A Passover in Self-Imposed Exile

Published April 23, 2019


“Why is this night different from all other nights?” The question is so important that someone must recite the four questions at the seder even if there is no child unfamiliar with the answer. So this year, I asked the question myself, because it was Passover and I was the only one to ask it. Indeed, I was the only one in my room—and it was the first year of my life not attending a Seder at all.

I am in East Africa, here on a medical mission—seeing patients, and teaching medical students and residents. There is something eerie about being here on this holiday. God leads the Jews out of Egypt with a mighty hand and an outstretched arm. In a kind of reverse exodus—is it defiance?—I have returned to the continent of our enslavement. At the Seder table we remember that God led us out of Egypt, freed us from the yoke of slavery. But for me, I live temporarily in a land where nefarious diseases and poverty metaphorically enslave a population.

I examine a 15-year-old female with newly diagnosed AIDS, likely contracted from sexual abuse. And no social worker or legal system exists to help her. Here, a 14-year-old girl goes permanently blind for the rest of her life from a disease easily treated in the United States. We shine lights into her pupils to see if they will react, but nothing happens. We ask if she can see the light and she asks “what light?” Patients with hemorrhages into the brain come in living one day and pass away the next. Infectious diseases reign, especially tuberculosis, caused by a mycobacterium which passes through the blood and into the brain, resulting in fevers, neck stiffness, strokes, paralyzed eyes, and eventually death. We see patients with mumps, tetanus, and fungal infections. And then there are the stroke patients with locked-in syndrome, an affliction of multiple patients here—they are awake, aware, alert, but are completely paralyzed. Victims of autoimmune diseases leading to paralysis of the limbs, where antibodies from one’s own immune system attack the nerves, also come under our care. These are different, certainly, from the 10 plagues of yore yet they are a slight variation of the same theme, or at least the same effect.

But aside from the range of pathology, the paucity of resources and medications here often result in ineffectual efforts to save patients. We have had to watch as numerous patients die in front of our eyes due to lack of space in the intensive care unit, a lack of defibrillators, a lack of CT scans or X-rays. On the first day of Passover, I watched for an hour as a woman took her last breaths, gasping for air in the setting of a blood clot in her lungs. We stood at her bedside as her labored breathing deteriorated, running through the potential options to help her; there were none. The strangest thing is a feeling of helplessness in the face of events that one could easily manage in the same setting back home. The autochthonous physicians here accept this and, after an amount of time we have accepted it, too—a form of bondage inescapable in this part of the world.

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