MSF Blog: Chiradzulu part 18

My staff started playing Christmas songs during the day. I guess it’s expected, but as the days get hotter approaching full summer mode, hearing Silver Bells sounds a bit off kilter. I suppose the entire southern hemisphere celebrates Christmas in summer. Is it necessary to change hemispheres just to see another point of view?

Billboard on AIDS prevention in Chiradzulu (photo by Rupa Kanapathipillai)

Next Monday is World AIDS Day. I know I ought to write something, considering I am on an HIV/AIDS mission in sub-Saharan Africa, but I don’t know what more to say. I’m grateful for the change of perspective gained from living here. I see first-hand the challenges of running an HIV/AIDS program, which seems to have as much to do with inadequate infrastructure and poor motivation as insufficient resources.

I won’t repeat the tale of irregular electrical and water supplies, or the inability to regulate the lab temperature, or the incapacity to process x-rays, and I don’t even know how the surgical ward copes. Even with a laundry list of infrastructure problems, this is one of the better hospitals in the country, mostly because people know MSF is here. Why does motivation to run a functioning hospital have to come from foreigners?
Our hospital doctors and nurse come home each day as if spent in a boxing ring. (I try not to complain when they are around.) They see Death daily; he walks hand in hand with the apathy of the underpaid, under skilled hospital staff. It’s difficult for me to understand how government clinicians and nurses see their job as a 9 to 5, clock-in clock-out, how-little-can-I-do position. The patients suffer, and then die. Even providing water to the hospital takes cementing pipes into the ground to prevent villagers from dislocating them and taking water for themselves. I don’t know what it’s like to have scarce water – or none at all – but you’d think people would respect the hospital’s water source. Then again, maybe it’s not about respect but rather survival. When you’re living for today, it’s hard to think about tomorrow. HIV has kept life expectancy around 40 – so how concerned can one be with life at 55?

View of shops in front of the hospital in Chiradzulu (photo by Rupa Kanapathipillai)

Many of us come to Africa with enough answers but few questions. It’s a cyclical story of short-term goals, insufficient collaboration, recurring apathy, and eventual burn-out, or the politically correct term, “donor-fatigue.” How long are we supposed to care about a continent when we don’t feel like they care themselves? But is it about how we feel they feel? Within a few months, or even years, have we gained enough experience to unravel motivations for all kinds of behavior and practices? Surely our post-graduate degrees have conferred some knowledge on us to understand why people do what they do. In the words of a Hollywood movie, we come to Africa with our hand-sanitizer, malaria prophylaxis, bed nets and laptops and hope to make a difference. Perhaps hope is not a strategy.

In graduate school, my friend had written on her mirror in lipstick to remember how to get through each day: First understand, and then be understood. We are all biased by the impressions put upon us since childhood, whether religious, cultural, or societal. Yet we use our own background as criteria to judge others, despite the differences. It’s easy to judge someone based on our own standards, but much harder if you understand their entire history. Does having a little patience and understanding take more effort than changing hemispheres?

Sandy, from Chiradzulu in Malawi