It always starts with someone. A face, a smile, that connects you to a place. This time it was Joy *, a woman I'd known for years before moving to Uganda, back when I first came as an Internal Medicine resident to spend a month at an HIV clinic. Joy had HIV. I had known her, before Uganda knew ARVs (anti-retroviral drugs). I had known her when her CD4 count was so low that she was sick often. I had known her as a patient. But in the years between finishing my training, and returning as a volunteer physician, Joy had become well on ARVs, HIV positive, but no longer sick. Joy now worked at at the clinic and gave others the hope that she'd been given- she wanted to spread the fullness of her life, and she wanted that to extend beyond the city where clinic was. She wanted that same hope to make it to her village.
So she started a small community based organization. She gathered a team of people with the same passion, to bring hope and bridge the gap in equity of care. They spent their own time and money and organized a village outreach clinic held at the village Catholic church one Saturday every few months- a nurse, a pharmacy technician and Joy. Word spread and people came. They taught them the importance of being tested for HIV, about transmission and prevention. They taught people not to fear- because look at Joy- look at what ARVs can do- her example spoke the loudest. People were tested and those who were HIV positive were gently told, and encouraged to go to the closest town and get ARVs. But few people did, in fact almost none.
When we moved to Uganda four years ago, I returned to the clinic as a volunteer physician and Joy told me about her village work and asked if I would help out- they needed a doctor- they needed ARVs. I was honored and a few weeks later we all piled into my car and trekked out to spend the day in the village.
Our goal was to bring hope, in the form of holistic care. Before clinic started we taught health education , and before that we talked about God and His love and the hope that we can have in that love. But people have bodies and when bodies are sick, hope can be hard to find- even the real and true hope from God's love. As I saw people all day, one after another, suffering from illnesses reflecting low CD4 counts- I knew we needed to get them on ARVs, the drugs that would help them feel better, be stronger, be able to work again, to farm and care for their families- that would give them hope- that would show them the love of God.
Actions speak louder than words. Jesus knew that. He healed sick bodies and he fed hungry ones- because how can you talk about a loving God when someone in front of you is in active pain or great need? You kind of can't. How can you talk about hope when people know they have HIV but also no access to ARVs? It's kind of hard. Jesus cared for ALL of people- so should we.
Our little organization began to hold meetings with members of the community, and we all agreed that bringing hope and fullness of life, needed to start with bringing life saving medicine, ARVs. We looked at what we had. We had land given by the village chief that could be used to build a clinic- but we had no money to build, and no one trained to run and operate the clinic. Even if it were built and I was then able to register as a doctor and get ARVs from the government, I lived 4 hours away, we would need to find or train people to provide care. All of that would take time- too much time. We had government clinics, but they were far, and there were barriers to accessing that care. People lacked an affordable means of transport and a way to pay the fee at clinic. There was a lot of brainstorming around addressing the barriers and planning the building of a clinic- but we still needed ARVs right away. People were dying in the village, while people in the city with the same illness were thriving.
I knew our city clinic provided ARVs and testing and all other care related to HIV, for a very small membership fee that was income scaled, why not plug this village into our city clinic's mobile outreach program? Joy and the others said that wasn't a good idea. They said they had kept quiet about the village work they had been doing- because they were very afraid that they would lose their jobs if it was discovered. They feared being found guilty of replicating this very effective city clinic model in the village, as if that were wrong.
This was a complete surprise to me. Culturally in the US, when something works well- we are proud to use it as a model of success. We hope that people will adapt and build on our ideas. But here, there is fear. And fear can be a big barrier. So we talked about what to do with the options we had and the barriers to those options. I encouraged them knowing the city clinic, and said I was fairly sure that not only would they have job security, but they would be respected for replicating this model with their own means. I praised what they had accomplished and were trying to do. I wanted to empower them, and support them in their endeavors- not by my agenda, not with my funds.
While I was gone on a visit to the US, they approached the city clinic leaders and our village became a part of the outreach program. I returned to see that all of our clients had become their clients- and were now on ARVs!
This was a Ugandan run community based organization that successfully achieved their goal of bringing hope and the fullness of life, by educating, testing and treating people in the village with HIV. It was done without me generating another pool of western funds, that may accomplish only part of what needed to be done. It was done by connecting with a system that was already up and running and running well. It was done with bravery, by overcoming fears, by doing the best thing for the people, and being willing to wait for what they ultimately wanted- their own village clinic. What I brought was a different perspective, and encouragement, support and empowerment. It happened because of relationships, and time, and trust. It all started with someone.
*name changed for privacy