A World of Difference

“You should try the cheese and chocolate,” she said. “Cheese and chocolate?!” A confused facial expression accompanied my response. The local Stone Town woman smiled warmly under her ornate hijab and instilled confidence in this Zanzibar pizza chef – she was a regular. I couldn’t decide between the savory tomato, meat, and cheese or the sweet nutella, chocolate, and banana. She’d made my decision for me. “Don’t worry,” she said as she walked off with her pizza in hand, “you’ll try it anyway – this one’s on me.”

The first few times I traveled in sub-Saharan Africa, it was only natural to be confronted with how different this was from my world. There were people living in conditions like I’d never seen, receiving healthcare in clinics and hospitals considered substandard in Texas, and those with cultural practices and beliefs that seemed so odd. I was confronted with these differences each day, smelling the air, hearing the sounds, feeling the heat, stomaching the tastes. But following a more prolonged stay, becoming more comfortable with the setting, and after wading past the differences, I’ve started to appreciate all of the similarities. Why is the focus so frequently on our differences?

In American politics, we focus on what distinguishes one candidate from another, bringing us to the polarized place in which we find ourselves. In religion, one hears the call to prayer and sees the dress and thinks about the divergence of Muslims from Christians. In healthcare, physicians are trained to observe or judge patients based on differences in culture, gender, generation, or sexual preferences. And in current events, the media highlights the many challenges our dissimilarities have brought us. Perhaps if our global village started to focus on our similarities, our mutual reliance on a healthy economy and environment, and our collective desire for basic necessities, we would avoid much of the needless conflict we see ourselves in today.

When Ebola first set foot in the U.S., we were already 8 months and about 4,000 cases into the current epidemic. It was already 10 times larger than any prior Ebola outbreak. And then the West took notice. We were different from Liberians, until we were in the same boat. Ebola was a world away, until prevalent international travel put us on the same globe. Then we started a furious search for a drug or a vaccine. Lower resource countries don’t have the market power to create the demand to inspire solutions to many tropical diseases. Instead we wait for vocal advocates such as Bill Gates, Bill Clinton, or Margaret Chan to push donors into these arenas to find an answer.

The silver lining of this experience with Ebola ought to be a resurgence of civil debate on how we spend our abundant resources, with renewed focus on the societal good.

The last two weeks I spent learning predominantly about Palliative Care and HIV/AIDS care in Uganda. Our week at Hospice Africa Uganda involved learning about the expansion of oral liquid morphine access for pain control in terminally ill patients, followed by home visits to those receiving home hospice services. Our home visits involved two women dying of cervical cancer, dealing with pelvic pain and urinary incontinence. They simply wanted pain relief and urinary care to die with dignity and in peace. Much like patients in the U.S.

These patients many times get confused by difficult drug regimens, despite only having ibuprofen and morphine for pain control. Primary care doctors, nurses, and clinical officers at times are not trained to refer to Palliative Care at the appropriate time. There is also a shortage in these providers to competently prescribe this powerful drug, which lowers the amount of patients who can benefit from it. And Hospice Africa Uganda is on the brink of a severe funding shortage, with 70% of their funding coming from external donors, much of that being cut in the near future, leaving inadequate funding from the government to keep the service up and running as it is now. They are the only producer of oral liquid morphine for all of Uganda. All of this – poor funding, health worker shortages, patient education challenges – we deal with in the U.S.

The HIV/AIDS epidemic is showing signs of improvement. The number of new cases each year is dipping, but due to a lack of functioning health facilities and a severe shortage of health workers, many are still diagnosed late, dying of largely preventable causes. Mulago Hospital, the national referral hospital for Uganda is overcrowded and under-staffed, but still the best place to handle complex cases. There, we rounded on patients with advanced lymphoma, visceral leishmaniasis, advanced lung cancer, and toxoplasmosis. The chemotherapy or proper treatment is largely unavailable or too expensive, and thus these patients rely on family to take them home and care for them, without the help of the public health system. Despite seeing this for a couple months now, it doesn’t make it easier. In the U.S., we too still have many without basic health insurance and poor access to primary care services, thus they present late in their disease, which can lead to worse morbidity or even mortality, and is more costly on society.

When I return home from traveling and studying this time, I’m sure I’ll be asked about the differences. But in addition to telling of these, I plan to speak of the many similarities, and how we are in this together. Whether we plan to bring the current Ebola outbreak to an end, or to control tropical ailments with basic public health efforts, or plan to alleviate poverty in any setting, it may just be in our interest to focus on how similar we are, rather than taking the easier route of considering us all so different.

My cheese and chocolate pizza was ready around the time my friends caught up to me circulating the nighttime food market on the water’s edge. We each tried a bite and she was right – it was a hit. So we ordered three more to finish off our dinner.


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