they (they i think being stalin) say that the death of one person is a tragedy, but the death of a million is a statistic. it is fascinatingly human how we need the closeness of experience to most effectively galvanize our emotions. we try to condition ourselves to think with logic, in the abstract realm of probabilities and statistics, but to make another trite quotation, these don't speak as loud as our hearts.

the life expectancy of the average zambian is 40.9 years. the life expectancy of the average canadian is around 80 years . the per capita income of the average zambian is $395. the per capita income of the average canadian is $39183. what does this mean?

i am working at university teaching hospital, probably one of zambia's best non-private, non-expat hospitals. today as we were doing our major rounds, one of our patients started gasping for air. he had been admitted five days ago at emergency with a three-week history of headache. the day before admission, he had stopped talking. he had been in a semi-comatose state since then, but for whatever reason i don't think that the necessary tests for the likeliest diagnosis (a fungal infection of the brain and meninges - cryptococcal meningoencephalitis) was never done.

some more background - corruption scandals in the zambian government have led to widespread strikes across the public sector. first it was the junior doctors, then it was the nurses, and as of today several other government agenices have gone one strike as well. as the number of strikers has gone up, the quantity and quality of care that we provide has declined. our unit would normally be in charge of 40-50 patients; now we manage only 16 as aggresive discharging has been the modus operandi in response to manpower shortages. the hospital is manned by the few senior doctors we have and a load of student nurses and medical students.

back to our patient. i can't say i know much about him - i know his name - francis, and i know his age - 30. i haven't talked to him really, being in the comatose state that he is in. today, at around 9:50 am, francis started gasping for air. we tried to give him oxygen, but the wall attachment for oxygen was not working so we moved him beds. i think he was in fairly acute respiratory distress, so we tried to get him onto a ventilator in the ICU. alas, all of them were being used (even in our hospital's reduced state) and so we moved him to the neighbouring bed were the oxygen wall socket was working better. he was producing major secretions that were blocking his airways, so we began suctioning. we gave him adrenaline as his condition declined. we gave him cpr as his condition declined some more. we gave him another shot of adrenaline.

at 10:50, my senior shined a torch into francis's eyes to look for a reaction, and found none. he placed his stethoscope on francis's chest and heard nothing. he moved his fingers over francis's radial artery and felt fruitlessly for a pulse.

certified dead, 10:50 am, june 10, 2009.

a young man, only 30 years old. while i never talked to francis, i remember everytime we rounded we spoke to his 'collateral' - a family member that stayed with him and looked after his needs (this is very common in zambia, and practically everyone in hospital has one or two). so francis had family. i'm going to venture that francis had friends like we all do, memories like we all do, aspirations like we all do. 30 is a young age to pass away at. if any of my friends (many of whom will be 30 in a few years give or take) were to pass away, i would be heartbroken.

it is very human that over a single story we will shed tears and reflect (and maybe even blog), but we can not bat an eyelash as the most gruesome numbers

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yet another trite quotation - we take these truths to be self-evident, that all men are created. equal. what does being born into a country with a per capita income of $395 mean? it means that your country is probably not wealthy enough to mount an effective public health campaign against hiv/aids and so prevalence rates will be high - 20%, let's say. it means you won't have the resources to be screened for hiv/aids as the disease wrecks havoc with your immune system. it means you won't hace access to the family doctor when you begin to feel troubling symptoms. it means you will come to the hospital in a semi-comatose state, your relatives desperate for care, but your doctor knowing that the prognosis is quite, quite dismal. it means being certified dead on at 10:50 am, on June 10, 2009. i am going to venture to say that this would probably not happen in canada, where our income is a tad higher.

can we truly say that all men are created equal when we are born into such inequality? can we rest with confidence on our laurels when all it took was a flip of the cosmic dice?

and let me just reiterate that university teaching hospital is one of zambia's best hospitals. i am sure things are worse in rural areas, where people are poorer and the facilities are shoddier. i am sure that things are even worse in refugee camps and war-torn areas, where a perfect storm of overcrowding, infections, unsanitary conditions, and co-morbidities can easily decimate populations.

last night i watched atonement, a movie about a woman's desire to seek atonement for the sins she has committed, sins that have caused the deaths of her sister and her lover.

if you were walking by a river and saw a child fall from the tree into the water, if you saw that she could not swim and would drown in minutes without assistance, and just walked away because you didn't want to get your new shirt wet, how could you seek atonement for this sin of omission... is there really any difference between that and the relationship between us in rich nations and our fellows in poor nations? so we add the element of distance, and differences in language and culture to the formula, but nothing has fundamentally changed: the links in the chain of causation remain lucent - we have the ability to change the outcome from death to life, but we walk on by

hahaha - too much pontification! stories and didactic examples and statistics aside, while it is true that the issues are complex and many, solutions are within our grasp :)