Spring 2007 Grant Recipient
Jed Fahey
Democratic Republic of the Congo
School of Medicine, MD program
(adapted and translated with permission from the research proposal of Tony Louppe, Nutritionist, World Food Programme, United Nations)
With more than 40 million people infected with HIV at an increased risk for malnutrition and more than 40% of those presenting as malnourished in some areas, there is an important need to establish cost-effective, readily available nutritional supplements for populations at-risk for AIDS-related wasting. Moringa oleifera, or the horseradish tree, is found abundantly throughout the tropical regions of South America, India, and Africa. It has been widely used for medicinal and nutritional purposes with broad anecdotal evidence for its utility. Extensive research on its nutritional composition support theories of its nutritional benefits; however, no rigorous, clinical research has been undertaken to support these claims. The purpose of this research project is to establish the benefits of M. oleifera (in the form of a powder from dried leaves) as a nutritional supplement for those suffering from AIDS. In a small double-blind, randomized, controlled trial, we will randomize 160 subjects with AIDS and currently using anti-retroviral medication (ARVs) to nutritional supplementation with M. oleifera powder or placebo (chlorophyllin powder). We will follow-up on patients for 6 months, taking bi-weekly anthropometric measurements and examining blood sample indicators monthly. Our primary outcomes will be changes in weight, with secondary examination of changes in CD4 count, viral load, and incidence of opportunistic disease. Every experience that I have had in Africa contains the same inconsistency. This contradiction never ceases to amaze me. It is one of the reasons that I have continued going back, and one of the reasons that I will always be drawn there. The incongruity is this: despite living and working in conditions that are at best frustrating and at worst infuriating to the point of driving one mad, people continue to show a hopefulness and a generosity of spirit that not only survive but flourish in this harsh environment. During my six weeks in Brazzaville, Congo, an extraordinary number of people made an effort to welcome me and make me feel comfortable. I was overwhelmed with invitations to dinner. Many people only loosely affiliated with my research project welcomed me into their homes and made special arrangements to introduce me to various regional or ethnic specialties. My work partner, Tony, took my well-being and happiness so seriously that for three days, he left my side only when he dropped me off at my home at eleven or twelve’ o’clock at night. He would then arrive at eight ‘o’clock the next morning to insure that I could make it to whatever meeting or activity was planned for the day. I am convinced that he was prepared to continue this pattern for my entire six-week stay. I only saved myself from this generous but absurd act by making a passionate plea for some independence during my time in Brazzaville. 
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My original thought was that this overdeveloped sense of devotion or responsibility was born out of an uneventful schedule that allowed vast amounts of time to be dedicated to these activities. It is in fact the opposite. Deficits in infrastructure, technology, and personnel have made life in Brazzaville, Congo a continual struggle. It is a race with a seemingly overpowering outside force that keeps everyone running on a treadmill that is simply moving too fast. One painful example is the internet. It is slow and erratic, maddeningly so. On one occasion, I spent, and watched my colleagues spend, more than an hour trying to send a single email. First, the connection took three to four minutes to load each page. When the email was in the process of sending, the connection was lost. A quick learner, I copied a version to a word document so that it would not be again lost to the void if the connection broke. The second time I tried to send the email, the power went out. When I wrote the email for a third time, I saved it to the hard disk. As I tried to again send it, increasingly infuriated by repeated error signals, a technician told me nonchalantly that my computer did not usually allow the user to send emails. I took my flash drive out of my pocket, unwilling to write the email for a fourth time. As I was plugging it into the USB port, Mme. Homb, my supervisor, stopped me. She said that the computer undoubtedly had viruses, and we would do better to simply write the email again. Like the hamster, we were working hard, almost furiously, but getting nowhere.  | |
These types of set backs were commonplace –phone calls, cars, banks, appointments with government officials, meetings with funding agencies. There seemed no end to the disappointments that one could face on a given day. There was no amount of time that we could allot to a given activity that could not be wasted by various impediments. I was a transient visitor to this strange land of exasperating delays and malfunctions. I could only imagine what it must be like to live in these conditions with no relief in sight –delayed or cancelled salaries, benefits, contracts. As irritating as I found these conditions for my six-week stay, they must have made life desperate for those who lived here permanently.  | |
And here is where the incongruence appears. Despite comments, small tirades against the madness of the system, people remained productive, encouraging, and even hopeful. They realized the absurdity that they were living in, yet they did not give in. They continued to spin their wheels. Mme. Homb took me on tours to see the various broken monuments of the city. Tony took me to eat monkey and porcupine. Merdard (a man who used to work with Mme. Homb, but now had no connection to her or her research) brought me home to an abundance of energy and questions from his three small children. I have found only one good explanation for the paradox that I find every time that I set foot on African soil. It is simple and almost intuitive. People act as they do because there is no other way they could possibly act. Life would simply be unbearable in the chaos that is Congo without a richness of spirit and a communal source of hope. People find that in each other. At least, I found that in people. It made life bearable, and it made all the unbearable things unimportant. >> See all Framework Program in Global Health winners |
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