Friday, January 30, 2009

Global health inequality gets personal

There are many ways global health inequalities can be expressed. The usual one is statistics, expressed in graphs, comparing countries using some health indicator or other. Haiti and Canada on child mortality. Sweden versus Senegal on life expectancy. You can see the Powerpoint presentation in your mind's eye. And you might also anticipate that, despite the massive human suffering that lies behind these statistics, you would probably be bored watching it.

I have a personal anecdote about global health inequality, acquired the hard way. On my trip to the Democratic Republic of Congo last week, I felt an unusual bump under my neck on Day 2. I thought, well, it is probably just a swollen gland, some temporary reaction. After all, just being in Kinshasa -- with the dirt, the car exhaust, some of the food, the humidity -- probably compromises your immune system no matter what. Maybe it is the start of a cold from the air-conditioning. So I continued with my bioethics activities.

Except the lump started getting bigger. I started developing two competing amateur self-diagnoses: some sort of a glandual infection or a tooth abscess. I continued to work. Anyway, what doctor could I see about this, and even if I could get a correct diagnosis, would there be available medicine for whatever I had? It was all very doubtful. Eventually I stuck it out, got on the Air France flight to Paris with a massive lump under my chin, and flew back from Paris to Chapel Hill. By that time, the lump increased in size again, my head was aching and I started feeling chills. After a trip to UNC's Infectious Disease clinic, a diagnosis of lymphadenitis was established, and I was put on antibiotics. A few more days in the Congo, and I might have developed septicema.

I could have, using my privileged position and if I had worked hard at it, eventually found a suitable doctor, a correct diagnosis and the right drugs. And in the end, I could count on a flight out, a high-quality clinic and medication inexpensive relative to income. Which made me think: what happens to the Congolese who develop lymphadenitis? My guess is that some (most?) are powerless to do anything but watch the infection grow and eventually die from it. A horrible, unnecessary and unjust death.

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Blogger Jim Sabin said...

Hi Stuart -

Thanks for this personal story. It makes a very powerful point come alive. Having the swollen gland getting larger and larger must have been scary. That makes it all the more telling that you waited until you got back to UNC to connect with the medical establishment. Your experience says a lot about the life expectation statistics. As you say, we might be at your funeral now if you were Congolese.



9:41 PM  
Blogger Marin Gillis said...


poignant but scary. glad to hear that you are better.


1:33 PM  

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