IISMAS / Publications / International Jour...nscultural Medicine / International Jour...al Medicine - no. 3

International Journal of Migration and Transcultural Medicine - no. 3

Volume 1, no. 3, September/December 2006

International Journal of Migration and Transcultural Medicine - no. 3




Once again I am on a plane, in Africa , recalling years of engagement and struggles, and come to share with thousands of people their efforts to reach a better, more decent life standard. Up at dawn, at the voice of the muezzin, a rush to the airport, hoping that the flight has not been cancelled, as usual. No cancelling! Only a delay… As usual. As usual everything s eems delayed compared to Europe . A notice to the passengers: the flight papers are missing. No problem! They will arrive.

Meanwhile I remember that I have still to write the editorial for the journal, a special number we want to publish on the occasion of the first international congress Dermatologic care for all: a basic human right that we are trying to organize in Addis Ababa and Mekelle from 1 to 4 November. A number of women and men of science have strongly wanted to challenge a system which only looks concerned and considerate, to challenge a science which looks more and more on the increase, but mostly towards itself rather than towards sharing its discoveries. An international scientific congress with no sponsorship from pharmaceutical companies. Mission impossible? I am trustful and believe that analytic-instrumental reasoning can be replaced by cordial reasoning (L. Boff, Saber cuidar…), by tenderness, by deeper feelings, and the centre can shift from the reason- logos to the feeling- pathos .

Does our continuous rush from morn to night, through meetings, seminars, phone calls, emails make sense? To be overwhelmed by the emergencies can allow us to soar? Do we really save, or only pretend to save thousands of human lives, leaving behind a much nearer and more difficult daily routine? Does Africa really need the help of the so-called industrialized countries, Europe and the USA ? Is it really possible to be “good” and “considerate” even if belonging to the Northern world? In their book The conversion of the good people A. Maggi and A. Thellung affirm that the syndrome of good people is exactly in their feeling that they are in the right. We all believe that the wicked should convert and become good, whereas in the Gospel just all of us should convert to become children of God. I am a bit suspicious about the division between “good” and “wicked”. Our societies rely on structures based on “good” principles as order, hierarchy, obedience, submission to the law and its exponents. If the world, as we know it, has been nearly always in the hands of the “good people”, perhaps it time it passed in the hands of the “wicked”.

Probably this is why I always feel to be on the wrong side, even in this small plane. I am aware to belong to a minority. Perhaps we should break the rules which produce such side-effects as hunger, poverty, despair, wars, diseases for hundreds and hundreds of million human beings: the majority of the people I meet in this immense, fascinating and desperate continent.

Today it is impossible to candidly believe that poverty is an accidental event and to ignore the causes of the systematic impoverishment of some social groups. Even more so if considering that our society is supposed to conform to a Christian background.

Experience has taught us that quite often solidarity is full of dangers and ambiguity, especially when it is not an intermediate stage towards justice. I think that we need many more “just” people rather than “sympathetic” ones.

It looks as though we are taking off at last! The papers are there. A short delay of an hour or so… The view of the town with its (few) skyscrapers and its (many) slums slowly disappears. I am afraid, as usual, but unwilling to admit it. Fokkers are small planes but according to experts they are quite safe.

I resume my mental wandering. When thinking of Africa we recall images of misery, shacks, flies glued on children's faces with mucus straining down their nose, corpses, ethnic wars, malaria, Aids. Is it really so? Are we able to go beyond the clichés? We have too fast forgotten our past responsibility towards this continent: the million slaves, the robberies of artistic objects, geo-mineral and human resources. The slave trade, in particular, not only killed and deprived of their humanity million people but irreversibly biased as well the development of the African society: whole families were splitted and scattered and numerous societies collapsed, opening the doors to the European invasion and colonization. The irresponsible rush to Africa started in the XIX century when Europe conquered the continent, and in the span of three generations the colonial powers had gone away, leaving behind a series of smoking ruins. A number of “countries” arbitrarily created to comply Europeans' self-interest, with absurd straight or curved lines delimiting borders where the interests of the colonial powers collided.

Sad to say, Africa has not succeeded in developing as they deserved, also because in the sixties and seventies, and often still at present, Western “experts” were there to suggest to the African countries policies that would lead them to catastrophes. Between 1975 and 2005 the GDP has decreased 45% and exports have dropped more than a half owing to the slump in the prices of the raw materials.

And yet in Africa , even if with great difficulty, modern scientific technologies are being relaunched, which can help some countries to start a better future to the extent that they will be able to master them and do without the foreign experts from the Western governments.

When economy goes badly and governments decide to cut the expenses, usually the health system and the education are the first to face the music. The International Monetary Fund (IMF) has been renamed Infant Mortality Fund by many African physicians who affirm that after the visits of IMF the children in their countries drop off like flies.

The economical crisis and the policies imposed by the IMF and the World Bank have produced a negative effect: now the people, even in the most serious cases, must pay for medical services that formerly were freely dispensed.

Below me are boundless cultivated fields, green and brown spots which remind me of the mimetic suits of the soldiers, to be found in so many countries. This year there were heavy rains in Ethiopia , too much. The floods have killed thousands of people and thousands of livestock. It seems a cynical and cruel fate, drought or floods, and so famine or malaria.

At the congress we have invited health professionals, scientists and researchers, from the most important European and American scientific institutions, to confront reality in the thick of it, where diseases are generated amidst social and environmental conditions conflicting with a decent life.

"Neglected diseases of neglected people" might we have called the congress, as indeed it is a question of left-behind diseases and abandoned people. By whom? And why?

In the words of G. Maccararo, science can be a multiplier factor of the establishment, or a liberation instrument. A certain form of science has always been an expression of the political and economical power. At present, science is the cornerstone of power, and of power men live and die. To deal with science has always meant to work in favour or against mankind and every one at present is reached by science to become more free or more oppressed. Medicine itself is more and more complying with the merciless logic of the market rather than that of life and health. Apparently, only the diseases giving an immediate profit are studied and treated. Also in Italy , the trivial diseases affecting low-income pensioners are little considered in our modern health institutions.

Hence, a strong feeling of indignation arises, also because you feel to be part of an unjust system difficult to change. Indignation for the injustices, for the gap between the rich and the poor, between the people born in Europe and the ones born in sub-Saharan Africa . Indignation because they have no future and, above all, no voice and respect. Indignation is not outdated, not useless. If it leaves room for the emotions, for tenderness in the relations, it may lead to a deeper and mature commitment. I believe that emotions, pathos , tenderness emerging from the act itself of living with others in the world, may be more than a simple hope. We are never alone, we co-exist, co-live and are in com-union with the apparently most far-away realities.

Blaise Pascal introduced an important distinction which helps understand care and tenderness: l'ésprit de finesse and l'ésprit de géométrie . L'ésprit de finesse is the spirit of sensitivity, care and tenderness. L'ésprit de géométrie is the calculating spirit, an activist interested in efficacy and power. Here, I believe, is the demarcation line between compatible development and existential distress.

We are landing. The captain confirms, everything's okey. The weather at the ground is good and the temperature is 21 degrees centigrade. Yemanè, Margherita and Maria Concetta should be at the airport to meet me. Without them… and without Daniela, Francesco, Beppe, Luigi, Ottavio, Anna, Gennaro, Isa, Valeska, Silvana, Ugo, Nando, Rita, Paola, Massimo, Alessandro, Tedros, Terrace, Barnabas and so many collaborators and friends… I would not be able to look at the stars and feel that they are smiling amiably at our attempts to perceive the beauty, through our fellow-men's face, of the most impoverished and marginalized. Thanks to you all.


Hand-written, October 18, 2006, during the 7:10 Flight ET100 from Addis Ababa to Mekelle