Thursday, November 24, 2011

I live, she dies: Access to quality health care

(A version of this blog appeared in Global Post)          
I am thankful this season for good health care, and yet I am sad that many don’t have it. Here’s why.
            Three weeks ago, I flew to Manila, stayed a week, and then flew back to Washington, D.C. My calves felt extraordinarily tight during the whole trip, and when I went running one day in Manila I had to stop every three or four minutes. I have run marathons, but I couldn’t breathe after three blocks. (And that's where I left things in my last blog post. See below.)
            Back in Washington, I walked up three flights of stairs and again had to stop to catch my breath. I knew something was wrong so I opened my computer and typed in Google: “calf pain + shortness of breath + long flights.” Google told me what I feared: deep vein thrombosis, or dangerous blood clots that could migrate to my lungs and possibly kill me.
I drove myself to an emergency room, where 15 minutes later a technician using ultrasound found two clots in my leg; a doctor told me the clots were also almost surely in my chest. A nurse injected me with blood thinner, and after a few days in the hospital, I am now out of danger. I left for home and now recuperating.
            I am fortunate. I know this from years of experience of reporting about people who have poor or no access to quality health care, from rural areas of West Virginia to Afghanistan to Zambia. But today I feel this deeply, in large part because of an email that I just received from Rudi Thetard, the country director for Management Sciences for Health (MSH), a Cambridge-based non-profit that works globally to improve health care.
This summer, I met Rudi in Malawi and he had introduced me to Lucy Sakala (see Dominic Chavez's photo above), an HIV counselor at Salima District Hospital in Malawi, about a two hour drive from Lilongwe, the capital of the southeastern African country.
            Lucy was battling cancer and I wrote about her difficulties in getting treatment. Here’s what she told me in July about how she tells people that they are infected with HIV:
            “I tell people who just learn their diagnosis that they should live positively,” Sakala said. “I tell them that there are several conditions more serious than HIV, including some cancers. And I tell them I have cancer, and it’s difficult, but that I live positively. Then I say it’s so important for them to take their medications properly so they won’t have opportunistic infections, and that they shouldn’t fear much. They should listen to their health provider.”
            Those patients, Sakala said, sometimes “feel sorry for me, and their problem becomes a little lighter. But I tell them not to feel sorry. I tell them to live as positively as I am.”
            The story documented how Lucy couldn’t afford the cost for chemotherapy. MSH staff around the world donated $2,000 for her treatment.
            In the end, it was not enough. Rudi’s email was Lucy’s death notice. She died a week ago from her cancer, which had spread from her uterus to her brain, esophagus, and lungs.
            Here’s what he wrote:
            “Lucy has for the last year battled her own cancer whilst continuing to counsel persons who have tested positive for HIV.  Her death has been felt strongly by MSH staff in Malawi as we had all hoped that she would recover.
            “Her story echoes the story of many other cancer sufferers in Malawi.  Following the diagnosis of cancer she was able to start with a program of chemotherapy which had to be supplemented by radiotherapy.  It is at that point that that the doctor advised a course of radiotherapy which was only available in Zambia.  MSH staff (in Malawi and globally) contributed generously to the expenses she incurred in travelling to Zambia and she was able to complete a course of radiotherapy.  She returned to Malawi a few weeks ago and had to face a reality of a shortage of essential chemotherapy – these drugs have been out of stock since September in Malawi.  She died this morning and was only 28 years old, leaving a daughter and husband.”
            I told this story to Dr. Kevin De Cock, a pioneering global health researcher who is now director of the Center for Global Health at the Centers for Disease Control and Prevention in Atlanta.
            This story of the 28-year-old woman is regrettably a common one,” he said. “But at the same time we need to step back with non-communicable diseases and say where we are: The world is just starting to recognize the global problem. Not a large amount of resources are being made available to for specific non-communicable diseases, such as cancer, hypertension, and diabetes. … Still, a great deal can be done through appropriate public health policies. This does not solve the problem of the sad story of this woman, but there is an awful lot we can do now.”
That is almost surely true. The reality today is that someone like me who was born in a middle-class family in a rich country has the means to access health care that can add years – maybe decades – to my life. Lucy Sakala, by virtue of being born in a poor country with poor health care, didn’t have that. Basic chemotherapy treatment was not available to her. And because of these facts, I live and she dies in November of 2011. It’s not right.

Saturday, November 12, 2011

Manila: Xmas, shops, and ‘I want to marry that girl’

            HONG KONG – I’m now at the Hong Kong airport, on a layover, thinking about Manila and running and thinking about Manila and not running.

I had a run that I would rather forget. At dusk one night, I ran inside a gated Makati neighborhood – an exclusive part of the city -- and then rather foolishly went out the next morning at 6 a.m. A few minutes into the morning run, I wasn’t running. I was out of breath. So I walked. I started up again, and I stopped again, covering four blocks. My run-walk continued for a half-hour.

I’m not sure if it was the Manila humidity, the air, jet lag, or general fatigue from my life of too much travel, but it didn’t matter. I had one choice. No more running for a few days. And when I don’t run, a couple of things happen. One is that I have time.

So I explored Manila in a different way, just not in my running shorts.

It was hard to avoid experiencing how the city was gearing up for Christmas, even in the second week of November. My five-star hotel, the Makati Shangri-La, produced a “lighting of the (fake) trees” ceremony in its giant entryway.  The hotel brought out a choir of women all dressed in red floor-length gowns who sang from the top of a curving staircase. They hired a woman who wore a flowing golden gown and who belted out Christmas tunes as she walked down the stairway. She burst into a Motown song at one point, and the Filipinos in Red shook like they were from African-American sisters from Detroit.

The hotel also erected a two-story-high artificial Christmas tree, which stood in the middle of a forest of artificial one-story trees. And running around them were a bunch of elves, or girl-thin women dress in red skimpy outfits with caps on their heads.
A crowd witnessed the spectacle, of course. Who wouldn’t want to see this? Everyone had some sort of camera, either real ones or those on phones or other devices. (People were forever taking pictures in this hotel, even in the elevators, of themselves.)

Later, when I talked about this scene to a Filipino friend who had come to take me shopping (I had to find time for that), she said, “We’ve been celebrating Christmas since September! This is a late party!”

Shopping followed. Bernie, the mother of a friend in DC, took me to a shopping mall an hour’s drive away. Inside was a kind of an upscale flea market featuring knock-off brand clothes and bags, pearls, coral jewelry, hand-made bags, and Santa-and-elf figures. Plus a lot of Jesus statues.

(Did I mention the Philippines was “100 percent Catholic”? It’s not, of course, and in fact the Muslim population is large in certain areas, but people like to joke (sort of) about it.)

Bernie is a shopping pro. All foreigners need Bernie to take them by the arm. We had a short strategy session beforehand (I was looking for over-the-top pink/oranges/reds polos for my suddenly fashion-conscious 17-year-old boy; jewelry; anything locally made) and she marched into the place. I struggled to stay two steps behind.

We wandered into a maze of little booths selling thousands of strands of pearls and coral beads. We waded deep into the booths selling polos on major discounts. We found woven handbags, including some with coconut shells, and silk ties going for $5. “Give him your lowest price,” Bernie kept telling them.

When they lowered their price, Bernie would say, “No, I said, your lowest price.”

So we bargained and bought presents at their “lowest price,” and I filled a couple of bags, and felt like Christmas was here, even if it wasn’t.

But the best non-running moment was a third excursion – to a massage parlor. I went with my two companions on this trip. (The purpose of this trip, by the way, was to report on how the Philippines has attacked the ancient disease of tuberculosis.) Toward the end of the week, the three of us, all guys, found an upscale massage place and treated ourselves to an hour of massage.

It was heavenly.

When it was over, as I changed back into my clothes next to Riccardo Venturi, an Italian photojournalist who is working with me, I asked him how it was.

“Oh,” Riccardo said, “I want to marry that girl.”

“That good?”

“If I don’t marry that girl, the girl I marry will have to know how to massage like that girl.”

 We laughed. He said it was his first massage.

“First professional massage,” he said, correcting himself. “Shall we come again?”


“Tomorrow night?”

We later went out for a beer, a San Miguel, which everyone in Manila calls a “ladies’ beer,” probably because it’s so light. I enjoyed the ladies’ beer, the massage, the lowest-price shopping, and the elves and the two-story-high fake Christmas tree. This was not a running trip, perhaps for the best.

Sunday, November 6, 2011

A first-time run in Manila and rule No. 18

The flight here was horrendous. Thirty hours door-to-door. One 16-hour flight in the middle, during which both of my legs cramped up. It meant I was really looking forward to my run this morning in Manila.

I’m staying at the Makati Shangri-La, a five-star hotel surrounded by malls on all sides. There’s a triangular-shaped park a few blocks away – I can see it from my 14th floor room. It doesn’t look so big, but it may be my best bet. A doorman pointed me in the right direction and also talked about going into a neighborhood “past the park.”
That’s the trouble, and the opportunity, when it comes to running in a place for the first time. I have been to Manila once before, in 2008, but I stayed in a section of town along the bay, about five or six miles away. It might as well be another country for this city of 12 million.

At first light, about 6 a.m., I found the park easily and started running around it. It took me seven minutes for the first lap. That meant it was too small. I want to run 40 to 50 minutes a day here, and I can’t imagine running around this park six or seven times a day. It’s leafy, it doesn’t have any traffic, but who wants to run in circles?
So after two trips around, I branched out.  I crossed a busy road for a smaller one and ran straight for a  half mile until I came to a line of cars waiting to get into a gated community. I ran past the guards without saying a word, appearing like I was staying at the place. That’s one of my rules of running, No. 18: Never ask permission to go into a gated establishment unless a) It’s an African game park; b) it’s a military installation; or c) You are in a country run by a dictator.

This was none of the above, and I had found a small version of running heaven in the middle of  a crowded humid city. I ran along the perimeter, passing large homes, men sweeping the streets with long-handled, heavy-straw brooms, and an occasional walker. One walker, an Aussie, was kind enough to tell me how to stay on the perimeter all the way along by talking a tiny alleyway that led to a bridge that led to a small pass-through, and then, he said, I would be able to run 2.5 kilometers (about a 1.6 miles) around. 

The run took me 45 minutes. I arrived drenched in sweat at my five-star hotel, found some free tea by the front desk, and hustled to my room. For a first-time run in a city, it was top-rate. I wouldn’t be running in seven circles every morning. I had found my gated community – not quite like my inner self, but not bad.