Hektoen International

A Journal of Medical Humanities

Nothing prepares you for this

Anne Rooney
Oak Park, Illinois, United States

Photo by Medici con I’Africa Cuamm

There are never enough beds.

Seventy women lie side by side on the floor of a hospital ward intended for thirty patients. Some sleep on torn brown blankets on the cement floor. Those lucky enough to have a bed have neither sheets nor a pillow, only a wafer thin blue striped mattress on which to spend their final days. The stench of bodily fluids, along with groans, chokes the air. Sunken glazed eyes follow our team.

Two exhausted nurses care for this entire ward. Medications are scarce. Staff report limited availability of soap and clean water. I am astonished to learn that the monthly health care budget for an entire district of 100,000 people is the equivalent of just a hundred dollars; little more than a penny per person per year.

This hospital is in the Copper Belt region of Zambia, near the border with Congo and close to the equator. Our project is to improve the quality of hospital standards throughout the country and today we are pilot-testing the most basic standards—hand-washing, medication safety, waste disposal—in order to see if Zambian hospitals can possibly meet them.

The petite head doctor, an Irish nun, seems to have seen it all in her twenty-five years as a missionary here. She notes with a rueful shake of her head, “You never get used to it.” She explains that most of these patients likely have AIDS as well as other diseases such as tuberculosis or malaria. But because the hospital cannot afford the lab tests, no one really knows.  

Perhaps that is for the best. AIDS carries a huge stigma, especially out here in the rural areas. Another doctor tells me, “A lady with AIDS was murdered in a nearby village. They came at night with a machete. No one wants the curse.”

The hospital has essentially become one giant hospice.

I have worked for fifteen years in the hospice field in the United States, but nothing has prepared me for this. This is not health care.

I recall the standards development workshop that our team held a few months before with the staff of the Ministry of Health. What were we thinking—that we could suggest what seemed like even simple ways to improve the quality and safety of hospital care? Under these circumstances? What could possibly make a difference?

That evening, back at my hotel, I spray the flea-infested blanket on my bed with the insecticide I carry in my suitcase. Despite the heat, I climb into bed wearing sweat pants, gloves, and a hooded sweatshirt with the string tied tightly under my chin to ward off the insects, leaving just enough of an opening to see and breathe.

I remember my first experience of Africa a few years before, a consulting assignment to assess the quality of medical care and health facilities for Peace Corps volunteers in Chad and Gabon. Before the trip, I thought I had seen poverty up close. As a nurse, I had visited homes with dirt floors in rural Mississippi, dilapidated farmhouses in Appalachia, and housing projects in the Bronx. I thought I was ready.

My physician colleague had chuckled and shook his head.

“Anne, Anne. You think you know. But nothing will prepare you for what you will see in Africa. Nothing.”

He was right. Even after a decade of working in Africa, I never completely got over my initial shock—or my sense of outrage. The pillage from European colonialists. The slave trade, which for centuries destroyed the fabric of many African families. Homegrown dictators who plunder their countries.

During my time in Zambia in the late ‘90s, I learned that there were one million AIDS orphans in a population of just nine million people. Twenty years later, little has changed. Children as young as five lived on the streets and on their own, begging for food. Simple wooden caskets were available everywhere along the roads, because the demand was so great. One village’s crops were completely ruined by drought. Villagers ate rats for protein.

Back home in Chicago, I thought about this for a long while, every time I shopped at our local supermarket and saw dozens of different varieties of cereal lining the shelves. I was as overwhelmed by this as I was with my first glimpses of the rural farm stands in Zambia—a few potatoes and vegetables on a wooden table, two scrawny chickens in a cage nearby.

The poverty and despair I witnessed throughout my journeys in Africa often overwhelmed me. I found it difficult to absorb at times, yet did not want to ever numb myself to the experience of the people who live it every day. At the very least, I wanted to be a caring observer who told others back home what she had seen. This was life as I had never known it before.

I often wondered how people kept going, day after day, somehow not paralyzed by unrelenting misery. Yet in spite of all the challenges, I also witnessed surprising pockets of generosity, courage, and humanity.

In Chad, a village woman brought our team a large pot of stewed okra for lunch and then beamed at our expressions of gratitude. In South Africa, I met David, a young hospital administrator from Zimbabwe who had taught himself English in just six months. Then with passion and urgency, he set about improving the quality and cleanliness of the Zulu district hospital he directed. The staff of a Zambian mission hospital, near where the famous Scottish missionary Dr. Livingstone had once lived, served me a morning break of tea and biscuits. Before returning to the routine of their day, they prayed together that wisdom from my visit would inspire them to provide better care for their patients.

On the list of the worst rates of maternal mortality in the world, the top twenty-five countries are all in Africa. I saw women in labor who traveled for hours on the back of an ox cart in order to deliver a baby at a small district hospital or clinic. The World Health Organization estimates that more than 200 million women across the world, many of them in Africa, have been brutalized by the practice of female genital mutilation, causing lifelong psychological and physical trauma. Many girls cannot attend school because of persistent bleeding, infection, and incontinence.

In the fifteen years since I have last been there, Africa has never left me. Yes, I remember the splendor of Victoria Falls and the magnificence of lions and hippos in the wild. The thrill of my first flight over the Sahara Desert on a cloudless summer day. Meeting the elderly Zulu village chief, the day I delivered “A Message from America” on the Zulu radio station. All of these memories are indelible.

But what mostly remains from my experiences in Africa is a sense of profound injustice. As a child, I never had to wonder if there would be a next meal, or whether I would go to school, ride a bicycle, wear shoes. Here, children wonder if they will survive to the next week. What orphaned five-year-old child should have to live and beg on the street? Walk past kiosks selling caskets every day? Or eat rats to survive?

Nothing in my life prepared me for Africa. She changed me. Yet, from the safety and distance of my life in Chicago, what help can I offer now that will make even a dent? Organizations such as Oxfam, Women for Women International, and RefugeeOne make a difference in the lives of real people—those who remain, as well as those who escape these desperate conditions to seek a better life elsewhere. I can support those refugees to establish new lives, hopefully of freedom and prosperity. I can add my voice to protest travel bans against people who simply aspire to the kinds of lives and opportunities that so many of us take for granted.

Critical funding support to African countries also comes from international development agencies such as the United Nations, the U.S. Agency for International Development (USAID), and the World Bank. We must continue to fund essential humanitarian initiatives supported by these agencies, in critical areas such as eradication of AIDS and malaria, child survival, family planning, and access to primary care.

Any resources that I can offer will always be infinitesimal in the whole scheme of things. It will never be enough. But “never enough” is not an excuse to do nothing.

ANNE L. ROONEY, RN, MS, MPH is a nurse and an international health consultant whose work focuses primarily on health system strengthening and quality improvement in developing countries. She worked as a consultant, surveyor, and executive for The Joint Commission and Joint Commission International for more than twenty five years. Her international work includes consulting and educational engagements in Europe, Africa, the Middle East, and Asia. She has published in health care quality journals and most recently in Globalization and Health. She lives in Oak Park, Illinois.

Fall 2018



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