Friday, July 25, 2014

Series: Technology, Morality, Power, AIDS Part VI of VI: Morality


What does this have to do with AIDS and ARVs?  AIDS is a frightfully powerful phenomenon.  Perhaps the best response to it is not to play its game—to try to overwhelm it with natural power.  Perhaps the best response is not a technological response, but a moral one.

Though they are of course technological, ARV’s are a good thing—a gift. They are saving the lives of millions. They are reducing transmission rates of HIV.  They have their place and they most certainly should be used.

But there are many today that believe that through the power of ARV’s, Africa may possibly be free of AIDS in a generation.  Two years ago, the cover of The Economist, a widely read and respected periodical, read: “The End of AIDS?”  The writer went on to explain why he and many of his persuasion think that because of new ARV technology, AIDS is all but beaten.  I question this.

If ARVs are so powerful, why in America, where we have all we want of the newest and best, are we still diagnosing new cases of HIV? There are new infections all the time.  As described above, I diagnose new cases in prison, a setting where free ARVs of the highest quality are physically handed to AIDS patients by a nurse twice daily. Despite the pinnacle of development and delivery of this technology, AIDS is hanging on in America despite the fact that ARVs are readily available and generally “free” to the patient.  (Though they must exist, I have never met an AIDS patient who pays for his own drugs). Pharmaceutical companies are spending hundreds of millions developing new drugs.  Would they be doing that if they expected AIDS to disappear?  But these are superficial arguments.

Five percent of the children in a typical African village are malnourished, even during harvest time, when food is plentiful in the community.  At this very moment, there are malnourished children waking up in homes within a few miles of where I sit.  What is the solution for malnutrition?  It’s corn and beans.  That “technology” has been around for millennia, and is manufactured right here in the village in large amounts by local people.  Yet malnutrition remains a common cause of death.  If less than 100% of the people are getting food, which is cheap and grown in the village, how can we expect 100% of the people who need ARVs to get them?  Simply delivering technology to people is not as easy as it may seem.

We have pushed condoms as a solution for AIDS for over two decades. The approach has largely failed.  ARV’s do a good thing.  They often keep an infected person well.  That person may live a long life.  ARVs should in no case be withheld from an individual that could be helped by them.  But the person who claims that ARV’s will be the end of aids is hoping that ARV’s will dramatically reduce the rate of new HIV infections—because for it to be truly the end of AIDS, that would have to happen.  ARVs are, in a sense, chemical condoms. Except for a few major differences: they are much more expensive, they have more and worse side effects, they are more dangerous, they are rarely manufactured on this continent (they have to be shipped in from elsewhere), they are less well understood, are harder to store, and are harder to manufacture and distribute.  Is it safe to assume that ARVs will be more successful than condoms have been?

And there is another difference that is pointed out to me by Africans all the while.  It used to be that you could at least tell who had active AIDS because they looked very sick.  With the advent of readily available ARV’s, now many people who are HIV positive don’t look sick. People who are seeking sexual partners cannot easily tell whom to avoid.  Now people fear that new infections will rise, because the promiscuous are taking risks without knowing it.

Morality actually could eradicate AIDS in a generation.   Abstinence before marriage and faithfulness during marriage have done tremendous things to decrease HIV rates in places such as Uganda.  Morality is inexpensive, has good side effects, doesn’t have to be manufactured, stored, or imported, and most importantly, comes from within the people themselves.

Morality is the resignation of the power of the "kingdom of self".  It is submission to a supremely good higher power.  God’s power in peoples lives, His empowerment to behave the way he has instructed us, really could stop AIDS.  Think about it.  What if people were faithful?

Please don’t misunderstand me.  Widespread use of ARVs is not a bad idea.  They absolutely have their place in stemming the tide of AIDS. But they cannot stand alone.  One of my frustrations in the last ten years in Africa has been how hard it can be to get ARVs in the village.  I wish we could get them.  I would not wish that if I thought they were foolish.  But I do think that hoping in ARVs as the end of AIDS is totally na├»ve. Just as Man is much more than just a physical body, HIV is much more than just a virus.  Reality is more than it seems, not less.  The solution is going to have to go a whole lot deeper than just a bottle of pills.

Beware the technological solution for a moral problem.

Wednesday, July 23, 2014

Series: Technology, Morality, Power, AIDS Part V of VI: Beware the Technological Solution for a Moral Problem

Beware the Technological Solution for a Moral Problem

A hero of mine has said, “Beware the technological solution for a moral problem.”  I have come to understand that this is one of the deepest problems in Africa—and America.

What does this mean?  Technology is a way of exercising power over the natural world.  So is shamanism (witchcraft).  This is front and center in Africa.  For example, I was just informed this morning—in earnest—that if you wear a necktie to church, you will receive more blessing.  Stethoscopes and white coats impart the same magical power: your doctor is most powerful when he uses these charms.  The necktie, the stethoscope, the white coat: talismans?

How should morality be understood?  If technology and spells and amulets are about power, what is the relationship between morality and power?  I’m honestly trying to make sense out of this.

Intuitively, I know that morality is not about exercising power.  With technology, you discover power in something, appropriate it, and manipulate it for your own ends.

Is morality actually about resigning the right (read, demand of the flesh) to exert natural power?

I have taken a week to think about this.

Consider the motivation and actions of Judas Iscariot, the Jewish leaders, and the Roman rulers.  These are all about exerting power in the natural world.  As their machinations begin to unfold, Christ preempts their power play with a resignation of natural power. Assuming the position and posture of the lowest slave, He washes His disciples feet at the Passover.  This is anti-power.  Which is why it so shocks Peter and the others.  They expect Him to exert power, and they can’t help assuming it will be natural.  Peter reverts to this reflex when he amputates the servant’s ear in the garden.  But Jesus works in exactly the opposite way.  Instead of grasping at power, he surrenders it.  

The cross—perhaps the ultimate moral act in all history—is anti-power.  Jesus refuses worldly power.  Instead He submits to supernatural power.   On the cross, He imparts His righteousness—His moral rectitude—to all His children.  True moral rectitude is not natural.  It is not natural to man and it is not attained through natural means.  It is supernatural.  Man striving to be good and right by his own natural power is a failure called legalism. True morality is resignation of my own natural power, and the submissive acceptance of the Father’s supernatural power to do and be good.  Jesus is a picture of this during his passion: the Passover, Gethsemane, His trial, and the cross.

Tuesday, July 22, 2014

Series: Technology, Morality, Power, AIDS Part IV of VI: A Tough Conversation

This is a conversation I’ve had too many times—in prisons, where at least I could offer medications, in Haiti where nothing was available,and numerous times over the last decade in African villages—during the time span from 'no access to medications' to 'greatly improved availability.'

I think I’ve cried every time I’ve had to tell a patient this harsh news.  God just made me that way.  I cry easy.  I guess (and hope) patients take it at face value—it’s just compassion.  I feel their pain—some of it anyway.  It is a big deal, so it’s not like crying is inappropriate exactly.  It’s just that I’m pretty sure that most
doctors don’t cry so much.

Antiretroviral medications (for the HIV virus) have exploded on the scene in the last decade.  In remote Kenya in 2006 we had to go to great lengths to get them.  By 2007 it was easier—we unloaded a box of them from the plane once a month.  But even in 2007, the clinic was paying for them out of their own budget.  Generous missionaries were paying for the pediatric patients.  I won’t forget those two little girls.  They brought my Joi three giant white land-snail shells from the forest—nearly as big as baseballs.  We keep them on a shelf in our home. They remind me to pray for those two little girls—and wonder if they are still alive.

By now, even in remote Tanzania, I know that I could have HIV drugs in my hands within two hours if I needed to. But I’m a mzungu (white person) with money, knowledge, and access to a car.  Our little clinic here still doesn’t have them.  We are waiting for the government to make good on their promise to provide antiretrovirals (ARVs). The clinic here just can’t afford them.  There is a government clinic eight kilometers away that sometimes has them.  For now, we send patients there—or into the city.  Even so, I’m amazed that they are available at all. Africa is changing rapidly.

Series: Technology, Morality, Power, AIDS Part III of VI: Maximum-security prison, USA, 2010

Maximum-security prison, USA, 2010

“James, you know how we did those tests two weeks ago?”

“Yeah.”  James was about my age.  He’s African American.  Though he was dressed in the denim and orange typical of prisoners, and had no access to real makeup, he managed to look pretty feminine.  His mannerisms and speech were very effeminate—a sharp contrast to the leg cuffs, handcuffs, and lengths of chain that bound him.

“Well, I’m really sorry to have to tell you this, but the HIV test came back positive.  You have HIV.”

His jaw dropped.  Silence.

“You mean, like, I’m gonna get AIDS?”  Tears began to flow.

“AIDS is what we call it when the HIV virus makes you sick.  I don’t know if it’s ever going to make you sick.  We are going to do some more tests, and figure out if you need to take medication now or if it’s better to wait.  If you take the medication, it might prevent the virus from ever making you sick.  You might even live a normal life span. We don’t know yet.  But lots of people that are HIV positive are living with it—living fairly normal lives—for decades.  We will just have to see.  Whether you start on the medicine now or later, we are going to have to do blood tests to check in on how your body is handling it.  We will do those about every three months.”

“Well, how’d I get it?  I mean…” he trailed off.

I was kind of hoping he wouldn’t ask—that it would be obvious to him. I guess it was, but he asked anyway.

James continued, “I mean, yeah, like I have had a lot of 
partners in here… But I just… I just didn’t think I would get it.  You think that’s how I got it?”

I nodded.  “Most likely.”  I was grateful I had not had to say it.

His tears burst out afresh.  “How am I gonna tell my mom?!”  He bit his lip.  “She doesn’t even know about me… that I have sex with men!”

I had no answer.  I answered a few questions about whether the test was reliable and other medical minutiae.

“I tell you what.  You’re gonna need some time to think about this. Take half an hour.  The nurses have a room back here where you can sit and think.  Maybe pray, if that’s something you do.  And I’ll be back in half an hour and answer whatever questions you have.  And I wanna see you back next week too.  You’re going to have some more questions. And I want to check in on you and see how you’re doing.  If you want me to pray with you when I come back, just say so.  You OK if I go now and talk to you in about half an hour?”

He nodded.

I tried to make sure that the nurses wouldn’t be able to tell that I’d been crying a little bit.  Prisons are not places where doctors typically cry with their patients.

Saturday, July 19, 2014

Series: Technology, Morality, Power, AIDS Part II of VI: East Africa

East Africa, 2007:

“Mama, we have the medication for your girls, and they seem to be doing well.  But I’m worried about you.  You are very ill.  The medicine doesn’t seem to be working as well as it did before.”  I tried to keep the language simple—for the sake of my interpreter and for the Mama.  She was a widow.  AIDS had already claimed her husband.

As with the woman in Central America, I suspected that the husband had been unfaithful while working out of town, and had brought the dreaded disease home.  But in this case, the demon had its claws into the children too.  It was heartbreaking.  She was too sick to work anymore.  She survived on the charity of neighbors and missionaries.

“How long will I live?” she asked quietly, meeting my gaze.

“I’m not sure.  Maybe a year.  Maybe more.  Maybe less.”

“The girls?”

“They are doing well.  They could live a long time.”  I honestly had no idea.

The unspoken question hung in the air, “What will happen to my children?”

“What can I do?” I thought.  “In a month, I’m going to be back in
America.  I may never be in this village again.”

We sat in silence.  Eventually I offered to pray with them, which they
accepted graciously.  “Come to the house,” I offered.  I turned to the
children, “Mama (my wife) has some sweaters to give you girls.”  I
hoped my smile seemed genuine.

“I’ll see you next week?” I said to their retreating backs.  Mama
looked over her shoulder and tried to smile.

Monday, July 14, 2014

Series: Technology, Morality, Power, AIDS Part I of VI

Remote Central America, 2003:

Sweat ran down my forehead and dripped from the tip of my nose.  But the family facing me in the dim light of the tent was decidedly more uncomfortable.  “How do I say this?” I wondered to myself.  “Lord, help me!” I prayed silently.

I took a deep breath and continued, “Senor, the test shows that you have the HIV virus—the virus that causes AIDS.”  I waited for the interpreter to communicate this news.  His face barely changed.  He knew already.  I thought so.  His wife turned and studied him.  The children huddled into the protection of their mother’s bosom.  I turned to her, “Senora, you have it too.”

She burst into tears.  Through my own tears I gave her the good news, “Both of the children tested negative.  They don’t have it.  And they won’t catch it from you.”  She hugged them tighter and put her face between their grimy heads, uttering something I couldn’t catch, probably a prayer of thanks.

I turned back to him, “Senor, we have some antibiotics which may help you for a few days or even longer.  But you don’t have long to live.”  Still he hardly reacted.  Maybe he felt too sick to react.  Surely he was weak.  He had been more or less been carried into this tent clinic in a dingy slum.  Slowly he turned and met his wife’s eyes.  His gaze strayed to his young children.  I went on, “I don’t have any medicine for AIDS.  And I don’t know where to get any.  I wish there was more than I could do.”

No one moved.  He looked at the dirt.  She wept silently and smoothed her children’s hair.  They stared wide-eyed, frozen.  I just sat there.  I prayed silently and felt helpless.

“Senora, you could like a long while still.  You don’t have any symptoms, and that could last for some time.”  I wondered if I should tell her that it was possible that there would be medicine available before she got sick.  I didn’t really think it was very likely.  I didn’t want her to give her false hope.  “You should check in with the government clinic in the city every few months.  If they get medicine, then maybe you can get treated.”

I kept praying.  I didn’t know what else to do.  I asked if I could do anything of if they had any questions.  They were too shell-shocked to talk about it.  Though there were other patients waiting, it didn’t seem right to get up and leave.  We sat silently for a long time. 

I wondered what was running through the mother’s head:
“Who will provide for us?”
“Where will get money?”
“How soon will I get sick?”
“Will I even be able to raise these children?  Will someone else raise them?”
“Will they be OK?”

After some time, a local pastor and a few others from our team gathered around them in the tent and prayed for them.  I wasn’t the only one with tears and sweat intermingled on my shirtfront

Sunday, July 13, 2014

Week 2: Campbell and VCOM students together at City of Hope

Here we are! And almost halfway through our time here at the City of Hope! The group of first-year med students from Campbell was joined three days ago by our VCOM students. So our other half is here, and the ratio of extroverts to introverts has been irrevocably changed (for the louder!). The decibel level of nightly conversations and card games has gone up considerably, but so has the uproarious laughter count.

Our first week here gave us plenty of time to acclimate and get used to Tanzania time… being in Africa means that hardly anything happens on time and, surprisingly, we love it. All of us feel like we are detoxing from the pell-mell, Western medical world. When we got here everyone’s first questions were about what we were going to be DOING. You can imagine how disorientated these task-driven Westerners were when they didn’t have a to-do list for their free time or a normal classroom for our discussions. Ty leads our daily class times underneath the acacia tree in the quietest corner of the compound. So each morning after breakfast there’s a long parade of students carrying their plastic chairs on their heads down to the Lion King tree, form a circle (the circle of life?) and our day commences.

Our time always begins with devotions. We have been working our way through Luke, in no particular order, guided by the Holy Spirit and the profound questions of whichever small group leads us that day. The VCOMers jumped right into the routine and yesterday’s discussion on suffering was especially deep (or dope, depending on who you ask).

Class time follows. The Campbell students bore the brunt of adjusting to Ty’s teaching style last week. And…they LOVE it. It’s not your usual lecture. Instead of spoon-feeding us information he poses questions to help his students rethink their assumptions about spiritual, soul and physical health on their own. In the past couple days we’ve really begun to dig into the worldviews that influence the majority of these future doctors’ patients. It’s not just about patients, it’s about people. The goal of all our discussion times is not to try to teach the students to integrate/insert their faith into their practice, it’s to expand their understanding of their faith so that their practice of healthcare will fit into it. The implications are practical, personal, social and spiritual. It’s good stuff!!!

To break up all the serious worldview talk, there have been a couple hysterical aspects to our mornings. In the middle of conversations grappling with suffering and the will of God, we often find ourselves interrupted by a neighbor’s cow that stays hidden behind some nearby bushes.  We’re convinced he was raised by donkeys. Have you ever heard a cow try to hee-haw? Well, use your imagination. It considers itself an integral part of prayer time…

Then there’s the swarm of African killer bees that decided it would start forming honeycomb on the acacia tree the second day we were here. We woke up the whole hive when we set up shop underneath the tree that day…  luckily they took off in the opposite direction. But we got plenty nervous. Apparently this is the same bunch that almost killed Ty a couple years back when he tried to take their honey. You’ll have to ask him about that one day…

Another local creature that hates Ty is the resident Holstein bull that freely grazes in the compound everyday. (Why they have a Holstein bull and no herd, I don’t know. As far I’m concerned, it’s free range beef, and we all know what that means.) He has a crazy eye and I don’t think he can see that well. I’m pretty sure he gets surprised when he sees us, and since bulls don’t have the flight instinct, FIGHT it is. He paws the ground and threatens us with a good bout of grunting. He has caused the circle to scatter on numerous occasions. I’m not sure that a bunch of white girls running away in brightly skirts has been all that helpful in these situations, but Mr. Bob, a good friend, has now resorted to bringing a 10 foot staff to our Bible studies in order to ward off the beast.

Other than that, we are busying ourselves with relationships and…not "DOING" much of anything. That’s the point. We are learning how to be and how to be ok with not “doing” something every minute of every day. To quote the vivacious and beautiful Erin Fitzpatrick (a Campbell first year) “well, I’ve spent maybe one hour in the clinic in the past two weeks, but I’ve learned more about healthcare here than in any other setting.” Our afternoons are open—open to conversations and time with the children, local villagers, workers, Bernard, Mama Jane, Dr. Ben (the amazing Kenyan man who runs the clinic), the Chacha family, and each other. Then there’s banana farming, corn-crib building, hymn singing, and our latest venture – runs with some of the older girls (I can’t explain how countercultural it is for that group of girls to go running through the village in the morning in all their skirts. Sunrise this morning with them was great.) Nights hold a lot of cards and epic dance parties (shout out to DJ Chacha!) with the kids. Weather is perfect, food is filling, people are beautiful and our God is good. Bwana asifiwe! (Praise God!)

And that’s the update from us! Hopefully more to come, although internet is persnickety…. For now, kwaheri! (Goodbye!)


Tuesday, July 8, 2014

Week one update

For those who are interested in news from Tanzania: We've been here
for a week and everyone is happy and well.  The only thing that has
gone wrong is there are still four pieces of luggage missing.  The
students are very engaged in learning a biblical understanding of
health.  The Holy Spirit has been faithful to encourage us and show us
truths in scripture.  Last week we enjoyed having five Kenyan students
in the seminar.  In two day, seven more students from America will
arrive.  We look forward to their safe arrival.

Tuesday, July 1, 2014

The simple and the holy

An update from Kristy
Kristy is a Blacksburg native and U of Richmond graduate currently living in Blacksburg.

"Good morning all!

We arrived safely in Nairobi last night after the shortest layover in history-- an outright sprint as we caught our connecting flight in London (of course security saw fit to empty at least two of our backpacks as we were passing through!) Unfortunately, not all our bags caught the flight, so we will be having those delivered to the border where we hope to catch them today before crossing into Tz.

We already feel blessed by local believers who are driving us about, and another family which is letting us use their guest house...we were welcomed by chai tea and the Costa Rica/Greece game on -- which I may or may not have stayed up to watch :) it's wonderful to sleep horizontally, and have this place to snatch one last hot shower and access to wireless. By tonight we will be at City of Hope and less able to keep up with email :) There's also a cold snap here in Nairobi, so we are keeping warm. Jeans AND a skirt, thank you very much!

So tomorrow we really begin our time here in earnest. I'm excited for what is in front of us. Yesterday on the plane I watched the Secret Life of Walter Mitty for the first time (spoiler alert). It's a story about a man who had to abandon his dreams for himself in favor of supporting his widowed mother and sister. He works for Life magazine in a dark lower room, processing the photos of those who are "really out there" experiencing life. The movie follows Walter as he tries to find a photographer with a missing negative--the photographer's master work. As you might expect, Walter has many adventures "out there" in pursuit of his friend. He loses his job over the pursuit, becomes a capable mountain man, etc. He gains confidence and relational "weight", sure. But the missing negative was not some elaborate plan by the photographer to help Walter find himself--it was an honest mistake as he had slid the negative into a wallet as a gift to Walter (cute, right?), a wallet which W had thrown out in a fit of disillusionment on his journey. In the end it turns out the wallet is rescued from the kitchen trash by none other than Walter's mom, his plain Jane faithful mom. And what was the master work of this world premier photographer? A portrait of Walter himself, taken from distance as he sat outside his work puzzling over a sheet of photo negatives. That's the master work...Walter in his daily life. And that is what I've realized we are pursuing here. Tanzania is not the proverbial mountain, mission here is not about some grand plan of our making. Rather, it's to see the sacred in the daily..that the daily IS sacred.

It's how God has designed us. We are eternal souls meshed with these wonderfully humble, physical, daily lives. And as we go to humble ourselves, to embrace the daily in all it's simplicity, I think we are going to experience the holy. We will experience the image of God in those we meet and walk together with them as we study what Jesus meant when he said he brought us life to the full. It's not mountain climbing that is the full life, it's going to be found in the daily. And we lean in to seeing our God there this month.

Hope to talk to you soon :) much love!!

Kristy, for all of us"