Nairobi The cultural shift of time zones and airports between New Orleans and Nairobi might only add up to 8 hours forward and cooler, drier temperatures but going from True Grit on the United Airlines screens to all of the news now from Al Jazeera is a big change worth noting.  Plane loads of lawyers negotiating development deals in Africa, missionaries en route to Kenya or on summer break to Liberia, and regular people trying to get home make globalism both real  and more ambiguous.

Catching up on back magazines, I read an article in The New Yorker with interest about a clinic and its experiments with “total care” in the Bayview/Hunter’s Point area of south San Francisco and its primary doctor, a young practitioner named Nadine Burke.  Using the results of an extensive study done by Kaiser Health in California on Adverse Childhood Experiences over a number of years, an ACE score had been developed from that work and the clinic that was frighteningly predictive of bad health outcomes in the future based on the perils of childhood.  I read this article with mixed feelings, both excited that doctors were finding some responses and struggling with the health crises in poor communities and depressed that it was so likely that so little would be done in most parts of the country  – and the world – given the imbalance of resources.

In this one island in the story, Burke’s work and energy has captured support and funding for a model program that will combine good health care with good social support.  With time and a fair trial, how can the results be anything but positive?  Any organizer who has ever worked in low income communities could tell endless stories of the health issues of member after member, leader after leader with hypertension, diabetes, and asthma as common as colds.  I listened to an argument among organizers only last week about whether or not to serve cake at a celebration since so few of the members should really have a piece given the diabetes epidemic in the community.  Despite how obvious the issues, without political power what would it now take to have “health equity” independent of the questions of sustainability?

Preparing to meet with ACORN Kenya organizers working in Korogocho, the oldest of the Nairobi mega-slums, it is hard not to extrapolate the ACE scores from poor communities in developed countries to the slums of developing countries where every day is a question of survival, which no doubt translates as stress on steroids.  We have so far to go to achieve equity and justice.