Out of Africa

I just got back from the trip of a lifetime: an African safari. I had the good fortune to visit South Africa (both Cape Town/Cape of Good Hope and Krueger National Park) as well as the Zimbabwe side of Victoria Falls. Wow. If you have done it, you know what I mean. If you haven’t, it’s so worth it. No tigers or bears, but lions galore. And elephants and rhinos and hippos (my favorite) and monkeys and I could go on and on. Even ostriches and penguins! It’s something to behold. Of course it’s hard to go the entire trip without making Lion King references or Book of Mormon jokes.

The trip wasn’t 100% perfect in that I had a particularly fun bout of whatever the African equivalent of Montezuma’s revenge might be called (Mugabe’s revenge?). But, while inconvenient and generally nasty, it did afford me a field trip around the Zimbabwe health system. Wow, that was another sight to behold. Basically Zimbabwe has no health system. The government doesn’t fund one that meets any standard you might assume should apply (average per capita spend by the government on healthcare is about $20/per person according to those with whom I spoke – yes, you read that right). The average American probably spends as much at Starbucks every month as the Zimbabwean government spends on public health.

For a tourist like me, with easy access to $20, it’s easy to drop into a private pharmacy/clinic/imaging center/maternity ward (it’s like if Minute Clinic were a superstore with basic surgery), ask for a particular drug and have it handed to you for cash. I did just that, luckily escorted by a private guide who knew better than to take me to the local “hospital”. The private clinic is open 24 hours and has a doctor available (he also happens to own the place – I guess the Stark laws haven’t made it to Zimbabwe). The local hospital, for which an admission costs $7/week for the locals, purports to provide a large array of services. But I was suspicious when the hand-painted sign at entry had “mortuary” displayed as prominently as “outpatients” and “maternity”.

I had asked the guide to show us what the hospital looked like after seeing the relatively upscale outpatient clinic where I got my tummy drugs. In contrast to the clean private facility that is very much for the well-heeled, the majority of locals must get their care from this hospital, which looks like a run-down elementary school circa 1950, after the tornado. According to my guide, you check in for $7, stay a week with basically no services and you get better or you don’t. Hence the sign. It is an all-too-real testament to the poverty, corruption and disease that have decimated Zimbabwe over the last decade. Nearly 10% of children die before they reach age 5. Estimated life expectancy is under 60 years old.

It’s a stunning thought that $7 gets a local Zimbabwean a week of so-called care particularly when contrasted with the fact that it also costs the locals $7 to enter and view the Victoria Falls park (tourists pay much more). In other words, most locals never actually see the mile-long waterfall for which their city is named because they have to save their money for things like food and light and, god help them, medical care. Having a baby in a hospital is prohibitively expensive for most at $7, so they have them at home and death rates for both mother and baby are off the charts.   Of course the country is further challenged by one of the highest rates of HIV/AIDS in the world, as well as all sorts of fun infectious diseases like tuberculosis, malaria and the rest of the 3^rd world hit parade. I spend a lot of time pointing out the challenges of our own healthcare system, but we have a solid gold Tesla by comparison. It certainly gives one perspective.

I noted that when tourists like me go out to lunch in Zimbabwe, restaurant proprietors conveniently place a mosquito spray at your table to detour flying visitors (by the way, anti-malarial medication gave me some of the most psychotic dreams I have ever had –who says you need illegal drugs to trip out?). In a feat of extreme marketing prowess, the bug spray of choice is called “Peaceful Sleep”. That’s a hell of a euphemism for “spritz, now you’re dead”. It’s a wonder they don’t call the hospital Peaceful Sleep.

Fortunately I lived to tell my tale and the trip itself was legendary. It’s like being inside a Disney movie in many ways. All of the animals you can imagine are still there to be seen, which is, frankly, surprising even though you expect them to be there. In Krueger, someone had to escort us to our room at night in case of well, you know, leopards. It’s quite disconcerting to see a big leopard print on the path you are walking, as we did in Victoria Falls. Without the protection, such as it was, of the jeep we rode in to view animals in Krueger, you had a real sense of primal mortality.   Even though actual animal-human problems are few, it’s impossible to shake the feeling you are being stalked.

One question everyone asks is whether we saw The Big Five while on safari. The Big Five is shorthand for the five most dangerous but sought-after animals for old time big game hunters to hunt. The five are lion, leopard, elephant, cape buffalo and rhinoceros. Yes, in fact, we saw plenty of each of them. They are out there in the bush, just chillin’, waiting for their daily 15 minutes of fame it seems. They don’t even seem to notice or care about the people driving up to them in jeeps, staring slack-jawed, hoisting photo lenses that would make the Hubble telescope feel inadequate.

The most dangerous but sought after list made me think about what we would consider the Big Five in the American healthcare system. What are the most dangerous challenges that we most seek to address? Aka, the five issues that vex us so and create the drive to innovate and improve? I decided to take a crack at that list, though I’m sure many of you might tell me I picked the wrong ones and have thoughts of your own (feel free to share them in the comments). But for what it’s worth, here’s the Big Five that create the most danger for our public and personal health, in my view, and the ones we should seek hardest to address with our own limited resources:

• Heart disease – killer of most – the lion of the disease world and often preventable if we started training people in their childhood about how to maintain cardiovascular health for life
• Cancer – of course on everyone’s list and a particularly challenging one since it’s a complex of many diseases; the real opportunity is to prevent it though most of our efforts today are around matching tumors to treatment to improve outcome
• Medical errors – whether you believe they are the 3^rd largest cause of death or you don’t, we know the numbers are big. We can do better here – much better. We need to expand our view of medical errors to both commissions (mistakes actively made) and omissions (things that are missed that we should have caught and addressed).
• Mental health care – like it or not, this is probably the most common set of diseases we face in America and the group for which it is hardest to find, access and benefit from treatment. Our suicide rates are off the charts (about 120 people kill themselves every single day). And if we are a nation that values productivity above all else, as some would suggest, it is probably the number one compromiser of that goal. If we value humanity above all else (probably not our strong suit, but we can dream), we have to take away the stigma and pour resources into this area.
• Tough call for number 5, but I’m going with appropriate care for our vast array of multi-cultural, non-English speaking citizens. We have done a pretty poor job addressing the cultural and language needs of our population and there is a massive underserved population for whom we have done little to accommodate. There are those among us who wish everyone would just be the same, but guess what – it’s not going to happen. Wall or no wall, we need to attend to the healthcare of all people in our country and make access to high quality care equal for all.

Yes, there are many other challenges to tackle, but these are my Big Five –dangerous and most worthy of active pursuit. We should hunt these to extinction before it’s too late and we see the tracks all too close for comfort.

And for those wondering what my favorite moment was from the trip, it was this: on a cruise down the Zambezi river we saw a giant elephant swim the approximately 1/5 mile across from bank to bank. Five minutes later we came across a pod of 7 hippos in the water, with one of the biggest carrying a baby hippo on its back as it swam around. Unbelievable. Disney has nothing on Africa.