Computerizing medicalized health; Lessons for Africa

It all depends. What gaps do we need to close ? It is like pointing out the real purpose of having  a car which does 350 MPH. In very rare occasions does one need to get the gauge to 350 MPH! The same applies to the internet! It will be very useful when it increases on the critical number of Africans who can be categorized as "informed patients." There is the disease and illness side to any ailment. The internet will help get many people in Africa aware of diseases. With interactive facilities, these people will add their own experiences of the "disease." This experience is called illness. Africa needs technologies that create interactive patient forms. It needs to make her health care workers savvy enough. It needs to make her care facilities computerized.  Most health workers are trained to diagnose diseases. Salaries are attached to disease groups. This explains the gap between what the health care workers prescribe and how patients make sense of things. If this disparity can be closed by the internet, Africa will begin to post quality care reports in large numbers. However, on the illness side, it is upon the skills and competence of the patient to break through the communication competence barriers that tend to arise in a doctor-patient relation. When patients become "informed patients" and are able to write or talk about their illnesses competently, we shall see a rise in the number of those who voluntarily seek quality life and wellness practices. All this is possible when Africa rises as one and invests in technologies that create interactive patient forms. It needs to make her health care workers savvy enough. It needs to make her care facilities computerized.

Anger among Ugandans has nothing to do with President Y.K. Museveni; it has everything to do with planned common resource development, sharing and use

It is symptomatic, it is historical, it is cumulative and has been undiagnosed since 1962. The fuel is:  internal unrest between 1966-1971, the debauched war to topple Amin, the international embargo against Uganda during Amin's regime, the devaluation of the Uganda shilling with promise to compensate people that was not fulfilled, the 1979 war, the 1983 Bush war, the promises to compensate those who lost property in the wars which were fulfilled for some and not others and the impact of HIV.

My late grandfather served as one of the first chiropractor-medical assistant in various places in Uganda including Mbarara and Masaka. He retired in the 60's. His children were educated in various schools. My father won an Engineering scholarship which took him first to Britain, Italy, Germany and then Brazil. In Britain, he excelled at the Guy-Leyland Industry, in Italy he beat the computer at assembling a Fiat engine. He helped improve circulation and reuse of oil in diesel engines. He was enticed to remain in Europe but chose to come back to Uganda. The Amin regime did not agree well with his types. He was unceremoniously asked to leave his job as the Government Vehicle Inspector. No compensation was made. He was forced to start afresh. I am sure there are many stories like these in Uganda. 

I can pointedly say more anger among Ugandans was furiously and fiercely stalked or reignited  by the occurrences between 1979-1986. HIV brought its strain of anger. This anger has never been fully assuaged. The early collective mind of a Ugandan black African in the early days of the HIV disease took on a multi-faceted dimension. In the earlier days (early 1980's) following the 1979 Liberation war many things happened simultaneously. 

A regime change that ushered in the road to democratic governance. People who committed atrocities were brought to trial. Others were not. Some who lost property, were compensated but others were not.  There were rumours of a disease far away from Kampala City Authority's comfortable zones. Othering those who had the disease became the norm. A vacuum and disconnect between those who were to provide services and recipients opened up. 5 litre jerry cans of herbal medicines that cost a limb became the symbols of self care in many a homes. It was a field day for unregulated herbalists. My own father sold all his 6 Bunga-Ggaba estate mansions plus the sprawling well manicured 8 acre land attached as he fought for his and the life of the wives. An insurance supported by government would have helped but, it was non existent. Today, the case of access to ARV's warrants an entire article on its own.

Meanwhile, it is still open market for the herbalist and other providers who promised cures which are not real.

Between 1979-1986, Uganda experienced tensions at political, social and cultural levels which in turn affected the way people experienced life and decided on what to prioritise. A mass austerity automatically kicked in even without the government's say so. People made austerity practices that affected food provision, sleeping arrangement, mobility, choices for wellness and investing in quality life. People became a dumping ground for trauma characterized by severe deprivation and living in squalid conditions. This has gone on even after it has been established that Uganda has one of the best government systems in Africa today. Somehow, this trauma has demotivated many from taking initiative. Not even "entandikwa," "ennyongeza" "bonna baggagawale," and other programmes can be carrot or stick enough. But, this does not give Uganda any excuse not to provide ways to addressing many unmet past recession, depression and austerity episodes. Another article will explain the meaning of President Y.K. Museveni's remark: "...I am not any body's servant. Me, I am a freedom fighter...." But quickly and as a scholar of intercultural communication. This message was not meant to posture or position himself as an isolationist. In fact, he was a proud elder about to surprise a clan with a bull roasting feast. It was a preamble! But, let me not digress. We were talking about Uganda's need to adorn the mantle of a true welfare state now that she has Oil.

Courtesy: Andrew Mwenda

Other countries went through periods of recession, depression and austerity because of war, cataclysm or government policy. Ireland, Germany, U.S. (What was 'The Great Recession') and many African countries come to mind. Austerity with hope in a government that will come around to address historical wrongs in all the spheres at political, community and household level is galvanizing. The U.S. has gone through periods of austerity and two come to mind: The Depression, the 2008 recession and the 2013 government shutdown did not stop the The U.S. social systems from providing a minimum redress. This gives people hope.

Hopefully Uganda which has gone through traumatizing events can use say, Oil, to heal wounds and provide spaces of hope for diverse communities. It will be possible to help many who may privately be grieving not only for HIV but loss of property due to wars. This grief followed the 1979 war, the "war in the bush" and HIV/AIDS.

Uplifting words have prophetic and catalytic empowerment; sayer beware

We need about 10,000 or more of us to indeed find time to read and write about Africa. We need that critical narrative by Africans about Africa and the World. Sometimes I wonder if the term "poor" has not corrupted some of us into complacency. Uplifting words have prophetic and catalytic empowerment. 

While in Uganda, I mostly worked in the regional health districts, urban areas, on the big islands, rural areas and in emergency situations like the two Ebola episodes we had. I saw more pyrexia of unknown origin, idiopathic, neurological, trauma, mental health, physiotherapy and psychological cases that went unaddressed. It is no wonder that many patients see our hospitals or clinics as "death destinations that need not be embarked upon." 

Medicalizing medicine and the practicing of medicine in Uganda (perhaps in Africa too) have created power structures. I have closely followed African country-based health outputs as far as the Millennium Development Goals/Sustainable Development Goals go. I have written comparison reports and shared with people from other continents. 

I am a member of the International AIDS Society and Africa AIDS Society. In those capacities, it is my opinion that integration is the way to go. A change of mindset was due by 1970. This means we have to redefine our sense of health by imagining a spectrum. At one extreme, we should have any parameter defining a condition e.g., maternal mortality. At another end we can have wellness measures such as how many people are able to afford full antimalarials; have shuttered (with good ventilation, windows and doors) homes; can afford to control or avoid mosquito bites and other aspects. 

Health is so immediate a context and we need to define the good and problematic parameters equally if we are to talk of progress. It comes as no surprise when it stirs different emotions and criticisms. Who wouldn't want want first class care?  We need to combine the medical and social aspects, evidence-based medicine and contextualize the belief models experienced by Africans. Hospitals or clinics should not be shaming spaces for patients who want to take the after-birth back with them and place it at a sacred place in their home gardens. We should look into the patterns of African empathy and how these add to the numbers of people who visit loved one in the hospitals. We should use statistical reports to predict trends in demand and supply. We can motivate health workers through provision of better work conditions, task shifting and proper housing. We may have solutions to overcrowding, drug stock-outs and absenteeism. 

Lastly, I still think in place of words like "poor" or "backward," we can actually borrow from social science research or theories and contextualize African situations in a more proactive way with a goal of upliftment. I posit the following adjectival epithet: "low resource context countries" instead of "poor." Thanks for adding a narration to what matters in Africa and other low resource context countries.

Text-book America, Hollywood America meets Street Level America; An African Immigrant’s Testimony

Five years gone by, it seems like yesterday. It was a hot July with the sun’s dancing beams reflecting fiercely off plane fuselages, that I landed at Washington DC’s Dulles Airport. I reminisce about that day. I also reminisce about the firsts, the onlys, the forevers and the lasts. It was my first time in Washington DC; it was the first time I was scared to leave my own apartment on Michigan Avenue right in the middle of Washington DC for fear of getting lost; it was the only time when I made up my mind to experience what it means to actually get lost; it was a gamble I never regret. Truly, I got lost! I missed my stop and ended up in Baltimore. 

It is at Baltimore Union Square that I met an officer who gave me the right directions. This person, also told me he had served as a Marine, part of a Corps that served in Uganda! imagine my reaction to this revelation. My take back home is that there is always “The Quiet American.” You guessed right, I am fixated to Graham Greene novels. This fixation will be the subject of another blog. But, suffice it to say that an Irish-Ugandan educator (whom we grew up calling our 'white' daddy, because he was initiated by my father into our clan) taught me how to read these kinds of books. 

Where was I? 

Ah! Yes, I managed to get my way back to my apartment and as if a veil had lifted I immediately started figuring out streets, addresses and where to pick up a cab, bus or train. I have since traveled to different American cities (Chicago, Minneapolis, Boston, Los Angeles, Berkeley, Oakland…) and I am comfortable in all of them. Last week I got a friend, who was visiting from Los Angeles, on a train. We traveled to three cities in the Bay Area in Northern California i.e., Dublin, Richmond and Pleasanton. 

As we were travelling we shared on what it meant to be New Americans from Africa. We touched on many things Africa has given to the world yet they are unsung. We decried the seeming tendency for African leaders to miss in the action. But, we also cautioned ourselves from taking the long view when we were actually comfortable in the arms of America and did not really know what was on the ground in Africa. 


It was this latter remark that made me reflect about my own life as events raced like a film running in fast-forward review. I also noticed the three long haired young girls speaking animatedly with three other boys. All were in their late teens or late tweens. I caught parts of their conversations and heard  “………Kamusta……….Salamat…………nognog.” This last one must have peeked my ears. When I next heard it,  I immediately looked at the three boys for reaction.

None showed any outward sign of reprehension or bitterness. In fact they also spoke fluently in Tagalog (a major language in the Philippines). I later knew that they were children of US Army officers stationed in the Philippines and were in the U.S. on vacation.  Behind our seat were four pairs of mixed white, Asian and black couples who it was clear were long time friends. They had tagged luggage and perhaps were so tired after a long flight. They were  coming from the San Francisco Airport and I imagined they were looking forward to one, two, three days of sleep. May be. 

I caught parts of what they were saying: “…………I’m going to say this right off the bat………………….I will bite the bullet and be your first……………………..home stretch….…”  This reminded me of the subtleties that textbooks on America don’t say about American people. Hollywood only paints a picture of villains vanquished by the good. 

In Hollywood films about America, the homes are big, food is aplenty, workers come back home after a hard day’s work and watch TV. The streets are well swept, the grass islands are well manicured, shopping malls fill up with shoppers and the address signs are all in place. 

But…….the tossed salad version is different. The street level America calls for reaching out and negotiate how to share space with others. It means noticing nuances.  One has to have appropriate intercultural competences or learn them very fast. The expectations of one’s task role or relational role behaviors must be spot on. Text books nor Hollywood can teach these unless one gets to interface with Americans blunders, sorry's and thank you's to boot.

Religion and Personal Culture influence the way I relate and communicate with other people

As a practicing Roman Catholic, I have had the chance to follow Pope Francis from the day he ascended to Papacy and I embraced his philosophy of: making opportunities available even to those were previously shunned.The Pope says that we should walk together and that we should not exclude anyone (Maike Hickson. 2016). I respected the Pope when he realized that he was not going to make impacting change within the Roman Catholic Church if he himself could not sacrifice or do away with some of the cultures of the Church that are a show off of splendid regalia bedecked with gold but impotent in feeding the hungry or housing the homeless. The Roman Catholic religion played a key role in education, invention, art, architecture and socialism. However, as an institution it is also looked upon, copied as well as vilified by many. The Pope and the way he has dealt with criticism is what fascinates me. His mature approach and readiness to face issues as they present themselves is what I am going to write about. Examples that come to mind include: the hosting of the Syrian refugees who saw themselves as moslems first and humans second. Yet, the Pope saw human beings with needs like any other and provided them opportunities for a shelter at Sant’Egidio (Paula Cocozza. 2016). Having lunch at the Casa Santa Marta, the hotel on Vatican grounds where Francis resides with 21 Syrian refugees (Crux Staff. 2016) is another example. The present crises of displacement, environmental catastrophes, famine, wars and poverty are some of the issues the Pope is tackling. His pronouncements on issues like Climate change have galvanized many  to do something. Pope Francis’s  in his encyclical on ecology, Laudato Si, says that climate change is real and mainly “a result of human activity” (Pope Francis Encyclical and Climate Change). As far as world views go, the traditional Catholic teaching on marriage and the family has reared its head again with many questions are being raised around it. Can remarried divorcees be married in two valid marriages at the same time? The Amoris Laetitia, is a letter the Pope wrote in which he explained why the Church should let divorced but remarried Roman Catholics play major roles in the Church. It is claimed that the letter leaves open the answer to this crucial question that it itself has provoked. The letter points out Non-sacramental, natural marriage can also be, in the eyes of the Church, a valid marriage, for example in the case of a mixed marriage. This has brought about a rift even far deeper than that caused when the Pope mentioned homosexuality in the same breath with forgiving. Many feel a betrayal and that the pope may be personally virtuous, but he is naive and a wicked antipope carrying on in positions of authority and influence (akaCatholic). Others, have taken a go slow approach that allows the Pope to make decisions as the Spiritual Head of the Roman Catholic Church (Maike Hickson.2016). Pope Francis affirms mercy and love. He said that unity is created on the move because unity is a grace we need to ask for. The Gospel shifts the axis of Christianity away from a certain kind of legalism which can be ideological, towards the Person of God, who became mercy through the incarnation of the Son (Pope Francis). The burning issues that are sure to have impact on a world view are: position of the Pope on his apostolic exhortation on the family, “Amoris Laetitia”; church’s ban on communion for divorced Catholics in new (and adulterous) marriages; and church’s traditional opposition to situation ethics (Ross Douthat. 2016). Religion has influenced the way I position myself and my spirituality. Religion improved on my culture positions and it affirmed my work ethics and relationships with other people. Because I believe relationships are a means of communication, I dare say  the synergy of my personal culture and religion influence the way I relate and communicate with other people.

References:

akaCatholic. BREAKING: Francis responds to the dubia. Retrieved from: https://akacatholic.com/breaking-francis-responds-to-the-dubia/. Retrieved on November 29th 2016.

Paula Cocozza. 2016. What happened to the 12 Syrian refugees rescued by the pope? Retrieved from: https://www.theguardian.com/world/2016/may/25/what-happened-pope-francis-syrian-refugees-rescued-lesbos-vatican-rome. Retrieved on November 29th 2016.

Crux Staff. 2016. Pope has lunch with Syrian refugees he brought to Rome. Retrieved from: https://cruxnow.com/vatican/2016/08/11/pope-lunch-syrian-refugees-brought-rome/. Retrieved on November 29th 2016.

Maike Hickson. 2016. Confusion, Conflict, and Chaos Increase in the Wake of the Dubia. Retrieved from: http://www.onepeterfive.com/confusion-conflict-and-chaos-increase-in-the-wake-of-the-dubia/. Retrieved on November 29th 2016.

Maike Hickson. 2016. Cardinal Hummes: On the Dubia, “The Whole College of Cardinals is With” the Pope. Retrieved from: http://www.onepeterfive.com/cardinal-hummes-on-the-dubia-the-whole-college-of-cardinals-is-with-the-pope/. Retrieved on November 29th 2016.

Pope Francis. La Stampa. Francis:“The Church is not a football team in search of fans”. Retrieved from: http://www.lastampa.it/2016/11/18/vaticaninsider/eng/inquiries-and-interviews/francisthe-church-is-not-a-football-team-in-search-of-fans-lyrmN8s0Uu3zpMsmG730VO/pagina.html. Retrieved on November 29th 2016. 

Pope Francis Encyclical and Climate Change.Retrieved from: http://www.catholicclimatecovenant.org/encyclical. Retrieved on November 29th 2016.  

Ross Douthat. 2016. His Holiness Declines to Answer. Retrieved from: http://www.nytimes.com/2016/11/26/opinion/sunday/his-holiness-declines-to-answer.html?_r=0. Retrieved on November 29th 2016. 

My personal culture informs my communication choices

My story is one of an immigrant and I kindly ask you to look at it from that lens. For me communication is not only verbal but also how one meshes or embeds in another culture. It is a deliberate negotiation in relation to one’s ethnic identity. It is a move toward engaging in cultural allegiances. It is an ongoing education that allows one to break into newer patterns of life (Tywoniak, F. E., & García, M. T. 2000).   I have lived in USA for quite some time now. As someone who chose to emigrate to this country, my priority needs were to assimilate, survive and seek subsistence here. I learnt at an earlier time reading notices, brochures and information from the State Department and United States Citizenship and Immigration Services (actually, I still look for any information on immigration and settlement in USA even today). This desire to  use existing literature to make informed decisions which A. L Kennedy calls “a tradition of fierce education and enlightenment” helped me figure out my requirements beyond proper documentation, e.g., Lawful Permanent Residency Visa (Green Card); proper immunizations; Social Security; Work Permits; and Identity Card. Without these it is hard to set foot out one’s house, or get proper employment and interact with other people. The needs for someone who has only lived here for say under a year, are different from those of one who has lived here beyond a year. They are also different from those of a person who is still undocumented and is always looking at their back for U.S. Immigration and Customs Enforcement (ICE) officers!  In my earlier years I had to find time to attend seminars and courses for refugees and immigrants. I wanted to immerse myself fully and hoped to achieve that through guidance of a do’s/dont’s list. I had my challenges too. These included: dressing down to casuals; figuring out the bus route and later on the train route; speaking even more slowly (because I was told I spoke a different kind of English); learning to go out; understanding the U.S. nuanced coffee culture as opposed to my own culture; and almost over indulging myself with Kentucky Fried Chicken, tasty burgers and sugary-drinks (something I later unlearnt). I would say, ensuring I lead a productive life in USA; where I am able to live peacefully at my place, pay rent/other dues; seek out and make friends; join community events; and participate in activities with others have become my belief, value and norm milieu. Indeed, I agree that intercultural communication can be seen as a negotiation of competing values, beliefs and norms (Week 1 Discussion). Sovereign countries have laws and codes that must be followed. But, those very countries also have cultures that are older than the sovereigns themselves. A.L Kennedy, in her essay, shows clearly the existence of Scots, Welsh, Irish and English cultures in Great Britain. In making the statement “I am Scot” now and not so many years ago shows how much the Scots wanted to  be part of and participate in a Great Britain owned by all who made it. I come from a country that was a former colony of Great Britain and I feel A.L. Kennedy is talking about an experience I knew so well from hearing fire side stories narrated by cultural elders. Now that I came across books and documents illuminating a reader on Britain’s divide and rule; subjugation of peoples (referred to as ‘uncultured’ in most correspondences. Meanwhile they were loading ships with gold, diamond, iron, copper, cotton and coffee and sending them back to UK in the name of Queen and Country); and raw material extraction policies in Colonial Africa, I can corroborate what she writes. I come from Buganda Kingdom which is part of Uganda. My tribe is part of 56 tribes that make up Uganda as a nation. We are both a matrilineal and patrilineal culture. As a first born boy, there things expected of me in form of responsibilities, duties and roles. But, now that I am in USA, all that changed. Right now, all that matters is to be a better participant in USA affairs. There in lies all the tasks that face me.

References:

A. L. Kennedy. 2012. “People will laugh at you if you sound like that.” Retrieved from: http://www.newstatesman.com/culture/2012/04/%E2%80%9Cpeople-will-laugh-you-if-you-sound-that%E2%80%9D. Retrieved on November 29th 2016. 

Tywoniak, F. E., & García, M. T. (2000). Migrant daughter: Coming of age as a Mexican American woman. Berkeley, CA.: University of California Press. Retrieved from the Walden Library databases. Retrieved on November 29th 2016.

Week 1 Discussion. Discussion 1: A Fish Out of Water: Cultural Transmission and Worldview. Retrieved from: https://class.waldenu.edu/webapps/blackboard/content/listContent.jsp?course_id=_16247427_1&content_id=_38983705_1. Retrieved on November 29th 2016.

A Health Educator /Promoter with Talking Drums: Community Event November 2nd 2016

My name is Tom R. Muyunga-Mukasa. I am inspired by other African-born immigrants who help raise what I call ‘health-consciousness.’ Yesterday we had a community event under what we call the “talking walls/drums” drum circle. The idea is we get a venue, in this case a park, through our drumming we mobilize people, entertain them while educating them. Now, I came across the story of Dr. Chimezie Raymond a Nigerian-born immigrant and it continues to inspire me. I realized our work is relevant. For that story see: https://www.waldenu.edu/connect/newsroom/spotlight/2016/channeling-his-passion-for-public-health.   This is wonderful. This is one of the reasons why some friends of mine and I came up with the Black, African, Atlantic and Indian Ocean Islands-born Immigrant Support Organization (BLAIR) dba Bay Area Healthy Living Support and Communication Platform (Bayheal). Between 2012-2015 alone, I had met 20 diabetic cases; 3 expectant mothers who had never attended antenatal check-ups; 14 people who confessed they had never done any medical check up ever since they came to USA in 2008-2009; 2 who needed dental surgery but had kept putting it off; and 9 who self-medicate. Please follow our work at: https://www.bayheal.org. I enjoy doing community work such as: community clean ups and it is not a problem to me to pick up plastics and discarded materials and safely put them in a waste bin. I enjoy conducting health education and promotion sessions with the San Francisco General Hospital’s Family Clinic; BayHeal (www.bayheal.org);  I also volunteer with San Francisco's Department of Public Health's Zero HIV/Zero Stigma Committee; UCSF ACTG; and SF AIDS Syringe exchange program. Someone said (a naysayer) in 2011 that one has to first acquire a degree to do community service work. Being an yeasayer, I went ahead and started an immigrant self help organization. In 2012, with common sense, a drive and planned focus,  I started by meeting and talking health issues to immigrants at social events (Washington DC, Boston MA, Minneapolis MN, Chicago IL), worship centres (Los Angeles CA, Oakland CA, Berkeley CA), restaurants and bars ( San Francisco CA, Antioch CA, Ashby CA, Lafayette CA, San Leandro CA, Richmond CA). Now, with the "talking walls/drums" project I meet large groups and talk about health. In the pictures you see, we are at the Nicholl Park of Richmond CA.

Once upon a time, perhaps even now, there was a drum

And three talented drummers

Through the talking drums, they shared the good news about healthy living

On and on the drum beat reverberated

drum.....drum....drum....

drum.....drum......

single drum......

double drum......

And finally the message was taken home, the audience dispersed and everybody went home happy.