A couple friends recently encouraged me to write from my unique perspective of living and working as a doctor in a limited resource setting for ten years but now being Stateside for this pandemic. So I’ve resurrected this old blog.
“Is it safe there?”
When people find out where I live in East Africa, this is frequently one of the first questions asked. I think this reveals a presumption (at least among middle and upper class Americans) that physical safety should be a priority. Safety was probably always an illusion, but in the light of this pandemic, the veil has been torn away and suddenly nowhere is safe. No one is invincible in facing COVID-19. And, while hand washing and social distancing will hopefully help, we ultimately can’t protect our loved ones either. Life feels like a zero sum game at the moment - there are only so many masks, ventilators, and rolls of toilet paper to go around. And that’s terrifying - particularly for those of us from privileged nations who have always assumed there would be advanced healthcare (and TP) when we needed it. My Facebook feed shouts that doctors around the world are afraid, and I see the terror in people’s eyes at the grocery store too.
Two of the four basic medical ethics principles are autonomy and justice. Autonomy emphasizes the patient’s right to choose or refuse medical care, to be involved in the medical decision making process. Justice highlights access to care and ensuring equal basic liberties for the highest number of people. American culture tends to prioritize autonomy - it goes along with our focus on individualism and freedom. Maybe it stems from the “protestant work ethic” - we want to believe that if we work/study hard and make wise choices, we will be rewarded with a good job, a nice place to live, security, and quality healthcare (no matter the cost). Of course the “American dream” has been unattainable for millions of Americans suffering the consequences of systemic racism and economic inequality. And I won't touch on the theological issues of the American dream or protestant work ethic here. But in the era of COVID-19, autonomy is being threatened for all Americans because there simply aren’t enough testing kits or masks or ICU beds to go around, and, with the orders for social distancing and lockdown, we also lose the autonomy to decide where we go and how we live. Suddenly the ethical principle of justice is first and foremost - focusing on the needs of the many rather than the rights of the few.
Both Burundi and Kenya (where I have lived for most of the last 10 years) are collectivist cultures. Individual autonomy is not really prioritized. Families make decisions together, and the emphasis is on what is in the best interest for the community. Our missionary team functions that way, too - which can sometimes be a shock to new people who are accustomed to North American independence! We collaborate on decisions about vehicles, pets, kids’ schooling, security plans, work hours, construction priorities, and, lately, COVID distancing measures. This is hard for us. Hard and good. For me, being single, it is mostly reassuring to know that I am not alone in making tough decisions and that someone always has my back. I belong to a diverse team with a wide range of experiences, personalities, and areas of expertise AND a mutual desire to serve and care for others. But autonomy vs. justice plays out in Burundi, too, on our team even now weighing different perspectives on what constraints to require in seeking to “flatten the curve,” and at the hospital. Even before the current coronavirus, we have had to make painful decisions about which patients get oxygen or a hospital bed or surgery. Who has the best shot at survival? Who has the most urgent need? How can we help the most number of people - and continue doing so for years to come (which means instituting reasonable work hours for hospital staff)?
These are hard days in our world. And suddenly we are all living in limited resource settings. I personally am struggling that I don’t have the autonomy to jump on an airplane and fly to Burundi. And I fear that injustices will worsen in many contexts - with the vulnerable and marginalized suffering even more from food insecurity, inadequate healthcare, and the achievement gap. But I also have hope. Because in some ways this coronavirus is a great equalizer. Around the world we have the opportunity to be united in our shared struggle, to love our neighbors in practical ways and maybe, in the end, to rethink some of the ways we live our lives. Maybe the next time I talk about my work in Africa, I won’t get as many questions about safety but will get more questions about how to join in the work God is doing in the most underserved corners of the world - even if there is some risk involved.
