Yaoli: My Favorite Things… Tanzania Version

July 19, 2009

#1 Bottle Openers

Here in Tanzania, instead of Starbucks or Jamba Juices, throngs congregate outside shops for soda. Walking around Uuwo village, you can find many little one-room shops along the way and plastic lawn chairs either directly outside or in a separate room. People here usually frequent the bi-weekly (Tuesday and Friday) market for vegetables, grains, meats, kitchen utensils, clothing, etc… and the little shops for any essential items during the other days. In addition to rice, oil, tea, toothpaste, peanuts, and host of other things, the shops also carry crates of soda. For 400 TSH (quite a good price at 1300 TSH per dollar), you can take your pick of Coke, Sprite, Fanta (Pineapple, Passion, or Orange), Krest Ginger Ale and Bitter Lemon, all in classic glass bottles. Most people have to take their soda in front or inside the shop, well in viewing distance of the shop owners. After all, 400 TSH only covers the cost of soda, not the bottle, which is sent back to the company to be refilled. But if you are a frequent customer of the shop and the owner knows where you live, then you are allowed to take the bottles home and return them later.

Soda is a special thing here in Tanzania. The children take delight in the rare sugary treat and the adults enjoy it after a hard day of work or during relaxation on the weekends. Soda brings people together. It is never taken alone. You always drink in the company of others, either while chatting in front of a shop or serving guests at home. Instead of buying people lunch or dinner, you treat them to a soda. It is cheap enough that even the relatively poor can afford to invite others. 350 mL of fizzy goodness is a guaranteed 15 minutes minimum consumption time. This is the perfect length for a good talk – not too long that you run out of things to say but not too short either. And besides, drinking soda makes for better pauses than chewing food. Soda is the perfect interlude during the day, an excellent way to pass the evening or whenever there is downtime.

Opening a soda is a truly exceptional experience. Bottle openers come in all shapes and sizes. The traditional one is a metal plate with various designed handles. But other ones can be more creative. It is possible to use one closed bottle to open another. Or use the edge of a table. Or a flat piece of rock. Or a belt buckle. Or for the true master, a bottle cap (although as of now, this is only a myth… people claim to have seen it, but no one I’ve met knows how). The ways are endless, and so much more interesting than twisting open a plastic lid. At shops and restaurants, people always open the bottle in front you, to prove that the drink is properly sealed and thus, genuine. The bottle cap comes off with a loud pop and the soda emits a hiss, accompanied by a swirl of cloudy mist. Bottoms up!

Yaoli: Living with Less

July 7, 2009

One of the first lessons we learned while staying in Tanzania was surviving with simplicity. You do not need to use the standard 35 liters a day of water consumed by an average American… you cope with maybe 3 to 5. This means turning off the tap when shampooing your hair, brushing your teeth, and soaping your body. This means not flushing the toilet as often and scooping out a limited amount of water to wash your dishes. Here, we do not shower everyday. Nor do we send our clothes for laundering after wearing them only once.

Another thing to be conserved is energy. We can never be sure that there will be a steady flow of electricity when we plug our devices into the outlets. Therefore, one should never be caught without a reliable flashlight or a candlestick and some matches. There is not enough electricity to support multiple appliances: the sound system cannot operate in conjunction with the TV. Turning on our laptops dims our ceiling light.

Only after deprivation of modern-day equipment do you realize how many hours you expend daily on watching TV, surfing the internet or listening to music. After finishing work at the dispensary, we often have nothing to occupy ourselves with and must come up with things to do. We play with the children of our homestay parents and those of their relatives’. They are ingeniously creative at entertaining themselves without Wii video games, computers, or sophisticated toys. We saw cars made from water bottles, a game involving just a wheel and a stick, and “hacky sack” made of a ball of grass. In the past two weeks, Sanaa and I have rediscovered the joys of jump roping, playing with cards, bouncing rubber balls, and dancing to the radio. We also took walks around the village, learned to peel potatoes using a plain knife, and rolled dough for making chapatti. Instead of iced coffee or smoothies, soda in a glass bottle became a rare sugary treat to savor under the afternoon sun.

Living simply brings people together. Hordes of children of different ages can be seen playing together in the fields. Without complex machinery, chores are completed under the collaboration of many hands. But this also means the work is difficult and time-consuming. Washing clothes, cooking, and cleaning can take hours.

Yet for many of those living with less, they embrace their life and its challenges. A bumper sticker I saw on the window of a truck summarizes their perspective: “Yesu Atosha.” Jesus Enough.

Yaoli: The River that Flows in All of Us

July 4, 2009

A heartbeat occurs about once every 0.625 seconds. The myogenic signal starts at the sinoatrial node and blood rushes into all four chambers. Tiny electrical signals, dictated by the opening of millions of molecular voltage gates, travel to the atrial-ventricular node via the Bundle of His. The movement of sodium ions is ultimately translated to a powerful flood of calcium. The ventricles contract, pumping blood to the lungs and the artery highways leading to the rest of the body. In the meantime, just as oxygenated “red” blood leaves the heart, deoxygenated “blue” blood returns and fills the upper atrial chambers.

Laden with oxygen saturated hemoglobin molecules, our erythrocytes travel inside muscular vessels which diverge to smaller and smaller streets. The map of a human body is remarkably complex: more highways than any nation, more alleyways than any city. Yet each cell navigates through the maze with ease… just routine. It happens every 0.625 seconds after all.

Finally arriving at its destination, the oxygenated blood wash over the tissues, bathing the cells in much-needed nourishment and hydration. With oxygen, our body can transform glucose, amino acids, and fats into energy… energy to power our legs, maintain our body temperature, even digest our next meal.

Our blood is our lifeline and the staff at Mwika Uuwo dispensary is its most competent plumbers. Blood pressure check, blood smear, hemoglobin count, ELISA for HIV, fast blood sugar level… these are tests the doctors rely on daily to infer their diagnosis. In addition to providing reliable diagnostic information, the circulatory system is utilized to rapidly deliver remedies throughout the body. Patients coming in with acute malaria or typhoid infections may receive antibiotics through an IV. Elderly patients suffering from dehydration or low circulatory electrolytes immediately receive saline drips to stabilize their blood pressures. In fact, almost all patients in the wards can be seen with a scalp vein or cannula affixed to the back of their hand or forearm.

The nurses diligently monitor the fluid level of the drip bags and change them every 6-8 hours. They ensure that the fluid is dripping steadily through the giving set and into the vein… 42 drops every minute, in fact. For the elderly, receiving an IV drip can be a difficult process. Forcing fluid through veins with poor circulation can be excruciatingly painful and result in edema at the infusion site. Many patients are frightened by the severe swelling and complain to the hospital staff. Clots are another obstacle. They can stop the infusion of fluid entirely and therefore require another needle insertion at a new site.

Blood’s dangerousness rivals its merit. Two of the most deadly diseases in Tanzania – malaria and HIV – travel via blood. The first lesson we learned while shadowing Dr. Raymond was not how to care for patients or treat diseases, but how to protect ourselves. “Any bodily fluid… especially blood, is a very dangerous thing. If you get infected, how can you continue to care for others? You must always wear gloves. After using a needle on another, you must be very careful to dispose of it. If you administer HIV tests, you need to observe the patient first. See if he or she is stable, calm, ready. You need to protect yourself at all times.” This couldn’t be truer. At our dispensary, staff is overworked and in short supply. It operates 24/7 on two doctors and only a handful of nurses. Stanley, the laboratory technician, multitasks between performing diagnostics, giving injections, and filing paperwork. Nurse Flora executes the duties of a pharmacist, accountant and secretary. She keeps records of the drug stocks, files the insurance claim forms, and dispenses the medication. They only get one day off a week and cannot afford to be sick. But of course, in a country as poverty-stricken as Tanzania, no one can.

Yaoli: A Stroll Around the Shamba

July 1, 2009

During the brief window straddling day and night, Gilbert took us on a tour of his farm. We have stayed at his house for more than a week now, but have never ventured into his fields. Meandering through the banana trees, coffee bushes, and rows of beans and maize, you can make many insightful observations revealing broader facets of Tanzanian life. Keenly perceptive and engaging, Gilbert has the uncanny ability of understanding how society and people function, even in environments vastly different from his own. During the trip, I witnessed his natural talent for tour-guiding and story telling.

Never sparing a moment to rest, he had just spent the afternoon planning an addition to the chicken coop. On top of wild chickens, his shamba also boasts three goats (which he breeds to sell the young), seven pigs, and a bull (for harvesting manure to fertilize the crops). We strolled past the animal pens to survey the land. He points out the branches laden with still-green coffee fruit. Once red, the fruits are harvested and crushed to yield crude coffee beans. The beans are dried outside in the shade, then sold to commercial companies capable of roasting and refining. Farmers here in Tanzania sell their beans at less than $1.50 for a kilogram. In contrast, even the cheapest instant coffee will run you more than 7x that. “So we are very stupid, selling it so cheaply.” This is the plight of commodity exporters worldwide: poor countries such as Tanzania sell cash crops or natural resources at bargain prices to companies which turn the raw material to expensive end products.

Walking further, we passed by dark rich upturned soil fertile for planting. Rain here in Mwika Uuwo is thankfully frequent and the land is abundant in vegetation. Labor is all manual. Farmers carve out the steep hills of the Kilimanjaro region by hand; powering large-scale equipment is impossible. Logs from fallen trees are sawed by the power of man, not electricity. Tanzanians take their children’s education seriously – their country has one of the highest literary rates in Africa. However, the large labor demand also meant that a child’s primary priority is not education but doing their share of the chores. Firewood for cooking must be gathered, grass to feed the cows must be cut (very difficult, as the blades are short) and water must be lugged in buckets from pipes far away.

Wearing flats unfit for the precipitous dirt trail, I struggled to stay on my feet. Gilbert paused to show us the flat, long leaves of a plant on the side of the road. “This plant has special meaning to my ancestors, the Chaga people. It is used in ancient times to mark one’s territories.” We learned that you can also tie the leaves in knots to signify “no trespassing”. A gesture of peace, one can tear a piece of leaf and give it to someone in order to resolve a conflict. It is now prized as a robust and handsome houseplant, too. The national boundaries here were not drawn by Africans, but arbitrarily by European powers during the “scramble for Africa”. Thus, signs of Tanzania’s multi-tribal, multi-language culture can be found everywhere.

In many of the neighboring shambas, we could see children kicking around a makeshift soccer ball or old women sitting and chatting outside on the porch. But one plot of land did not possess the rich foliage typical of the others. Instead, the ground was a carpet of yellowing and desiccated patches. “Many young people nowadays go to the city, where they think life is better. They leave and there is no one to take care of the land.”

As the sky deepens from azure to a rich navy, we stepped down the trodden path slowly towards home. The view was breathtakingly beautiful, staggered mountain peaks peeking from a hazy grayish mist. The hills were blanketed by lush emerald canopies, not the glittering lights of civilization. The only sign of mankind was the twin cellular communication towers flickering softly in the distance.

Yaoli: 10 Meters Between Life and Death

July 3, 2009

If you ever come to visit the Uuwo Dispensary, you’ll notice that behind the main two-story building, there is a little dirt path that leads to a smaller shack. Most days it sits abandoned and empty. Perhaps a warehouse for tools, you think.

On certain days however, the little shed fills with people and life. More villagers crowd outside its tiny porch than in the whole dispensary. And then you learn that the hut have a name – “mochwari”. Inside, a tomb-like silvery fridge protects the bodies in its frozen dark abyss. Another room showcases a metallic table and cabinets laden with strange and foreign tools. The “Maponyesho” (master of the mortuary) aka Robertson is a friendly energetic man. Thin as a rail but tough like a well-drawn wire coil, he can be seen working on the gardens, helping the nurses wash the bedsheets and blankets, or doing handyman work on days when the mochwari is vacant. But today Robertson is nowhere to be seen in the dispensary. Instead, he has more important work at hand.

Meanwhile, the midwives of the mother and child clinic upstairs at the dispensary are also busily scurrying about. On a different metallic table, a young mother is in the turmoil of labor. She lies struggling on her side; her hands clutch the steel bed-frame in pain. We were following Dr. Raymond on his usual morning rounds downstairs when he was called to assist. The fetus initially was not crowning. Even after midwife Mary managed to rotate the fetus into place, the uterine contractions were still futile – the head was too large. Dr. Raymond assessed the situation rapidly, then reaches for a nearby thermos from which he pours out a molten black liquid. “Black tea, to increase the contractions.” The mother receives the cup with trembling hands and takes a few sips before collapsing again in pain. She alternates between gasps for breath, groans of pain, and prayer.

The contractions are increasingly stronger now and the doctor and midwife doubles their efforts, offering more sips of tea and kneading her swollen belly. They position the mother on her back, bending her knees up towards the ceiling. Her fingers grip her ankles until they were nearly ashen. Mary tug at the vaginal wall and I feel a shiver race down my spine. The head seems impossibly big compared to the already extended aperture. They cannot afford to wait much longer; the fetus’ life is in graver danger with each passing second. During a particularly strong contraction, Mary seizes her opportunity. Her gloved fingers grasp onto the dark matt of hair tenaciously and she pulls with all her strength. The baby’s head pops out and the rest of the body follows, sliding like butter through the vaginal canal and out into the real world. “Asante asante Jesus,” the mother cries in relief.

The baby girl is silent for the first few seconds – perhaps to catch her breath or maybe to recover from the shock of being immersed in a new environment. Does her skin sense the cool air of the delivery room? Does her ears detect new and foreign sounds? Mary wipes the newborn with a washcloth and the baby gives a resounding cry, sealing her assimilation to mankind. We welcome her warmly, enveloping her in a colorful khanga, the first of many that she will wear in her lifetime.

Yaoli: We Are All One God

June 30, 2009

Here as in the States, getting to know someone begins with the gathering of some basic information: first name, last name, ethnicity, age, hometown… However, another common inquiry for Tanzanians not found at home is religious affiliation. Founded on the bedrock of liberty, justice and the pursuit of happiness, America have had an distrust of religious institutions for centuries. Waves of immigrants, starting with the Puritans, journeyed to the New World to escape the snarls of persecution. They vow to separate religion and state. Rhode Island became a model state for tolerance of all beliefs.

But rather than complete acceptance, modern America has chosen the path of avoidance. Although we haven’t gone as far as the French to ban all discussion of religion in the educational system, our culture nevertheless shrouds religion in a veil of silence. One’s religious affiliation is not something shared along with one’s name. Extremist groups such as polygamist Mormons, Al-Qaeda Muslims and fanatic evangelical Christians give religion a reputation of being conservative, orthodox, and discriminatory.

While some stereotypes against Christianity are indeed unfair, I cannot deny that Christians can be prejudiced. How can I treat other religions equally when my church tells me Jesus Christ is the absolute savior and that accepting him is the only path to heaven? The perspective is resolute and rigid… no room for compromise or discussion. You either believe in Him or you don’t.

So imagine my surprise when I was asked over and over again “what religion?” “what denomination?” And Sanaa? “Ah, Muslim, yes, we are all one God.” They accept it with such ease, they talk about it so openly. They tell me, “we do not want strife. There are more than 120 tribal groups in Tanzania. We cannot afford to fight. So we say, we are all brothers.” We eat lunch daily at the Parish and we all take turns praying, in English, Swahili, and Arabic. People here are far more devoted to their faith than Americans: they go to service every Sunday, make tides to their local church, send their children to confirmation school… Yet paradoxically, they are also some of the most tolerant people I have ever met.

Yaoli: First Impressions

June 29, 2009

Tanzania… in little more than seven days those four little syllables has come to represent so much for me – the dry dusty soil that turns into an orange mist behind the roar of rubber tires, lush green canopies of banana trees, women in colorful khangas and hordes of smiling children always eager to greet and exchange hellos. Our journey has taken us 8700 miles from America, but the mere 16 hours of flying cannot convey the differences in geography and culture.

As a foreigner grappling to adjust, I feel the surroundings for points of commonality, anything at all that can relate my life to theirs. I notice similarities in food – tea with cream and sugar, rice and beans, boiled eggs, curried vegetables, toast with jam for breakfast… They also prepare cole slaw, potato salad, and spaghetti especially for us. I learn that American pop music is global. Radios emit the most contemporary US hits; walking past shops, you can hear the echoes of Jay-Z rapping about “dirt off your shoulder”. The death of Michael Jackson reached Tanzanians faster than me. It was the doctor at the dispensary who first informed me that the singer had passed away the night before. All over the media, from local papers to broadcasted news, radio programming to late night sketch comedy, people celebrated the life of Michael Jackson and his musical legacy. I am thankful that there are people who can speak English here – our hosts Mama-nanci and her husband Gilbert, the two doctors from the dispensary, nurses Flora and Rachel, the English teacher at a nearby elementary school, and staff of the Parish. We struggle to overcome our language barriers, utilizing gestures and facial expressions to transmit what our words cannot.

But the disparities far outweigh the similarities. The clinic looks nothing like the hospitals of home. They operate without the technologies which are indispensable to American doctors – imaging devices (X-ray, ultrasound, MRI/CT scans), diagnostics tools (culturing samples, performing and interpreting biopsies), and drugs. Doctors examine cases clinically, relying process of elimination to determine causation. Most of the symptoms are vague – general malaise, coughing, fever, diarrhea and abdominal pain. The prescription can be equally broad – painkillers, a course of antibiotics, and an IV drip to make up for lost electrolytes and mitigate low blood pressure. Patients who do not respond to treatment are referred; it is their responsibility to make the trek over to the other hospital.

Many people live in poverty. Quality of life for even the relatively rich are subpar to that of a middle-class American. Things which Americans take for granted – hot water to shower everyday, a working toilet, steady supply of electricity – are all luxuries here. There is no Medicare for the elderly, Medicaid for the disabled. The sick here rely on family and their community to support them. Basic drugs such as painkillers and antibiotics can suck from a family all of its savings. The clinic does what it can, charging only enough to maintain itself. But even that is too much for some. An elderly woman we saw today could only pay 4000 of the 9500 Tsh prescription fee, medication that costs only about 7 US dollars. She owes the clinic the rest. Her repayment lies only on a verbal promise. And what about those without the care of relatives? The response is simple – “death”.

Yaoli: Why Maternal Health?

We moved recently to a new house late February. When my mother first toured with the real estate agent, she did not notice his animated speech about the newness of the wood floors. Nor did she pay attention to his zealous discussion over the finished basement and the recently updated water softener system. She peered out into the yard and instead of grass and weeds, she was struck by a vision. She pictured flowers bordering the fence, the barbecue pit scrubbed so it gleamed in the sun, and a bountiful garden nurturing baby vegetables springing from the earth. My mother was sold.

On March she began to work towards realizing her dreams. She bought seeds from the local plant nursery. She airated the earth, fenced up a square patch of earth where sunlight shone the fullest, and carefully placed each seed its into its earthly bed before blanketing them with a handful of soil. The rows were neatly arranged and labeled and everyday she faithfully watered them. The radishes, which preferred shade and cooler temperatures, germinated first. Everyday, my mom and my sister worked in the backyard, eagerly charting their progress, noting the number of new leaves and how much taller they grew.

By the time I had gotten back from college early May, it was ready for us the reap the fruits of our first harvest. My sister, though she did not find the planting process terribly engaging, was eager to uproot the plants. Her little fingers grasped around a large, robust plant and plucked it from the ground. Then her little nose wrinkled as she examined the radish before her. An inverted iceberg, it was large, green, bushy on top, but for all its magnificient crown, the real treasure was no bigger than a marble. Kimmie pulled out another, and then another. All the same.

My mother decided to go to the library and consult some gardening books. The reason, she learned, was that she had planted the radishes too closely together. Plants, like all other organisms, are complex organisms very in tune with their environmental conditions. Under certain situtations, they may bear large, bountiful fruit, but in other cases, they may divert their energy to growing leaves only.

People, too, thrive under the right conditions and do poorly in others. We settle in large masses by plentiful soil and near bodies of water. Mothers who were well nourished in pregnancy can afford to expend more energy for their babies. Well nourished babies in turn are shown to have less predisposition towards cardiovascular disease, diabetes, and other metabolic disorders. The benefits of a stronger body and better passive immunity factors from mom means a stronger immune system and a greater chance for survival. A baby is most vulnerable in the first year of life and infant diarrheal disorders have claimed the lives of many. The three brief trimesters spent in a mother's womb is precious time. Time for organ development, rapid growth, for laying down the foundations to a potentially long and healthy life. It is not enough to bury the seeds and water them. We must invest energy and care, for these nine months are the most crucial nine months of a person's life.

4 days until departure

Yaoli: Fears

As my MCAT exam date (June 18th) and my flight to Tanzania (June 20th) approaches, I find each day passing faster and faster now as I juggle between test preparation, medical schools application decisions, more Swahili exposure, and pre-departure research . There is still much to do.

Being the first generation of students to be sponsored by DGHI for Mwika Uuwo, we face a lot of uncertainties. On-site conditions are a mystery and our contact person, Vera, is from KCMC in Moshi, a city more than 40 minutes away from our village. All I know for sure is that we will be living less than 5 minutes away from the clinic, that we will have no access to internet, and that the clinic has very recently purchased a computer for patients' recordkeeping. Our team has generated a list of lofty project ideas we were interested in pursuing - antenatal care, the study of chronic disease in the population, health education (on smoking, diabetes, cardiovascular disease, medication side effect), Down's syndrome, and of course, computer literacy training for hospital staff. However, many barriers stand in the way of generating well fleshed-out, workable and innovative proposals. And many questions remain unanswered.

Take medication side effects, for example. In the United States, we want drugs to be clearly labeled with all potential side effects and pharmacists to tell us how to take it, when to take it, and what symptomes to expect. There are compelling reasons for labeling and many forseable benefits to making sure this practice is adapted in less wealthy nations. While westernized medicine monopolizes the American healthcare landscape, conditions are different in other parts of the world, where a patient may seek care from a variety of sources - government sponsored clincs, religious healers, herbal medication, etc... Many view Westernized medicine as an unfamiliar new concept and approach it with caution. Now imagine a scenario where health officials try to implement a TB control program with pills which have to be taken on a rigid schedule. If the pills come with sudden and debilitating side effects (such as nausea, or diarrhea), a patient might conclude that the pills are making them sick and stop treatment. This failure to adhere can result in increased drug-resistance. So shouldn't telling patients to anticipate side effects be a good thing?

Not necessarily. The relationship between doctor and patient differs from culture to culture. Revealing that a drug can actually generate harmful effects may drastically decrease uptake. People living in endemic TB regions have been coping with the disease for generations. Perhaps being TB postive is a better alternative to symptoms of nausea, which can hinder someone from working and earning the money needed to support their families. It also can increase patient distrust, especially if other forms of "milder" medicine is available. As Americans, we are instilled with a strong sense of individualism and having the choice to make our own decisions regarding health. Paradoxically, in other countries patients do not want to be given a choice. They expect doctors to know what is best and they expect one and only one right answer. This is reflected in the numerous studies that report the frustration health care workers feel towards the ever-changing breastfeeding protocols. 6 months exclusive breastfeeding or bottle feeding only at the discretion of the mother was simply too wishy-washy of an answer.

There are so many other scenarios I can think of that can prevent us from achieving those goals. What if the language barrier is too great? Will we have someone that speaks Swahili to help implement the health education classes? What if the real solutions to chronic health care in the community are beyond our resources? Maybe those that do get cardiovascular disease have genetic predispositions and what they need the most is beta blockers, not dietary changes. What if pregnant women do not have the means to increase iron in their diet or make sure they have enough calcium? How much difference can 2 students really make?

Pondering about all those fears led me to consider my purpose in going. I am not the naive westerner who's embarking on a journey to "save the world" or "make a difference". I know that Tanzanians have more to teach me than the other way around. Nor do I hold any preconceptions of what is "right" or what people "need". Yet I cannot deny a strong desire to make the trip purposeful, to make achievements worth the funding we received. What appealed to me the most about civil service is the opportunity to generate something meaningful with my own abilities now. Gaining knowledge to prepare for a future in medicine and to become a good doctor is great, but I want to apply my Duke education now, to know that while I have many years of learning ahead of me, there are still things I can accomplish today.

Maybe I should put less weight on these reasons. We are merely students, we've only lived 21 years and we're new to the real world. Our knowledge and resources are limited. But our capacity to connect with others, to share our experiences, is boundless. We may not create great policy changes or generate sustainable programming, but we will undoubtly leave a mark on the people we meet and they in return will touch our lives deeply. Perhaps that is enough.

25 days until departure

Yaoli: Reflections from DukeEngage Academy

Although personally not required to attend DukeEngage Academy, I nevertheless decided it might be useful and stayed around campus a bit longer. Two days filled with workshops and panelist discussions from 9-9 was exhausting, at times overwhelming, yet also enlightening. Navigating around campus with a standard-issue name tag bouncing from my neck and being surrounded by bright-eyed, eager college students felt a little campy at times, but it was encouraging to be in the presence of people that cared about the world and wanted to participate in civic engagement.

The experience made me realize how naive and young most of us are. Many have not traveled outside of Europe or interacted with people of different cultures. Our values and beliefs we derive from our parents and teachers, and this inherited culture influences how we perceive the world. It shapes our decisions, guides our emotions, becomes a pair of glasses we are blind without. As Americans, we have always embraced diversity, been cognizant of different ethnicities and supported human freedoms. But in spite of all these differences, there is a foundation of "American-ness" that is instilled in each of us - traits that we share and principles we have about the world we live in.

An example illustrating this occured during our ethics workshop, when we were asked to decide whether to take send a very sick Kenyan girl (likely from end-stage AIDS-induced pneumonia) to the clinic for treatment at the risk of showing favoritism, bringing stigma upon the girl for exposing her positive HIV serostatus and disobeying the wishes of the community. Many of the participants were confident in the clarity of the solution: the girl should be sent to the clinic immediately. Popular arguments include the sanctity of life, that nobody should allow this girl to die when means are available to save her. Others pointed to the fact that a DukeEngage participant in the story was bitten by a scorpion and airlifted away. Shouldn't all life be considered equal?

Like them, I agree that I would save the girl should she requested help. Much of the rationale stems from the fact that I simply could not face watching someone I cared about die. However, that life is the most important thing and should be preserved at all cost is a very Western presumption. Many cultures consider life transient and a very small role relative to all eternity. They might have different views on how time on earth should be spent, what kind of goals are the most important, and (for us global health students) what is the value in being healthy. The workshop leader raised a final point that left me in astounded - it is not right to base this decision, which can forever change the life of another human being, on our feelings. We should not do it because we dread the emotional consequences of our actions. This is not about fearing that we would never be able to live with ourselves should we "let her die". This is about evaluating the potential outcomes, looking at all the possible solutions, reaching out to the community and making it about them.

42 days until departure

You can find the case study from the workshop here.