Optimism of the Will

Riding in the back of the Landcruiser along the “road” leading from northern South Sudan into the Nuba Mountains, we lolled side-to-side like a weeble-wobble, a toy from my childhood. “Weebles wobble but they don’t fall down.” They feel nauseous and develop migraines, but they don’t fall down. Because there was no room in the packed cab to fall down.

At each stop, crowds ran up to the window to greet “Dr. Tom.” A child who recovered from tuberculosis. A mother with HIV and Kaposi sarcoma (a skin cancer) who ran out of her medicines the night before. Five hours away from the hospital. Could we squeeze her in? Absolutely. Missing your HIV treatment can lead to dire consequences.

It felt like Tom and Gidel Hospital had helped half the people of Nuba. Including me. At the halfway point, sudden dizziness and fatigue rolled over my body along with the hot equatorial air.

“I think I’m going to faint. Is there a soda here?”

Tom returned with a miracle: a cold Sprite. Did it drop from the sky? Wherever the elixir came from, it was just what was needed to reverse the hypoglycemia.

A day after returning home, Tom was back at work. COVID has come to Nuba, finally. 

After the world and the surrounding countries had been through three or four massive waves, cases were starting to show up nearby in significant numbers. The fact that it took so long speaks to Nuba’s isolation. The WHO had provided a PCR testing machine. I was impressed. At the hospitals where I work in Kenya, we don’t have access to this kind of rapid and reliable testing (carried out by lab technicians trained by AMH in Uganda).

COVID and HIV weren’t the only viruses to make an appearance. Measles had popped up a few hours to the west. Fortunately, vaccines are on the way. Gidel Hospital will have to store them pending distribution.

I visited Tom in Nuba for a few days and got to see firsthand the kind of impact he is making.

Ugandan priests arrived on one of their many trips to fit prosthetics for those maimed by war. Dr. Bill Rhodes and his team from Kenya were visiting for the third time to carry out a reconstructive surgery camp: cleft lip repairs, burn scar releases, and advanced operations that patients would have no hope of accessing elsewhere. While Tom was away, Drs. Jim Peck and Mike Pendleton worked with Dr. Martin Kodi to hold down the fort. AMH sponsored Martin’s medical school in Kenya. His passion is to become a surgeon. Between Tom, Dr. Rhodes, and Dr. Peck, he is getting good experience.

We talked about the planned clinical training school to be built about a 20 minutes’ walk away. Construction should begin soon, followed by the new operating theater and pediatric ward expansion. A real challenge for physician assistant education in Africa is having a solid, functional hospital where the students can actually learn. Because of the faithful support of partners like you, Gidel will now have that system now.

Patients have started coming from Khartoum, from Darfur, from the border with Chad, and from the far eastern part of Sudan. I am told that for some it is a day and a half in a car. Just within Nuba, it can be five hours between hospitals—if you can actually find a ride. Otherwise, it is days of walking. Imagine a five-hour ride on a jagged road as a mother in labor, or in pain from a broken leg, or struggling to breathe from pneumonia.

This predicament doesn’t just face those in Nuba. A patient in western Tanzania suffered a femur fracture. He hired a taxi and said, “Take me to Burundi, to Kibuye Hospital.” Six hours away. Why? Because everyone in that area of Tanzania knows that is where you go to get your leg fixed. I asked a manager of a Zimbabwean mission hospital that periodically has a surgeon, “What do people do the rest of the time?” “They travel five hours to the capital Harare and hope for the best.”

This week I watched a documentary about the remarkable work of Drs. Paul Farmer and Jim Kim of Partners in Health. They refused to believe that quality medical care could not be provided to the world’s poorest, most remote, most marginalized.

“The key is,” explained Dr. Kim, “to have a pessimism of the intellect but an optimism of the will.” This formulation reminded me of a line from Camus’s The Plague, in which the narrator Dr. Rieux describes the importance of “a never-ending tension of the mind.” You can choose the (short-term) pessimism and walk away, or you can choose the (long-term) optimism, put your head down, and keep at it.

What I think Dr. Kim meant is that, yes, you look around and everything seems hopeless, the obstacles daunting, the resources insufficient. But if you keep moving forward with persistence, solidarity, faith, hope, love, then you will see progress, patients healed, and something enduring built. Dr. Pendleton said that one of the things he appreciated about working at Mother of Mercy Hospital is the creation of local capacity, the training of the Nuba people to deliver quality care.

Over the years, I’ve indulged in plenty of pessimism. Seeing Tom at work, seeing more trained staff providing better and better services, allows me to choose optimism for a change. A teaching hospital in one of the world’s most remote and conflict-ridden regions. A child emaciated from tuberculosis now strong and well. A mother with two serious diseases on treatment and raising her children.

Pessimism of the intellect. Optimism of the will.

Yours in Struggle,

Jon Fielder