Issues raised by AIDS
We have discussed protection of health workers from AIDS at a number of meetings. The conclusion is always - not a great risk, unless you have cuts and even then it’s OK as long as you’re careful to cover the cut and wear two pairs of gloves!
On several occasions I have been liberally splashed with blood, and it’s not always possible to run and wash it off in an emergency. One day I received a large cut on my hand while hurrying to break open an ampoule of valium for a patient having a fit. Next day, I was handed a baby to resuscitate. It was an emergency and the last thought on my mind was putting on gloves. Other health workers I talk with have had similar worrying incidents.
However careful our medical training about how to protect ourselves, there are always emergencies which demand an immediate response. I know of six doctors who have contracted AIDS through their work in Africa. Doctors, nurses and midwives are at greatest risk, especially in Africa.
I find myself hoping that I won’t be asked to give blood if no donors are available for a patient. All donors are tested - how would I cope if the lab staff came and told me I was positive?
One of the hardest things for me would be the way people would assume I had contracted the disease through immoral behaviour. Would I be able to stay quiet and not try to justify myself, not say to people in a self-righteous way, ‘Oh, but I got it while taking care of a patient, you know.’ What does this tell me about my own attitude to people with AIDS? Disturbing…
Sitting in church one Sunday, I was thinking it all over again - particularly the cost of remaining silent about the reason for contracting AIDS. In an amazing way it made Isaiah 53:7 come alive. What it must have cost Jesus to bear our sins silently!
’He was oppressed and afflicted, yet he did not open his mouth. He was led like a lamb to the slaughter and as a sheep before her shearers is silent, so he did not open his mouth.’
Was this the way to react? Could I do it? What would be my response to the Lord if he allowed me to get this disease when I was working to serve him? Would I be able to love and trust him? How would I feel about the people who had given it to me? How would I tell my family? Would I be able to continue midwifery now that I was a risk to other people?
I hope this may help some of you who are in a similar position to myself to think over your feelings. All of us need to be realistic about the risks and be prepared to meet them as Christians.
I am concerned about the glibness of some publications on caring for AIDS cases. Have these authors actually looked after terminal cases of ‘slim’? Do they have any idea of the volume of diarrhoea these people produce? They arrive at our health centre here in Karamoja, soaked in it - clothes, blankets, sheets, all wet through. They are too weak to bother going to a latrine, which few people have anyway.
They come here because their families abandon them. Karamoja is hot and dry during the day (this has the advantage that the sun quickly sterilises diarrhoea on open ground). But at night, if ‘slim’ sufferers sleep outside in a soaked sheet they become dangerously cold. We offer shelter and a welcome. The other patients don’t want to go near them, despite the example of our staff.
We find most patients eagerly respond to the gospel and, not surprisingly, do not fear death. Heaven is clearly a lot better! However, their last few weeks are, physically, a miserable existence. To care properly for an AIDS case with classical ‘slim’ requires a lot of water, preferably hot, a lot of changes of clothes, plenty of sheets and preferably a ‘cholera bed’. Usually none of that is available.
The reality is that love, prayer and an eagerness to share the good news of the gospel are here, but the amount of diarrhoea these poor people have, makes caring a real sacrifice of love.
Dr Dick Stockley, Karamoja, Uganda
Doctors and medicine men
A reply to the knotty problem of working in an area where the medical doctor and medicine man are often tried out in turn (Footsteps No.7)
I am a regular reader of Footsteps and was interested to read the story about Anastausia who delivered a dead baby after chewing a root given to her by a medicine man.
This type of problem is usually common in places where primary health care is not very effective and where the importance of the traditional healers and medicine men is not recognised.
Until they are fully recognised and trained, unhealthy rivalry will be going on between them and the medical doctors. The traditional healers should be respected. We should try to learn from them and improve on their knowledge. Since they are part of the community, they often understand the needs of their people better than the doctors who may not come from that community.
Health workers must understand the beliefs, attitude and culture of the community they work with. People may not have any trust in western medicine, they may find that they have to waste a lot of time in waiting to be seen at a clinic or hospital, or they may be treated with little respect. None of this will be so with the traditional healers. We need to understand that they are part of the local resources to be learned from and used wisely.
Mrs Kunle-Alarape O, Ibadan, Nigeria
Technical and scriptural
I have recently begun to receive your magazine, Footsteps. I want to thank you very much. I find the magazine interesting not only for its technical information on various subjects, but also for its rich scriptural touch.
Bulus U Ali, Musi, Nigeria
I spent seven years with the Malinke subsistence farmers in South Western Mali. I did nothing that they couldn’t do with the resources they had. I had many small plots using different varieties and different methods such as alley cropping with leuceana or mulching with roof grass. I had many failures, but every time I had a success the farmers noticed. They would come to me and ask about that crop. What had I done to make that plot so much better than the one next to it?
The women would see that the varieties I was growing were different from theirs. They would ask for seed of those which grew best. Of eleven new varieties of cowpeas which I tried, eight were failures. The remaining three were very successful and in this way were given to 129 families.
I had two big assets. They knew I loved their children and them. They also knew that I would help them in any way I could.
Serving in Jesus love,
Don Mansfield Development Resource Center 1539 E Howard Street, Pasadena CA 91104, USA
I have used trials both in farmer’s fields and on demonstration land. I believe firmly that there is a place for both. Normally I would not go into a new situation and start arranging trials with farmers until I was certain that the trials would work in that particular situation. Many things can look wonderful when first tried. For example, here is a story about one village where I worked many years ago.
An extension worker had tried a new variety of sorghum in a farmer’s field and had a very good result: much better than the traditional millet. The village people were very impressed and the following year planted more sorghum. In the third year most of the land was sorghum. Then the sorghum midge arrived and attacked the sorghum flowers. There was practically no grain to harvest. Rats and weevils, which do not bother millet, attacked what was left.
By encouraging people to plant most of their land with this new sorghum variety, the extension worker exposed the villagers to too much risk.
Result - the people were starving and did not want to try other alternative methods for a long, long time.
Demonstrations on farmers’ land must only be done when you are completely sure that they will be effective. Choose the less successful, poorer farmers for such demonstrations. If they are successful, have an open day and let the farmer explain how it was done. Everyone in the village will know then, that if this particular farmer has been successful, they too will be able to do the same thing.
P J Storey, Cumbria