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Expanding the circle of compassion  pdf

'A man is really ethical only when he obeys the constraint laid on him to aid all life which he is able to help, and when he goes out of his way to avoid injuring anything living. He does not ask how far this or that life deserves sympathy as valuable in itself, nor how far it is capable of feeling. To him life as such is sacred.'
-- "Civilization and Ethics,"
Albert Schweitzer

As students of global health, we aim to alleviate suffering in the world, to advocate for the weak and the vulnerable, to preserve and elevate life. And yet I find that my vegan lifestyle is met often with some measure of skepticism. "There are too many human problems in the world to be solved before we think about animals," some say. I find this stance puzzling. The issues of human and nonhuman exploitation are not mutually exclusive; in fact, more and more, I am convinced that they are inextricably intertwined.

During a recent visit to the home of a tea laborer in India's northeastern state of Assam, I found myself watching intently as a flock of pigeons pecked delicately at the spread of rice grains sun-drying in the courtyard. The woman of the house made no motion to shoo them away, though the family's resources were far from abundant. "They'll wander off once they‟ve had their fill," she calmly observed. "We'll have plenty still."

In our everyday life, most of us can live comfortably without pitting our own needs against thoseof other living beings. When there are viable ways to sustain our own lives without detracting from other lives - when it is possible to feed and clothe ourselves without causing suffering and loss of life in creatures with the capacity to feel it - why not do so? Just as I feel compassion for the tens of thousands of people across the world dying from hunger daily, so do I feel compassion for the millions of animals slaughtered for meat each day. My circle of compassion can be extended to humans and nonhumans alike.

In my mind, speciesism is morally objectionable in the same way that other forms of discrimination are. Like racism, sexism, or classism, speciesism excludes beings from the scope of moral concern on the basis of an irrelevant criterion. Regardless of race, religion, gender, sexual orientation, or species, avoidable suffering is intrinsically repugnant.

Many altruistic people admirably want to change the world yet do not see that the most important change comes at the level of the individual. As Mahatma Gandhi famously said, "You must be the change you want to see in the world." I want a world without suffering; therefore, I embrace the ideal of "dynamic harmlessness" in my everyday choices. There is undoubtedly much suffering in the world, against which my individual efforts can only go so far. At the very least, I can strive to create as little hurt as possible in the wake of my own existence.

Rachel M. Amiya
Dept. of Community and Global Health
The University of Tokyo
~ From Tokyo, 18 November 2010

Thriving on ART: window of a life pdf

"At seventeen years I am looking forward to completing my final Form Four national exams in two weeks. I see myself as a normal girl and I will score division one, as I am quite bright."

I met Winnie* during my data collection time in Dar es Salaam, Tanzania. Although she is a teenager and thus not included in my study of HIV-positive children, Winnie quickly drew me in and was eager to talk; I sensed that she needed an ear to receive her hidden stories and be taken into her confidence.

"I was born with HIV/AIDS passed down from my parents," she tells me. "No one expected that I would be HIV-positive as a child 17 years ago; although I frequently fall ill from cough and have difficulty in breathing, most thought I was suffering from asthma, the hereditary disease thought to have killed my mother." Her brother tells her that she became so accustomed to antibiotics through her illness that eventually she was no longer afraid of needles and syringes like most children would be. Though her frequency of visiting health facilities was uncommonly high, at that time it simply would not have occurred to anyone to imagine another serious disease like HIV/AIDS. "My parents were so much involved with church activities and were good-mannered in the eyes of the society; how would anyone ever have suspected them of leaving me alone to be HIV-positive?" Winnie asks, proving her point that it's not possible to know someone's status by looking solely at lifestyle.

Winnie's family moved to Dar es Salaam from Mbeya, expecting her to get better in Dar es Salaam's warm climate. But to her disappointment, her condition worsened, and she suffered from frequent colds and fevers. "In 2005 I decided to get tested for HIV," she explains to me, "My friend accompanied me to the VCT clinic, and we both got tested, and I learnt that I was HIV positive. Although I felt like the whole world was falling on me, it was then that I decided to live positively and concentrate only on my health and studies." She started ARVs five years ago and ever since, her illnesses have disappeared.

She confesses that her life has had more value since she got tested, and she knows that she is going to be alive for much longer now that she has her diagnosis.

"Nobody knows my condition except for my father and brother," Winnie confides. "I kept it a secret after one of our colleagues lost all of her friends after it emerged that she was on ARVs." She does not know how long her situation will remain private, as she goes to the clinics every last Friday of the month, but she is optimistic that she will be prepared for the worst eventually.

Reflecting on relationships and sexual desires, Winnie says, "I have the urge to have a boyfriend and to live the life of a normal teenager, but then who is ready to have an HIV-positive girlfriend?" She adds, "I know I can use condoms and protect my partner, but what if he discovers my situation? I think relationships are not for HIV-positive girls."

Winnie is confident that the ART programmes will not fail her. "I am sure that the government will always take care of us, as we are entitled to this basic need; and to us the most fundamental need is not food, nor it is shelter or clothes, but our ARVs."

Bruno Sunguya., MD, Rachel M. Amiya
Dept of Community and Global Health The University of Tokyo.
October 3rd, 2010
(*Name changed to preserve anonymity.)

Hope floats pdf

"My illnesses made me think I was a mistake in being born; back then I could not imagine that I would live to see my next birthday, but because of ARVs the worst is over for me."

Jane* is 13 years old and lives with HIV/AIDS because her mother, like millions of others in the world, was unaware of her own HIV-positive status during pregnancy and hence could not access HAART for prevention of mother-to-child transmission (PMTCT). Although she is now essentially living the life of a normal Tanzanian child thanks to high ART adherence and proper self-care, Jane has a lot to share with us in her singular spirit and story.

"I started attending the clinic when I was in class one, six years ago", she says; this was just around the time the ART programs started in Tanzania. "I got tested when I was so young, but there were no treatment options for me, I frequently fell sick and tinier than my friends; I was in a terrible state. She knows how she got the disease but casts no blame: "I got HIV from mother, but my heart has no resentments toward her; having lost my father to this disease, she is all I have. It was her hard work and love that have made it possible for me to be alive today. She is the reason I go to school, stood by me in my nightmares, and for that I never skip a single pill." Saying this in a confident tone, looking straight into my eyes.

Speaking of stigma towards her, she reflects, "My friends and teachers know about my condition. It was difficult at the beginning, but after a few lectures on HIV at school, they think I need more attention. I don't like it when everyone feels sorry for me, as if I am dying. I want them to treat me as normal." She is among the best students in her class; her teachers are proud of her but her opponents think she is being favored. They even mock her by saying that she will not make it to see the fruits of her hard work. She has ambitions that she wants to achieve: "I want to become a doctor like you. I want to be able to work on HIV and help children who suffer like I did when I was younger."

I met Jane at the Sinza Care and Treatment Center in Dar es Salaam when she came to the clinic for her normal ARV refill. Her viral load was undetectable and her CD4 count had risen to 2970. She represents thousands of children in Tanzania who need these programs to continue so that they can realize their dreams. "I am not worried about the sustainability of my clinic; it is for the government to worry about, and I am confident I will still have my medicine until the cure is found," she told me in a sharp tone.

Jane and others like her need us; they need our renewed commitments to ensure that they live to see their future and live that future. Our role as members of the global health community is to make this happen.

Bruno Sunguya., MD, Rachel Amiya
Dept of Community and Global Health, The University of Tokyo.
September 18th, 2010

(*Name changed to preserve anonymity.)

From failure to failure without loss of enthusiasm pdf

'One more life saved!' This is a sentence I commonly heard while working at the hospitals back home in Brazil, every time a surgery was finished. It didn't matter what kind of surgery, from the simplest to the more complex. The phrase was repeated so frequently by doctors, nurses and nurse assistants that it ended up losing its real meaning to me.

Nevertheless, life always finds a way to give us that wake-up call and to teach us some lessons. One day, at the end of a surgery, I couldn't say, 'One more life saved.' Even unsaid, its real meaning suddenly broke into my mind. The incident occurred during my first mission with an international NGO in post-tsunami-hit Indonesia. It was my first day of work and the first patient I saw entering the hospital.

The patient, already in his 80s, had typhoid fever and was very debilitated. It did not matter; I just couldn't say that commonplace sentence. I was frustrated. After all, I, as an overconfident medical doctor, was sure that I had traveled half of the world to save lives after that huge natural catastrophe. I knew that if I were at any other better-equipped hospital, I would be able to say the popular sentence at the end of that surgery. The only problem was that I was not at any other hospital.

Some days later, still depressed by the incident, I had to go to the main city of the region due to dental problems. After 6 hours travelling by car, I finally got to the guesthouse where I was supposed to stay. The telephone rang the moment I crossed the door, and the call from the coordinator was for me. 'The team is having some problems with a pregnant woman's labor. We have reserved a place for you on the next UN humanitarian helicopter flight. Go save some lives!!' This last sentence echoed in my ears like a roll of thunder. Would I be able to do it? One hour later, I was already back in the field, a cesarean section was done and mother and child were alive and kicking. Finally, I thought to myself: 'Two more lives saved!'

The new mother wanted to give my name to the newborn. Hearing this request, all previous frustrations vanished from my mind and my spirit became light like a feather. Only my tooth continued heavily aching for some more weeks.

In the field of global health, I learned, it's important to not give up at every failure or frustrating experience. Sooner or later, successes will come and cross the way in front of us, and when they do, they will come in double. As Winston Churchill once said, 'Success consists of going from failure to failure without loss of enthusiasm.'

Otávio Omati
Dept. of Community and Global Health
The University of Tokyo
September 9th, 2010

The sun is shining ? pdf

Scientists are sometimes nasty to practitioners in the field of global health. They are proud of their knowledge and preach to the practitioners working in low- and middle-income countries. The practitioners, indeed, may at times not be aware of the most up-to-date knowledge and may make similar mistakes again and again. However, the practitioners stay close to the suffering people, and they know as well what is not written in the textbooks or in articles out of famous journals. Their knowledge of 'now' should be more appreciated.

I watched a Japanese movie called 'Sunshine Ahead' during my flight from Narita to Paris on 17 July. The Japanese title is 'Teida-Kankan,' which literally means 'the sun is shining and shining.' It is the true story of a couple that was successful in transplanting and spawning coral reefs in the damaged Okinawa sea.

Mr. Kinjo, a practitioner of coral transplantation, achieved success in his work by his creative ideas, after which a Japanese scholar advised him to make a presentation at a Marine Biology Symposium. When Mr. Kinjo made his presentation, however, many other snobbish scholars severely criticized him, using technical terms and new frameworks of knowledge.

One of them said to him in public, '...coral transplanting should be positioned as a component of reef conservations and coastal management. What about genetic disturbances and damages to donor colonies?...This isn't something for amateurs.'

Mr. Kinjo was deeply disappointed, but he also learned that his continued efforts would be meaningful if he could be successful in spawning coral reefs. Thereafter, he continued to work hard and finally succeeded in his endeavors. In recognition of his great work in spawning coral reefs, Mr. Kinjo received an award. At the ceremony, he delivered a speech about the past and the future.

'When I was a kid my mother told me "the ocean used to be so much prettier." My late granpa also said "it was so much prettier in my day." And now, I have to explain to my own kids, "It was so much prettier before." But through the work I am doing now, I am hoping to tell my grandchildren one day. "There was a time...where there weren't many corals in the sea."

In the context of the award ceremony, the scholars said they were supporting Mr. Kinjo from the beginning and that they appreciated his work. It is good that they had changed their attitudes at this stage, but I wonder if they were indeed aware of their previous attitude toward the practitioner, Mr. Kinjo. I can't help but wonder if I have done the same as a scholar in the past, and if I can change myself just by watching this movie once. If not, I am afraid the sun may not shine on me.

(Masamine Jimba edited by RMA, from Vienna. 24 July, 2010)