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On parasites, torture, and the Creator (part 1)

2010 August 28

Deogratias is a young man from Burundi who was a medical student at the time of the 1993-1994 civil war (it parallelled the genocide in neighbouring Rwanda, though it is not as much talked about internationally). He barely escaped it after six months on the run, and now he has eventually, incredibly, regained a life and a purpose in his work with Partners in Health. I recently read his story in Strength in What Remains, the most recent book from Tracy Kidder, the author of my favourite book.

Deo grew up among people constantly afflicted by parasites, anemia stunting their cognitive development, with no access to modern medicine, barely scraping together enough to eat; throughout his youth, he heard his pastor vigorously decrying the myriad ill effects of poverty and urging its relief. Then, somehow, he watched as his neighbours, previously perfectly peaceful, were whipped into a fabricated racist fear by more powerful manipulators, and convinced to carry out unthinkably savage attacks on one other. It was of course only a small minority of people actually carrying out the violence, but it was enough.

This hideous catastrophe did not arise out of nowhere. It was not, as some would like to characterize it, an isolated incident—see Sudan, the Balkans, Germany… Burundians are not, intrinsically, unusually violent or hateful or stupid people. These things have identifiable causes, and if we can identify a cause, we can also try to prevent.

Public health people love to prevent illness: it’s usually easier than treating illness and leads to less suffering. So we convince people not to smoke, we get the lead out of household paint, we try to get schoolchildren to exercise, we give out free condoms and clean needles, we quarantine infectious tuberculosis patients. All these strategies are proven to work. Deogratias, my Burundian colleague, wants to prevent genocide: “Don’t wait for people to feel like their lives are not worth living. Once they feel that way, how are they going to feel about another person’s life?”

The cause Deo figures he can do something about is the chronic deprivation and vulnerability of the people. He has organized the buliding of a clinic in his parents’ adoptive hometown of Kigutu, which is providing people with physical relief, and — perhaps more importantly — with relief of hopelessness.

There are many disabling, painful, shameful, life-threatening physical ailments, and we should do all we can to help people avoid them. But to me, physical health is not an end in itself; it is really only important in so far as it impacts a person’s joy or suffering. The relief and prevention of suffering, and conversely the preservation and restoration of joy, is really what I see as my primary aim in life. It is hard to imagine that there could be greater suffering than that endured by the victims of torture; of weaponized rape; of attempted genocide. So public health, if defined with appropriate breadth, must include this aspect of the human condition—indeed, we must emphasize it.

With this in mind, I recently learned that I will be spending some time this month at the Canadian Centre for Victims of Torture, alongside other experiences with refugees in Toronto. (Later this year I’ll be at the McGill Centre for Tropical Diseases, which will provide another piece of the same puzzle.) I know it will be an immense learning opportunity for which I feel truly grateful, which will significantly inform how I want to spend the rest of my life. I am itching to get started. But it is also a frightening thing for me to try to approach this problem directly. I have a comfortable life; I have never been directly affected by any significant violence or abuse, so in all likelihood and hope, I will never be able to relate to horrors endured by the people I would seek to help. I don’t know how I will cope with hearing their stories. Today I read a chapter on torture in a textbook on immigrant and refugee medicine, and I became upset to the point of tears just from that. Nobody is intrinsically invulnerable to some degree of “secondary traumatic stress“—the persistent psychological disturbance that may result from hearing about the trauma of others. But I know I reflect a lot, I am happy with my own life, I have good social and family support, and many other caregivers do cope, so I feel prepared.

(Update: I’ve now posted part 2 of this entry.)

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