THE POP CULTURE OF BUGS AND DRUGS: A Changed Perspective on International Health

By Bryan McColgan

Published on June 2009

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I have just finished weeks of studying for the minutiae that is microbiology and pharmacology. As is the life of most second year medical students, I have been spending an inordinate amount of time struggling to comprehend the vast language of ‘bugs and drugs’. The lectures and readings have made me nostalgic for a time when infectious diseases occupied a very different place in my life. This time was during my year living in Zimbabwe, and it was an experience that has forever changed how I perceive the many complexities of international health.

I went to Zimbabwe from August 2005 to June 2006. I was there on a United States Fulbright Fellowship to further study a cohort of HIV positive patients I had been researching for my undergraduate honors thesis. Two years of laboratory research on Zimbabwean blood samples made it essential for me to visit the distant country I had only known through ninety-six well plates and PCRs. I arrived in Zimbabwe with an attitude common among American premedical students going to the developing world for the first time. I wanted to “do good.” I wanted to “make a difference.” I wanted to “change the world.”

However, I did not immediately warm to my new African home. The disintegrating economy with rampant hyperinflation, the near absence of gasoline, the incessant power cuts, and the reality of resource limitations including food and technological communications were all aspects of Zimbabwean life that I had to adjust to. As an American with a type A personality, this was not an easy task, and to make matters even more stressful and complicated, the HIV research I had proposed was no longer feasible. The necessary equipment could not be found in the capital city of Harare, and it could not be brought into the country because of government regulations. By the end of my second month in Zimbabwe, I had no project and no direction, and the novelty of carrying around tens of millions of Zimbabwean dollars to pay for a week’s worth of groceries had almost completely worn off.

At no point during this tortuous introduction did I ever think of leaving Zimbabwe and returning to the States. No matter how frustrating, slow, and tedious Harare life seemed, there was still so much potential to do great things and work with inspiring people. One of those people was Anna Miller, a British physician and public health consultant at the Elizabeth Glaser Pediatric AIDS Foundation¹. Anna and I became friends, and she shared with me the idea of a collaboration involving the Zimbabwe AIDS Prevention Project (ZAPP), a local drama group of HIV positive performers who scripted and acted in plays about living with HIV. Elizabeth Glaser wanted to produce a short film with this drama group to showcase their work in the local community of Chitungwiza. However, Anna was perpetually overworked and asked if I would be interested in taking on the project. As a strict biological science major with absolutely no experience in arts or film, I had my reservations, but any hesitation or doubt was quickly cast aside by the realization that I was an out-of-work ex-patriot living in Zimbabwe.

Initially, I did not think that making a thirty-minute film of a play by HIV performers possessed the gravitas for the change I so desperately desired on coming to Zimbabwe. I merely saw it as a novel distraction. However, I soon realized that something like film, which I viewed as mostly frivolous entertainment, could actually be a key element of real public health change.

Chitungwiza is a high-density, poor urban area about fifteen miles outside Harare with one of Zimbabwe’s highest urban rates of maternal HIV infection². The members of ZAPP recognized this problem, and as men and women living with HIV and AIDS, they performed their awareness plays every week at the local HIV clinics in order to be a public presence of positive living while sharing their experiences of mother-to-child transmission of HIV (pMTCT). Working with the cast, I began to learn more about how personal these plays were for them. Stories of lost family and friends, broken marriages and homes, infected children, and painful suffering were themes woven into each of their lives. They could not escape HIV in their world, but they could find consolation through their community work.

Through their plays, these men and women gained a strong sense of purpose. Their messages were felt by so many in the community, but no one outside of ZAPP was willing to talk about their traumas with adultery and infection. We felt the film needed to addresses these difficult subjects, so the story on which we focused our thirty-minute film revolved around a young, pregnant wife who is infected by her unfaithful husband, blamed for the virus, and then kicked out of her home because she is a woman. However, in the play, the woman fights back. She confronts her husband with the support of her aunt, and the couple works through their issues to have a healthy, HIV negative child through the clinic’s pMTCT program. While this story was not a ZAPP member’s personal experience, it is a common story among the women and families of Chitungwiza. Sadly, most of these women never fight back or seek medical assistance, and helping these women is an essential ZAPP objective.

The video, entitled Ndizvo Zvandiri (This is What I Am), added another layer to ZAPP’s work by giving them a platform that has become a universal aspect of 21^st century information dissemination: mass media and pop culture. Television, films, and YouTube are changing how we access information through entertainment. Zimbabweans, despite their resource limitations, are no different from Americans when it comes to falling for the seduction of Hollywood products. People in Chitungwiza love Brad Pitt, Grey’s Anatomy, and Beyonce. As is the case with Americans, Zimbabweans learn a great deal from these forms of media. In a place such as Zimbabwe, the sense of glamour and light-hearted escape from the reality of life is perhaps even more powerful and coveted than it is in the developed world.

The results of our Elizabeth Glaser project supported these ideas. The members of ZAPP would work long days, through sicknesses induced by their medications and opportunistic infections. They would do it for the excitement of sharing their messages and the ability to temporarily set aside their sickness through performing in film. Even after my time in Zimbabwe, ZAPP and Elizabeth Glaser went on to share Ndizvo Zvandiri on national television and in DVD format throughout the country, and it is still available through Elizabeth Glaser³. Accompanied by a discussion guide, it has become a teaching tool and a way to facilitate discussion about HIV without coming across as a dry, finger-waving lecture regarding the perils of infection. It speaks to the people of Zimbabwe because it originates from their own lives and experiences. I believe they listen even more closely because it is presented in the persuasive format of entertainment. By blurring the lines between personal experience and medical information, ZAPP had found a way to evolve a pop culture distraction into a meaningful focus for people living with HIV.

This project showed me that progress in international health does not only stem from rigorous research. While research is an invaluable and absolutely essential component to new medications, vaccines, and healthcare, people’s lives are more than just ‘drugs and bugs’. People’s lives are about living. They crave these non-essential elements that make life human and beautiful. As superficial as they may seem, pop culture and mass media have the capacity to engage this need. They speak to billions of people and can affect real change, and I hope to use this knowledge and these elements in my future work as a physician involved in international public health. Ideally, this would involve documentary film work; possibly a Real World: International Medicine style television show; and journalistic writing, blogging, and YouTube-ing from the various countries in the world where I can be of greatest value. Each of these aspects of media offers a new possibility for people all over the world to share their experiences in an entertaining format while affecting change on a global scale. When I now think about “changing the world,” I no longer think of it as naïve cliché of premedical students. I think of it as the reality of what I want to do with my education, skills, and passion. Ndizvo Zvandiri may not have changed the world, but it has changed and improved many lives, including my own.

Bryan McColgan is currently a second year medical student at Columbia University College of Physicians and Surgeons (P&S). During last summer he worked at the CBS Evening News with Katie Couric where he learned a great deal regarding the development and production of broadcast medical journalism from Dr. Jon LaPook, the chief medical correspondent. He is actively involved in the P&S International Health Organization (IHO) through its inter-graduate school Global Forum for Health and Human Rights as well as the inaugural issue of the IHO Newsletter. He can be contacted for questions or comments at bjm2123@columbia.edu.

References:

² Zimbabwe Epidemiological Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response 2008 Update. http://www.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_ZW.pdf

³ http://www.genderandaids.org/modules.php?name=News&file=article&sid=993

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