differently than you would treat each other in Volker Hall. Ask about the family. Ask about the future. Dote over the babies.

Foster hope.

I believe that we, as ambassadors of the Western world of opportunities, must foster the hope that treatment for HIV disease provides. You may have heard me talk about statistics, that the life expectancy in Zambia is lower than anywhere else on our planet at 32.7. Life is uncertain in Zambia. And people will be looking at you with uncertainty. HIV treatment has brought with it uncertain times. I believe that just as Zambians are looking at all foreign aid with uncertainty, they may think, Does treatment work? Are they trying to poison me? Is this a plot against we Africans? I believe, by virtue of your initiative to want to visit Africa, that you know that our discipline of medicine has a great deal to offer in terms of HIV care. Part of our mission, I believe, as fledgling MS1 physicians, is to provide reassurance that we can help. Drugs can change people’s lives. People can live twenty or thirty years more, if they take medications on time every time.

Thus I reframe my second point like this: once you observe and feel the impact of HIV, it is incumbent upon you to look beyond HIV, to see it as a barrier, but not an insurmountable obstacle, to foster hope, and to encourage discussion about the disease, within the framework of Zambian or Rwandan or Kenyan society, to expand the conceptual framework of the culture to include the Western views of medicine that will reverse the effects of the HIV epidemic there.

In a Western way of thinking, I would apologize for being long-winded on this topic. But in a global perspective of things, and knowing my audience of you who have selected to take your free time to see this part of the world…first, I applaud you. Second, I know you understand this, but I have to say it anyway, your work this Summer provides you with the opportunity to take part in changing the world. Make the absolute most of it.

Suck the marrow out of it. Give it your all like you’ve never given to anything else.

All the best,