A disease of poverty

One of the things that’s been on my mind over the past couple months came from our very first training session with Dr. Berggren.  Wade had asked Dr. Berggren what scabies are and Dr. Berggren proceeded to describe the pathology of Sarcoptes sabei and how it is treated with promethrin. However the words she used to describe the disease really caught me off guard: “It’s really a disease of poverty.”

A disease of poverty. I don’t know if I’ve ever heard something described in this way. In microbiology, we’ve been learning about infectious diseases and the risks of giving birth in “unsanitary conditions” but not once have we talked about how sometimes – people have no other choice. In the classroom – we talk about how one should avoid “poor sanitation,” “bad hygiene,” and “stagnant water” nonchalantly like “it’s just common sense.” But never have we addressed the fact that there are places in the world that have very little access to something as simple as clean water. Diseases of poverty are diseases that are more prevalent among the poor than among wealthier people. In many cases poverty is the leading risk factor for such diseases, and in some cases disease can (or allegedly) cause poverty. Why is that?

A few years ago I watched a documentary about a couple who had decided to live incarnationally as Nike factory workers in China. They lived in the same living quarters, worked in the factory, and tried to live off the same wages as their co-workers. At one point, the wife had become extremely sick due to the poor living conditions. Not only was she unable to work, but her husband was forced to choose between using his day’s wages to purchase food for them, or to save up for medicine for his wife. Without food and/or water, she continued to become sicker. Diseases of poverty reflect the dynamic relationship between poverty and poor health; while such diseases result directly from poverty, they also perpetuate and deepen impoverishment by sapping personal and national health and financial resources.

214 out of 228. That’s where Ethiopia ranks in the world in terms of GDP. Definitely not good enough to be on the all-star team of life – at least not in terms of money. What does this mean? This means that the greater majority of Ethiopians are poor. A lack of physicians means that when the people of this nation contract preventable diseases like Scabies or Trachoma, they sometimes can’t find someone to treat them to rid them of these infections. Once they do, the issue of money comes back into play. The more and more I read and learn about Ethiopia, the more I see that the issues are not singular, but systemic. Ethiopia lacks the infrastructure necessary to maintain sanitary conditions for all of its people. What happens when people wash, bathe, and drink from the same water that is used to dump sewage? Or when space requires families to live in huts with their livestock? People become infected with (often preventable) diseases. What happens when there is disease but not enough health care workers? What happens when those health care workers cannot be paid?

While our hope and goal is to go to Ethiopia and bring about some good in the sector of healthcare, the deficit of healthcare is due to problems that run much deeper than they eye can see. And the need for healthcare comes from situations that seem far beyond our reach. Where does the cycle stop? And what is our role as medical students, as future physicians, as fellow citizens of a single planet in bringing this seemingly downward spiral to an end?

The Challenge of Empathizing with Ethiopians

Medicine is often framed in terms of a dichotomy between science and humanism. On one hand, the practice of medicine is rooted in the unwavering principles of science that are applied in a rational and predictable manner. As a first year medical student, I often feel inundated with the teachings of this part of the dichotomy, which I like to think of as the what of medicine—what tests and procedures do I need to perform to diagnose and treat the disease? Less apparent in the first year curriculum is the human aspect of medicine, which testifies to the why question—why do we treat disease? For me, this query is more appropriately answered wearing the patient’s cap. Anyone who has had a broken leg or a horrible case of the flu knows why he or she needs medical treatment; spending eight weeks on crutches or being confined to bed with a debilitating case of nausea is simply not the way human beings are supposed to enjoy life.

This ability to wear the patient’s cap, to understand and share the feelings of another, is more formally canonized in the doctrines of medicine as the quality of “empathy.” To empathize with another is to step out of one’s own shoes and to try to envision life in someone else’s. As I contemplate my upcoming experience in Africa, I find the ability to empathize with Ethiopians particularly challenging because the Ethiopian experience is so different from my own to the point that it seems impossible for me to emulate it in my mind’s eye.

I have never been to Ethiopia (much less Africa), so what little I know about the Ethiopian culture and condition has been gleaned from the impersonal transactions between myself and the information that has appeared in books and presentations about the country. In the context of our medical trip, I have been confronted with sobering statistics about the abysmal state of health care in the country. As I ponder these statistics, I find them compelling, but I think I fail to appreciate fully their significance. As much as I try to empathize with the plight of Ethiopians, I have never felt that truly visceral reaction that I expect will come with the actual experience of living among the Ethiopian people and knowing first-hand what it means to live in one of the poorest nations in the world. I hope my experience abroad will allow me to feel truly for the suffering of those with conditions so difficult for me to imagine right now.

I heart Water.

Over the last few weeks, we have had many training sessions with Dr. Berggren and Dr. Usatine in preparations for our Ethiopia medical trip. Walking out of each session, I have not only learned more about the history, culture, and needs in Ethiopia, but my heart for that country has only grown more and more with every story and every need.

There is no debate that Ethiopia desperately lacks in healthcare, but one fact that I have been thinking about the most the past two months is the lack of clean, drinkable water in the country. Honestly, I have never really thought too much about water and the lack of it in my life - ever. Clean water is something that I always thought was available no matter where you were, and stories that indicated anything different was a vague concept that seemed somewhat unreal. But after seeing several pictures of women filling up water containers with brown, stagnant water and hearing stories about the fact that so many of their medical problems stem for this lack of a basic necessity humbled me in understanding this major issue that faces so many Ethiopians.

Now, everytime I turn on a faucet, take a drink of water, brush my teeth, or do laundry, I think about how easy it is for us to do any of these things, but without clean water, none of these activities would be possible. I have only recently noticed how amazing it is to take a shower with hot, clean water. So many of us are so "rich," and we don't even know it.

Without clean water, we, as first year medical students, will see countless cases of Trachoma, the leading cause of treatable blindness in developing countries. Without clean water, we will see children and adults with scabies because they can't wash their dirty clothes and sheets. And without clean water, we will see gastrointestinal diseases, malaria, and other infectious and water-related illnesses.

Though these sessions, I'm sure, will continue to raise more reflection questions, I am sure I will not be able to comprehend the extent of the issues in Ethiopia unless we are there; and even then, those three weeks wouldn't be near enough time. However, I am excited for our team and for the opportunity to make even a small difference in the lives of Ethiopians.

Thanks for reading!