Chido Gowero hugs her younger brother, whom she cares for in their home in Murewa, Zimbabwe. Photo by Lowell Tindell.

• Advice About AIDS
• How To Be Connected
• Mission Hospital Renovation
• Landmines as a Health Issue
• Ethical Issues in Demining
• Pharmaceutical Distribution

Between her and me there was half a globe of cultural and economic and linguistic and experiential distance. She crossed it all. There could have been greater distance, of course. We had faith and good will in common. Her third language was identical to my only language. Her bashful smile could not be completely contained within her reluctance to talk with strangers or elders or men or foreigners. And it was her smile that first betrayed the humor we had in common.

She was a good, strong, smart daughter of Zimbabwe. And she asked: "If I touch somebody, will I get AIDS?"

"What do you mean?" I countered.

"I am a hairdresser," she explained. "I do people's hair. I like to do it because I can make them look pretty. Some of them come in and they seem sadder than I have ever been—and I have been plenty sad. They want to look pretty, and I want to help them.

"Mostly, they can't pay, but I want to do it anyway. I know they are sick. They've got AIDS. Nobody will touch them, but I want to do their hair so they'll be pretty. But I can't afford to get AIDS because my sisters and brothers need me. So, pastor, if I touch them, will I get AIDS?"

Advice About AIDS

"If they are bleeding—even a little bit—and if you are bleeding—even a little bit—and if some of their blood gets inside your body, it is very slightly possible that you might get infected," I told her. "If something that you use on their hair causes a serious scratch to both of you, and if you do not keep your equipment clean, then you are running a risk. But if you keep your equipment clean with soap, water, and perhaps alcohol, if you can get it, and if you wear gloves—even two pair of gloves—then you will be quite safe," I said.

The break was over and the other class members had retaken their seats. The lecture hall was nearly full again and I needed to get back to my presentation. So I summarized the question that my new friend Teresa had asked and described my answer. The balance of the day contained more earnest questions and, I pray, more patient answers. I never get tired of teaching young people about AIDS and about their health. I am now a little vague about the last few hours at the small college in Zimbabwe. But Teresa is still on my mind.

"They are so sick," she had said. "They want me to touch them. I want to touch them. I want put my hands in their hair. I want to lay my hands on their heads. But my family needs me. I must not get sick. My big heart may be my ultimate undoing. I want to do and not do."

How To Be Connected

Brothers abandoned by their father after their mother's death from AIDS. Photo by Lowell Tindell.

Moral dilemmas are not limited to matters of human health, but they find bold expression there. We rail against isolation that corrupts the human family and allows stratified societies, but safety can often best be found in separation and protection. One another's pathogens would not be mutually dangerous if we had kept our connected well-being in mind from the beginning. But we are in danger from one another, and need separation for our safety, precisely because we were connected by abuse or use of one another when we made the danger. Mutual endangerment is biological evidence that we reap what we sow.

Still, would it not be better if we could simply urge all young people to reach toward one another with reckless abandon, and never mind the modern complexities? I think that Teresa is way ahead of most of us. Her question is not whether she should be connected. Her question is how to be connected within the differing layers of responsible relationship. She is not about to simplify the question too much by shutting her village out of her family. Perhaps she ought to be teaching diplomacy between hairdos.

In this issue of New World Outlook, you will find articles about several of the health initiatives being undertaken by The United Methodist Church. I find in most of these initiatives opportunities to be in essential direct service among people whose need is great. But I also find, in each setting of health-care mission, opportunities to reflect ethically and theologically on mission in general. Matters of the people's health are always high-stakes matters, so within those topics we will usually find our values in high relief.

Mission Hospital Renovation

Our several projects related to the AIDS crisis in Africa and elsewhere illustrate the ethics of human interdependence. Our projects related to hospital renovation also raise great ethical issues about local dignity and respect for community human investment.

Clara Swain Hospital in Bareilly, India, was the first hospital for women and children in Asia. It was founded more than 125 years ago. Photo by Dr. J.S. Murthy.

As Zimbabwe's youth experience AIDS in their country, they desire to learn about it. Their inquiry opens the whole moral landscape, where health, immunology, contagion, and danger have other lessons for us as well. Human beings have been deeply and fundamentally concerned for one another for a very long time. When we walk onto the grounds of a mission hospital with a century and a half of births and surgeries and recoveries and mendings and scars and deaths, we have no idea how many of God's children entrusted their very bodies to sacrificial servants in that place.

Who is to say that the decisions that had to be made years ago were not indeed the very best ones even if, now, the boiler blows up or the concrete floor in the surgery is impossible to clean? So let us be cautious about our attitudes and assumptions when we step into a place where so many have cared for so many with such high stakes. Local indignation when dedicated service is not sufficiently noticed boils to the surface when new helpers are proud helpers. But local leaders hunger for new learning, are voracious consumers of knowledge, and want by any means to learn what you know.

So far the first experiences in our current hospital revitalization program have been very good. There are active projects in the Philippines, India, Pakistan, Mozambique, Liberia, Sierra Leone, and Zimbabwe. In every place, hard work has created tremendous human resources, and these workers have prospered even in the face of meager financial and physical assets.

Landmines as a Health Issue

I have written, above, about opportunities for ethical and theological reflection in educating young people about AIDS and in revitalizing mission hospitals. Two other topics on which I want to comment are landmine removal and pharmaceutical distribution.

The abundance of landmines in many parts of the world should be understood as a public assault upon the public health. Dismemberment as a terrorist strategy is brute ugliness. When it was performed by machete in Sierra Leone during the 1999 rebellion of Foday Sanko (whom the UN calls the Charles Manson of Africa), we all cringed at the sheer monstrosity of it all. But someone loses flesh or bone or life every few minutes when an indiscriminately placed explosive blows off a body part in Angola, the Congo, Mozambique, the former Yugoslavia, Afghanistan, Honduras, or El Salvador. There are 1.43 times as many landmines in Angola as there are people.

The obvious ethical issue is that landmines are bad and that removing them is good. But there are layers of ethics beneath the obvious. Dr. Sarla Chand, one of the principal authors of the 2001 mission study on Global Health, recalls seeing women in Angola unable to steady their babies on their backs because they need both hands to hold their crutches. If the baby starts to fall, the mother can reach for the child and both of them will fall or she can hold herself upright on her sticks and watch the baby fall. Dr. Chand pointed out that, when an Angolan woman loses a leg, she loses the use of three limbs, for two more are needed to hold crutches.

The Prosthesis Workshop at Ganta Hospital in Liberia was set up in December 1999. It was funded by USAID through UNICEF and is coordinated by UMCOR. It assists victims of war, of polio, and of birth defects. Photo courtesy Roger Boe.

In democratic theory, we reason that mobility is the measure of liberty.   We know we are free when we have the unrestrained option to move to destinations of our own choice.   Mobility and immobility are variations on the themes of liberty and confinement.   When The United Methodist Church helps poor people from India teach poor people in Africa to make and fit prosthetic feet and legs, it makes a huge practical difference in people's lives.   Some of the difference is about basic freedom.   Dr. Chand reports that those who wear new legs need a flat, straight, level surface on which to learn to use them.   Where better than the center aisles of United Methodist country churches?   "It adds a whole new dimension to ‘walking to the altar,'" she says.

Ethical Issues in Demining

The removal of landmines is often fraught with the same recklessness as is their installation. An engineer for a major oil company discussed with me the clearing of the Kuwaiti oil fields just after the Gulf War. He said that his company had hired planeloads of Bangladeshi soldiers to crawl across the sand and probe for mines. Some soldiers blew up. Bangladesh got paid by the oil company and sent more soldiers. Bangladesh is one of the world's poorest countries, and a steady income—even for several months—is not to be passed up.

Landmine removal in Cambodia. Photo courtesy NCC-CWS.

When the oil fields were cleared, the oil company ran sheep over the fields. Some sheep blew up, apparently finding the last remaining mines. At that point, the fields were certified, and shepherds were allowed to resume grazing their flocks there. Some shepherds blew up.

When I heard the Kuwaiti story, I decided that landmines are not just bad politics; they are a public-health risk and ought to be treated with the same dedication that we show in treating disease.

The General Board of Global Ministries continues in its preparation to remove landmines from the landscape physically. We have undertaken research, engaged consultants, and sent survey teams to distant places. We have interviewed deminers who have worked for us in eastern Europe. United Methodists are catching our enthusiasm for this work, and financial contributions are starting to roll in.

An ethical issue in the landmine-removal business centers around the skepticism of various experienced practitioners about mechanized solutions. We have been told countless times that the machines used in mine removal are expensive to buy, hard to ship, and costly to maintain. If all of that were true, and it certainly is, why are the conventional methods thought to be better? Manual deminers are put at tremendous risk, and when their work is done, it still needs to be certified by dogs or detection machines.

The church has found some demining practitioners who are ready to use a blended method of skills and devices and to choose machines in every application where exposing a person can be avoided. The progress we are making here is owing to our ethics about the inestimable value of human life.

An amputee maimed by a mine in Takeo, Cambodia. Photo by Richard Lord.

Pharmaceutical Distribution

A final arena in which our work reminds me of our ethical and theological commitments involves the purchase and distribution of pharmaceuticals. Some of the ethical issues are obvious. It is unethical to subject people to drug dosages that are incorrectly labeled or to give them medications that have expired. Yet such errors can be committed with the best intentions. Most folks have no idea how long a parcel of medicine can safely remain in transit or how dangerous are dosages not calibrated to the standard medical practice of the society where they will be used.

The church uses a mechanism called the "Medicine Box" program to fulfill its calling to provide pharmaceutical substances safely and legally. But the availability of needed medicines in the United States also raises our concern. One member of our staff has a young child who has received medication for a serious condition every day of her young life. Our church has health insurance for its workers and this staff person used the policy to help pay for the medicine his daughter needed. We changed health-care insurers, and the new company happened to be owned by a holding company that also owned a pharmaceutical manufacturer and a chain of drugstores. When our colleague sought to purchase the first prescription of the needed drug using the new insurance company, his claim was denied. The company responded to our inquiry with the reply that the medication was not manufactured by them but by their competitor, so they would not insure its purchase. The matter was resolved following an appeal.

It is unethical when medicine that is to be relied upon is not reliable or when it is denied because of purely commercial interests. The ethical lesson is that progress toward the people's health is in the interest of all vulnerable people, including you and me. Even if we are located at opposite points on the globe, each of us has a self-interest in global health.

"Is it OK to touch people?" young Teresa had asked in Zimbabwe. "Will I get sick if I do?" I wonder whether or not my answer is changing. Perhaps she needs to hear me say: "My dear, maybe we'll all stay sick until you do touch us with your hands."