Picture this: A tale of two babies

Lack of electricity should not dictate whether you live or die. By Kelly Lippi and Ari Hoffman

Newborn child in Ruhiira, Uganda. Photo credit: Millennium Promise.

Newborn child in Ruhiira, Uganda. Photo credit: Millennium Promise.

A premature baby is born by emergency cesarean section in southwestern Uganda. He is cold. Mom can’t keep him warm while recovering from surgery. Power is out. Not out from a storm or downed wire, not out during the 36 hours of planned weekly outages, just out. Nobody asks why, having long learned to accept these things as facts of life. There is no generator because fuel is too expensive. Baby lies alone in the cold, quiet neonatal unit and nearly dies from hypothermia. Finally, the power surges on and the incubator warms life into the newborn boy, who makes it home safely in mom’s arms.

A premature baby is born by emergency cesarean section in a large city anywhere in the United States. A nurse places him immediately in an incubator that monitors his breathing, heart rate and temperature. Any minute change in his vital signs results in alarms. His temperature remains stable. Baby makes it home safely in mom’s arms.

The baby in Uganda grows into an adolescent boy who is healthy and happy, until one day he falls ill. At the hospital his blood sugar measures extremely high—he is diagnosed with Type 1 Diabetes. He needs blood work to assess his electrolytes, but it is a Saturday so the power is out and chemistry panels cannot be run.

Because there is no electricity to power a fridge, health care workers in one rural clinic in Kenya float their insulin in a ceramic pot buried in the dirt to keep it cool.

Because there is no electricity to power a fridge, health care workers in one rural clinic in Uganda float their insulin in a ceramic pot buried in the dirt to keep it cool. Photo credit: Kelly Lippi and Ari Hoffman.

He needs an X-ray to evaluate his chest for infection, but the machine won’t function without electricity. He needs insulin to regulate his blood sugar, but insulin needs to be refrigerated, and the fridge has gone warm. Hospital staff creatively works around the blackout and the boy survives this crisis. He leaves the hospital overwhelmed by his new chronic disease and unsure how he will manage it at home.

The same boy in the United States visits the hospital and is diagnosed with Type 1 Diabetes. His electrolytes are drawn and analyzed every 2 hours, clinicians reading immediately available results on their smartphones and fine tuning his fluids; his X-ray is done within one hour of arrival; insulin is given continuously on an electrical IV pump. He survives this crisis and leaves the hospital, overwhelmed by his new chronic disease but assured he can manage it at home.

Without reliable electricity, the boy in Uganda struggles to keep his insulin cold and monitor his sugars. He has been hospitalized several times for complications. He makes it past 30 before developing kidney failure. His only option for survival is dialysis, but the cost is prohibitive and power is inconsistent. He dies at 33. 

The same boy in the United States learns how to control his blood sugars, using an implantable insulin pump tracked on an iPhone app. He checks his blood sugars regularly and adjusts his insulin doses as needed. At 50, he continues to live with his disease.

It is easy to romanticize a life with limited connectivity: candles, campfires and conversations. And how creative of the Ugandans to keep their insulin floating in a ceramic pot buried in the dirt. But the reality is that the only difference between the boy in southwest Uganda and the boy in anytown, USA is one was born powerless, the other empowered at birth. The Oxford dictionary defines power as “the ability or capacity to do something.” It is how things get done.

As Peace Corps Global Health Service Partnership volunteers, we are health care providers and clinical educators working in sub-Saharan Africa, where the global burden of disease is greatest and the number of health care workers the fewest.

We work to empower the next generation of Ugandan nurses and doctors with the capacity to close the chasm of health inequality worldwide. Without electricity, our impact is limited. Power is capacity. The time has come to give power to the people. 

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Kelly Lippi & Ari Hoffman are volunteering in Uganda with the Global Health Service Partnership, a collaboration of the Peace Corps, the President’s Emergency Plan for AIDS Relief (PEPFAR), and the non-profit Seed Global Health to send U.S. healthcare professionals abroad with a focus on teaching and expanding clinical capacity. Lippi, a nurse practitioner, and Hoffman, a physician, are from San Francisco, Calif. Learn more about the Global Health Service Partnership here.

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