Members of Nambula Girls Club, started after Kaino’s
death to help girls face the obstacles they will encounter.
I’m
in the passenger seat of an old white pick-up truck. My boss, Ms. Penny, a tall
woman with dark, chin-length hair is driving.
We are traveling down a dirt road into the bush. The heavy rain has made life appear out of
the desert. Grass has sprung up, the low
trees are full of small green leaves and their branches scratch the sides of
the truck as we weave between them. I am
in a remote village in the Northern tribal areas of Namibia. I live on a subsistence farm in a corrugated
iron and mud building. I teach at the
village’s school where Ms. Penny is the principal. It was a few days earlier, coming back from
an evening run that I got the bad news.
My student, Kaino, a seventh grader, had been swimming in pool created
by floodwaters. The water got too deep
and she struggled. Her friend and
classmate, Simon, had swum out to help her, but she had kicked him off in her
struggle. He was able to get away, but
she went under and didn’t come back up.
Miss
Penny and I are driving to the family’s home for the funeral. I know Kaino as the girl who sits in the
second row of my class. She’s in 7A, my
homeroom as well as one of my English classes.
She has serious eyes and always wears a knit red had no matter how hot
it gets. Kaino is not an especially great
student. She’s quiet but I always catch
her trying to hide her laughter after an exchange with one of her friends. She’ll cover her smile leaving only her eyes
showing in between her hand and her red hat.
Miss
Penny sighs and says, “Maybe its better this way.” I’m shocked and I scan my mind floods with
potential scenarios. Why would it be
better for a girl to die rather than grow up.
I think maybe there’s a bad situation at home but I’m not satisfied with
this. A branch scratches against my
window. “Why?” I ask. Miss Penny asks if I knew she was
positive. She means that Kaino was HIV
positive and I feel my stomach drop a little.
No I didn’t know. It’s not so
surprising though. This region of the
country has an HIV/AIDS rate that hovers just below forty percent. This also explains her red hat, which is
against school dress code. Exceptions
are sometimes made for HIV positive students to help hide hair loss and lesions
on their scalps. Miss Penny is saying
that its better Kaino won’t have to suffer stigma and isolation, better that
she won’t have to fight for inadequate medication, better that she won’t have a
drawn-out and painful death in a just few years. We finished our ride in silence.
As
my time progressed in the village, funerals piled up. Kids came to school hungry, distracted or not
at all. I started to see how deeply
illness, especially AIDS was woven into life.
I learned the social factors such as the prevalence of “sugar daddies”
that facilitate spread of the disease so easily, I got to know the orphans,
which made up more than half of my school’s population and who struggled to get
an education without the support of their parents. I read countless essays for class, which made
it clear that the extent of AIDS education was that “one should help with the
laundry of those affected.” I learned
that education, gender equity, and being able to envision a future are factors
that are scarce, but could have an enormous impact on reducing the spread of
the disease. It’s here where I learned
how interconnected all parts of a problem can be and that a single silver
bullet solution does not exist for such complex and fraught situations. Rather, a careful and nuanced look with
thoughtful action was needed.
This
experience propelled me to learn more about such complex and ingrained problems
like the HIV/AIDS epidemic that I experienced in Namibia. I decided to get my masters in Sustainable
International Development and have recently completed my degree. I learned guiding principles such as capacity
building, long-term partnerships, community ownership, needs assessment, and
taking a holistic approach to make
development not only sustainable but successful. Soon after this I came to FMEC to help start
a Global Health Initiative.
It’s
morning in early October. I’m sitting on
the couch facing a large window in my DC apartment. The sun fills my house with a warm
light. My computer rests in my lap as I
put the finishing touches on a series of questions. I am about to call Dr. Benjamin Fredrick and
interview him about his work in Haiti.
I began my work with FMEC about a month
earlier as the Global Health Coordinator.
Admittedly I didn’t know much about family doctors. When I heard that family docs work globally I
didn’t really know what to expect. The
medical work I had seen during my years working abroad left me skeptical. There was the group of Texan missionaries who
came unsolicited to the Namibian village where I worked. They stopped the school day to give a
presentation about hygiene in which they poured glitter over student’s hands to
represent dirt. Students were then
instructed to use soap while washing hands.
The Texans left feeling good with lots of pictures; sure they had made a
difference. What this group didn’t know
is that the school had one water pump that was often locked and only sometimes
worked. There was no soap. The demo was lost in translation and students
missed out on needed study time to prepare for upcoming exams. There was also the pharmacy at an orphanage
in Madagascar, which housed a collection of old, and defunct equipment left by
well-meaning foreigners over the years.
None of it was ever used. In what
I had seen in foreign medical assistance, there was little or no communication
with the community or understanding of specific needs.
So
it’s safe to say that coming into FMEC I was a little skeptical. However, Larry’s enthusiasm and belief in the
work that family docs do both in the US and worldwide was undeniable. He had incredible things to say about
organizations started by family doctors so I came in eager to learn.
It’s
time to make the call. I dial and Dr.
Fredrick greets me warmly. After
formalities I ask how he came to global health.
“Well,” he begins, taking a deep inhale, gearing himself up for a story
that he’s told many times before. He
tells me that this journey started years ago after hosting a Haitian boy who had
come to the US for surgery. Dr. Fredrick
grew concerned about the boy’s well-being and medical care upon returning
home. Dr. Fredrick travelled to Haiti. He went for a few days and met with a
regional health director who was overwhelmed and understaffed while responsible
for between 40,000 to 60,000 people’s medical care. After careful thought, Dr. Fredrick decided
to become involved.
As I adjust the phone between my ear
and shoulder, I’m, typing, trying to get all the details. Dr. Fredrick goes on, explaining how he then
launched Thriving Villages International (TVI), which provides healthcare to
communities in Haiti. After much research, thought, and discussion with the
local health director, Dr. Fredrick decided on what approach Thriving Villages
International would take. Instead of
building one clinic, TVI chose to focus on a method that would provide low cost
interventions designed to reach the largest group of people possible. Haitians were trained to administer
vaccinations and vitamins, and other low cost interventions, thus greatly
increasing the area of impact. This was
his initiation into global health.
As our conversation wraps up I can’t
help but smile. I thank him for his
time, we say our goodbyes and I hang up.
I take the computer off of my lap and look out the window at the yellow
leaves covering Rock Creek Park. I think
about the conversation and smile again.
It’s clear that that Dr. Fredrick believes strongly in communication,
community involvement and buy-in, and building long term beneficial
relationships. These are pillars I
strongly believe in and that I’ve seen succeed over and over again. This is the family doctor way of doing
things. They have a deep commitment to
their patients, think in terms of the bigger picture, and are able to look at
all the factors, which contribute to health.
Dr. Fredrick’s experiences are the norm
when it comes to family docs rather than the exception. I talked to Dr. Susan Kaye who started her
own foundation, the Josephson Fund which supports medical professionals as they
work abroad in global health. I spoke with Dr. Rebecca McAteer, a young doctor
who felt a calling to work globally and
moved to Nepal where she will be working at a clinic for the next two
years. She hopes to establish
partnerships with educational institutions and become a base point for other
young family docs interested in global health.
I talked to Dr. Omar Kahn who sees “drop in” medicine as out of date and
wants global medicine to look forward in a more holistic way, looking at
building capacity, seeing all the components that effect health such as water,
education, and infrastructure. These are
all elements that should be taken into account when envisioning the future of global
health. I talked to Dr. Jeff Heck, who
founded a remarkable organization, Shoulder to Shoulder in Honduras, where
local community members are being trained to administer effective, low-cost
interventions. His ultimate goal is that
Hondurans will eventually take over every aspect, enacting community ownership
in its purest form. I spoke with Dr. Tom
Wilkinson, a family doctor who is the Medical Director of Peace Corps and is
practicing global medicine by overseeing the direct primary care for thousands
of volunteers world-wide.
I have had many more such amazing
conversations with family doctors at all levels in their careers from students
to residents to established professionals to organization founders and board
members. It goes without saying that my
idea of what practicing medicine on a global level can be has undergone a
dramatic transformation. I am in awe of
family doctors and have even become something of a family doc advocate. I find myself bringing up the specialty all
the time. “Did you know that family
doctors have this thing called a bio psychosocial approach? Did you know that
when family docs work globally they focus not only on direct medical care but
get involved in water projects, girls education, and infrastructure? Oh your
sister’s in med school, has she thought about becoming a family doctor?” These are all things that I’ve said
throughout conversations with others over the past year.
I also sometimes find myself thinking
about Kaino. I wonder if her situation
could have been improved had family docs partnered with her community. After her death, a Namibian colleague and
myself were compelled to start the Nambula Girls club which focused on health,
education, and planning for the future.
We started a business, first selling snacks around the school, then
creating and selling traditional baskets nationally and internationally. We wrote and won a grant, travelled to see
professional Namibian women and hear their stories. We visited a national park for a mini safari,
and visited a college campus in the capitol. The girls excelled at school with
improved critical thinking and writing skills.
Members of the girls club had a 100% pass rate as opposed to the schools
rate of around 45%. I am proud to say
the club is still in action with many of the first wave girls now enrolled
college.
This has been an unexpected but
exciting journey for me. I began by
working in places where health needs were so extreme, where HIV/AIDS, malaria,
tuberculosis, high infant and maternal mortality were all very common and with
basically no existing health care systems.
Now I see that there are in fact healthcare change makers-- family
doctors-- who are able to go into such situations and work effectively, instituting
partnerships and enacting meaningful, long-term change in communities,
communities like Kaino’s all over the world.
