Nobody wants to be bitten by a wild animal.  Even my former housemate, who is exceedingly likely to wrestle raccoons or be chased up a tree by a flock of angry turkeys each time she visits her ancestral home, would prefer not to be bitten.  But let’s say you slip up.  Make a wrong move and let some critter sink its teeth into your wrist.  In the United States, there are limited consequences to your mistake.raccoon.JPG

Maybe you’ve heard that the rabies vaccine is scary, but it’s not so bad.  A series of four; none hurt; none made me feel sore.  It did hurt when the nurse injected human-anti-rabies immune serum directly into my wound.  I began a long, loud diatribe – I know this is for the best, and I know that it hurting is not your fault, but I am decidedly unhappy right now – that went on for the entire twenty minutes it took for the nurse to inject ten milliliters.  All the children screaming in the ER at four a.m. sudden became very quiet; because the hospital was overcrowded that night, I was on a gurney just outside their ward.

Still, I didn’t suffer much.  By five thirty I was home, snoozing contentedly.

I’m not saying that health care in the United States is great.  I was a graduate student at Stanford.  We had fancy coverage.  I could drop by a fantastic hospital for free.  Others are less lucky.  People go broke from medical bills in this country.

I am saying that health care in the United States is pretty great compared to the standard fare on offer in Malawi.

malawiMalawi is a very poor country.  We – meaning not you & I personally, but rather the people who engendered the prosperity of the United States, from whom the contemporary beneficiaries inherited both wealth and blame – are responsible for the poverty of Malawi.  Throughout Africa, resources were plundered.  Europeans brought horrific violence to the continent.  And, because wealth begets wealth, the repercussions of these sins have grown more severe over time.  Unless there is a conscious effort to repair past economic wrongs, they won’t vanish on their own.

This same principle underpins lingering individual inequality in the United States.  Some wounds, time does not heal.  A rising tide only lifts those comfortably ensconced in boats.  The world’s plundered nations are still struggling, sinking farther and farther behind.

In addition to dire economic circumstances, Malawi has been ravaged by an HIV epidemic.  Ten percent of the population, approximately 1 million people, are living with HIV.  30,000 or more die of HIV-related illnesses each year.  This public health crisis is tragically self-perpetuating.  Poverty exacerbates epidemics by reducing access to medication and pushing people toward riskier lifestyles.  And then it’s hard to escape poverty since young people are dying daily and huge numbers of children are orphaned by disease.

In the United States, we often discuss the curtailed economic prospects for children raised in single-parent households.  Those children have it hard.  Now picture all the Malawian children in zero-parent households.

My father, who has worked with sick patients in HIV clinics in the United States for many years, is now practicing medicine in Malawi.  It’s grim.  For instance, the reason I began this piece with a description of rabies vaccination?  Those vaccines are not available in Malawi.  Instead of four relatively painless shots, those who get bit face death.

After four decades of practice as an infectious disease doctor, my father has obviously seen patients die.  But a sign like the one below is new for him.

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“Dying from rabies is a terrifying experience for both the patient and their relatives,” it says, before admonishing, “Don’t forget to ask about spiritual needs!”  Nothing drives home privilege like the thought that someone else’s son would die from the sort of bite that simply sent your own to a hospital for a late night.

It feels even worse knowing that his doctoring – and my sister’s, who will be traveling to Malawi with her newborn child to practice pediatric medicine starting this fall – is a meager staunch against whelming calamity.  People are dying now.  They can’t make effective long-term plans when the short-term outlook is so bleak.

And yet.  Poverty there is so deep, and infrastructure so quickly deteriorating, that many people have been chopping down the country’s few remaining forests to produce charcoal.  For many, charcoal production is the only source of income.  For others, in circumstances only slightly less dire, it’s necessary to buy charcoal to weather the frequent blackouts.  Even those responsible for protecting the forests buy illegal charcoal.  There’s no winning.

Without the forests, there will be drought.  When the drought comes, people will starve.  Climate change – caused primarily by the nations responsible for plundering our world’s currently-impoverished nations, yet which will beleaguer those plundered nations first – will exacerbate this problem.  New tragedies are coming.

I’ve obviously benefited from the prosperity of the United States.  I have a computer.  I have access to the internet.  When I turn the tap, there is clean water.  When I flick a switch, the room is instantly (and always!) illuminated.

But this means that the blame for the current plight of our world’s plundered nations – which brought my prosperity – falls on me, too.  I’m glad that my family members are doing what they can to help.  I wish it were enough.