An Equation for "Why move to Africa?"

I wanted to give you an introduction to our medical mission vision.  A mentor once advised me to formulate an equation to measure my values, and thus give me a litmus test for decision making for our future.  This is it, the impact of our work is equal to need times patient care to the exponents of education and research.

 

 The first variable is that impact is proportional to need.  And this is a snapshot of the world in terms of mortality.  It compares mortality rates among adults by cause and region.  Your eyes are drawn to this bottom row, where the overall mortality for Africa more than doubles the rate of high-income countries, and the cause-specific mortality encompassed in these grey bars: HIV/AIDS and other infectious/parasitic diseases causes more death than all of the combined mortality in the high-income countries.  This is why I am an infectious disease doctor moving to Africa.

And here in the blog, I get to dive a little deeper into global health statistics.  And I think that these statistics have an important message.  I promise only one new acronym from the alphabet soup of the World Health Organization statistics set: Disability Adjusted Life Years.   It is the accepted way of quantifying years of life lost due to early mortality and years of healthy life lost due to disability, and gives a more holistic view than total mortality rates.  Because though more people in the world may die from ischemic heart disease, more disability and early death are actually due to lower respiratory infection, diarrheal disease and surprisingly to me: depression.

And these people, suffering and dying from these preventable and treatable diseases cannot be reduced to numbers on a bar graph.  I can see their faces, with their hollow sunken eyes, overcome and hopeless by the wasting disease of HIV/AIDS.  I can hear their labored breathing as they struggle to get enough air through their lungs, thick with tuberculosis and bacterial pneumonia.  And I can see the children, their unnaturally swollen potbellies from malnutrition.  These are real people, who Christ lived and died for.

Full Circle: Starting Point

This is a picture of us from 10 years ago.  It makes me smile.  There we are, 20 years old, our first adventure in Kenya together.  It’s set in a village called Maji Moto, a little outpost of civilization, rising out of the dust of Massailand around a geothermal vent (maji moto = hot water).  You can see a lot about these two characters by this picture.  They are young and browned by the African sun.  They like to stand close together, despite the heat and the dust.  They wear the beadwork handicrafts given to them by their friends, and rest in the shade of an mbati (tin) roof in the equatorial sun.  He wears around his neck a stethoscope, just taking a lunch break from a busy clinic.  It’s a symbol, of his dreams to be a healer, of the revelation in the human body; he is just beginning to hear the voice of God through it.  And it rests atop a thrift-store polyester button-up, uniform of the bohemian to match the afro that blends into the shade of the building.  I like this guy.  And there she is; the golden one that he’s pursued across the world.  The Peachtree Road Race t-shirt reminds her of the races she’s run and calls her to the ones before her.  Sunglasses and twin braids.  And you can see it in their eyes and in their posture: the passion and the idealism.  This is where it truly began for us; the opening act of this chapter of the story of Yahweh, in which our parts are set in Africa.

How was Haiti?

Last month I spent a week in Cap Haitien with a short-term medical team.  It was a powerful experience, deeply refreshing and challenging.  I am no expert, but here are some thoughts from that time:

                  The first thing that struck me stepping off the plane was the heat.  It has a force behind it from latitude, backed up by mountains behind the city that block the wind off the sea to create heat under pressure.  I heard it described as “walking through peanut butter that was warmed up in the microwave.”  This heat under pressure seems to affect many things: the musical, slurred French vowels of Creole, the tropical sense of “island time,” and the occasional bursts of frustration and protest.

                  There were the sights, smells, and the sense of desperation from absolute poverty.  The recent storms during hurricane season had led to an overflow of the sewage system, and a subsequent resurgence in cholera and intestinal worms.  The landscape around the city is brown and barren, and there is a sadness, hopelessness in the eyes of so many that you meet.  It reminds me that poverty is so much deeper than a lack of resources; it is a social, biological, spiritual disease/evil.

                  And in life on the ragged edge of survival, everything has meaning and purpose.  Food, water, shelter, medicine, security are not guaranteed.  I am humbled by the realization of the artificial dramas in which I play the leading role here at home: inconveniences and inefficiency in my work as an American physician, exercise as my right to relieve stress, artificial war/conflict through sports and television drama to fill a vacuum of meaning.  It is a reminder that these places on the edge are where I belong, not because I am noble, but because I am called, and perhaps because I am so easily distracted.

                  I have been taught that “It takes a whole world to know a whole Christ.”  Haitian Christians opened my eyes to a sense of spiritual reality that pervades all of life.  Speaking to pastors at each stop along the way, I would ask about the opportunities and challenges they and their churches face.  Each one of them turned to me, even standing amidst absolute poverty, disease, riots, and hopelessness, and they would speak of the spiritual forces of good and evil.  They could see clearly a deeper reality of which I have only glanced dimly, and have shuddered.  And their prayers sprang from a well of experience, their fellowship an honor I will hold proudly all my days.   

“But thanks be to God, who always leads us as captives in Christ’s triumphal procession and uses us to spread the aroma of the knowledge of him everywhere.” (2 Corinthians 2:14).

Living Between Two Worlds

This is the first post on the blog for Daktari Life. The idea to do this comes from a friend that I respect very much who read my update emails from our time in Kenya in January. I posted the pics of the Rift Valley and the Sequatchie Valley because it seems our life remains centered between these two. Just this afternoon I have finished the research abstract from our January's work in Kenya. The men and women who work in that clinic system do work that changes the world. My job is to tell their story. And it is a great story. Their success treating HIV amidst the greatest challenges to survival is a story that should be shouted to the mountaintops. And while we look to the future of medicine in America, and focus ourselves on the patient-centered medical home, we would do well to learn from some of the most unusual and difficult places in the world.

Our dreams still put us in both valleys, and bringing them together is the Gordian knot, the risk and uncertainty that drives us to faith. The next set of decisions for us are about ID fellowship, where and under what circumstances to pursue it. What is most in line with our core values and mission? The mystery is what leads to growth. "Don't ask yourself what the world needs. Ask yourself what makes you come alive. Because what the world needs is men who have come alive."