MIRACLES AND WONDER

By John Gillies
Contact the author via Chris Johnstone by e-mail at christopher.johnstone@ntlworld.com

‘These are the days of miracles and wonder, Don't cry, baby, don't cry.’
The Boy in the Bubble Graceland
Paul Simon 1985

Paul Simon's collection of songs was released in 1985. It was the result of collaboration with South African musicians, and together, they created an album that has been popular ever since. He was criticised by some at the time because South Africa was then still in the grip of apartheid, and Nelson Mandela still in Robben island, but the worldwide popularity of the songs has vindicated him. My wife and I spent three years working in Malawi in the early 1980s, and like many others before and since, enjoyed the music we heard around us-in church, on radio, in bars. In 1985, after my return, I was a GP trainee in Edinburgh, and Simon's songs made me nostalgic for the skies and landscapes of Africa, and the rhythms and cadences of African song and speech.

2006

‘These are the days of miracles and wonder
This is the long distance call...’

It's Sunday morning. I am speaking to my daughter, who is spending a gap six months teaching in a school in Domasi, central Malawi. The school is five kilometres up a mountain road which leads to Zomba plateau, one of the most beautiful parts of Malawi. She is talking on her mobile phone, and is watching the sun rise over Lake Chilwa. In the background, I can hear an a cappella choir rehearsing for the morning service. (In Malawi, nearly everyone goes to church on Sunday.) Thanks to the miracle of satellite technology and the wonder of Telediscount (www.telediscount.com), this costs 5p per minute. In 1984, you had to book a call to or from the UK days ahead, it cost a large amount of money, and the time delay made conversation very difficult.

She talks about her students and their exam results, shopping at the market, cooking for herself and her friend, going to Mulanje mountain for the weekend and her planned overland trip through southern Africa before coming home to start University.

‘Don't cry, baby, don't cry, don't cry, don't cry...’

I spent ten days in Malawi in May this year. Partly to see my daughter, but also to do some initial work on a project connecting the College of Medicine in Malawi and the Department of General Practice at Edinburgh University. This is part of the engagement between Scotland and Malawi that Jack McConnell set up last year.

(http://www.scotland.gov.uk/Topics/Government/International Relations/internationaldevelopment/malawi/introduction).

The project, initiated by Prof David Weller, hopes to help the newly formed Palliative Care Association of Malawi to develop their courses for training in palliative care. A further medium term goal is to look at establishing some basic training in Family Medicine for Malawi medical graduates. Palliative care is new in Malawi. It started when Dr Anne Merriman, the founder of Hospice Africa in Uganda, visited Malawi in 2002. People have of course, always died from cancer in Malawi, as everywhere, but the driver to establish the discipline of palliative care came from the HIV/AIDS epidemic. You will know some of the figures, but they are so large that they become difficult to fully apprehend: so many millions affected, so many million orphans, the culling of many doctors, nurses and teachers in mid-career, a drop in life expectancy from about 50 years to 38 years over fifteen years. The report written for the Scottish Executive by Dorothy Logie and Liz Grant after a visit to Malawi last year is an excellent summary and has all the numbers.

(http://www.scotland.gov.uk/Publications/2005/06/15105055/50596).

To go into why this has happened, and what should be done about it, is well beyond me. However, I was very struck by an address given by Solomon Benatar, the South African physician and bioethicist, at an AIDS conference in Edinburgh two years ago. He has written widely on this and a good summary of his ideas is in a recent Public Library of Science (Medicine) article http://medicine.plosjournals.org/perlserv/?request=get document&doi=10.1371/journal.pmed.0020400. You can't separate the AIDS crisis from poverty, he suggests, and part of the solution lies in addressing the global economic framework that condemns many African nations to poverty. Globalisation can only be viewed as a success if it benefits the poor South as well as the rich North.

As doctors, our impact on this is pretty limited, of course. However, he also suggests that we need to exercise moral imagination-trying to put ourselves into the position of these whose live “ a very deprived and threatened life”. For example, those who have been devastated emotionally and economically by AIDS - the children, the widows, the grandparents left bringing up small children in their old age. Every human being-African, American, Scottish-- has the same moral value, and a world that fails to recognise this is storing up problems for the future - for all of us and our children.

‘The boy in the bubble.’

Simon's song is a reminder that the miracles and wonder of technology don't, by themselves, solve problems or bring happiness. The boy in the bubble was an American child called David Vetter, who had Severe Combined Immunodeficiency Syndrome, and lived his life in a germ-free plastic bubble until he died at the age of twelve years in 1983. Stem call therapy can now offer some children with this previously fatal condition a chance of survival. However, one thing seems clear to me after my visits to Malawi in the last two years: we can't rely solely on technology to understand or solve the problem of AIDS, despite the arrival of Highly Active Anti-retroviral Treatment (HAART). Nor do we need tears; moral imagination and practical actions are required. Look at the Scottish Executive's website. Perhaps you can do something to help.

Other hoolet online articles by John Gillies can be found at:
hoolet edition 40 - 6^th WONCA
hoolet edition 33 - 5 Things I Wish I'd Known Before Becoming a GP
hoolet edition 29 - Hearts in the Borders

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.