Public Health

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Thinking Differently about HIV/AIDS

Thinking Differently about HIV/AIDS

Contributions from Critical Social Science
also available: Hardcover eBook
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Social Class and the Treatment of Alcoholism

An investigation of social class as a determinant of diagnosis, prognosis, and therapy
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Health Equity in a Globalizing Era

Health Equity in a Globalizing Era

Past Challenges, Future Prospects
tagged : public health
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A Doctor's Quest

A Doctor's Quest

The Struggle for Mother-and-Child Health Around the Globe
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Beginnings: Haileybury, Ontario, Canada, 1987

In January 1987, the phone rang at four in the morning. I stumbled out of the bedroom to answer it, my heart beating rapidly. A crisp European voice asked, “Is Dr. Roedde there? The doctor who taught at the Liverpool School of Tropical Medicine in England last year? That’s how I got your name.”

The frantic pounding of my heart slowed. Thank God it wasn’t an emergency.

“I’m calling from Geneva. Rosemary McMahon at Liverpool thought you might be interested in this job in Uganda. Could you be ready to go in two weeks?”

I was still struggling to wake up. “Yes, this is Dr. Roedde,” I said sleepily. “Uganda?” I was dimly aware that in Uganda the civil war was just ending and the country was plagued by HIV/AIDS.

“It will be a tough assignment. I am Katja Janovsky. I’ve been working there for years with AMREF [African Medical Research Foundation] before coming to the World Health Organization [WHO]. Whole villages are dying of AIDS, thin, wasted people struggling to keep on living. But they’re luckier than those who have died in the wars. There are fields that are still full of bones where Idi Amin has thrown the bodies of his enemies. I want you to be prepared.”

I collected myself. I was awake now. Almost. With one hand on the phone, I stretched over to add grounds to the automatic coffee maker with the other and switched the pot on, trying to focus.

Katja explained. “I’m building a team for German Technical Assistance [GTZ, now GIZ]. We’re going to help plan a primary health-care project in two poor, remote districts — Kabarole and Bundibugyo in western Uganda.”

Even half asleep I knew that primary health care was the most basic level of health care and included immunization, mother-and-child health, nutrition, water and sanitation, and provision of essential drugs.

Katja continued. “GTZ wants to strengthen primary health care because it’s low cost and saves the most lives. There will be a little hospital strengthening just to back up the primary level, but the major focus is to be on the poor. Can you go twice?”

As the caffeine hit my system, I learned that Katja wanted me for two missions: first, for this German project that she would be coordinating, and then for an AMREF mission that I would conduct on my own.

Over our clear transatlantic line, Katja explained more about the assignments. “There will be a couple of months for you to go home between the two missions, each of which will be four weeks long. The AMREF job is to strengthen the training for several different cadres of primary health staff, work you’ve already been doing in Liverpool. I know you’ve worked in Canada’s own developing world training Indigenous health workers and have had students from Africa, Asia, and the South Pacific at Liverpool. But isn’t it time you take this opportunity to work in the same conditions as your Liverpool students?”

Eager, I answered, “Yes,” but I tried not to let my nervousness show in my voice. “Katja, these will be my first assignments in Africa.”

After I got off the phone and while my family continued to sleep, I wondered how I would actually undertake these challenging journeys and how I could juggle them with the responsibilities I had to my family and my northern Ontario patients where I served as a locum physician in the small towns of Haileybury, New Liskeard, Latchford, Cobalt, and Temagami. At the same time I tried to pull together the fragments I knew about Uganda, many learned from my father, a retired librarian who is currently an artist, or from my husband, Jim, a historian who could provide political commentary on probably every country in the world over his gourmet-cooked meals.

A week later, with a cursory knowledge of German and the aid of a dictionary, I picked my way through the German contract that had arrived by courier. It was a delicate and difficult task, but by then I was fully engaged and energized at the prospect of going to Africa, something I had long wanted to do. But my excitement didn’t dispel my anguish at leaving my family for so long. When my daughter, Anna, was nineteen months old, I had left her for three months to study in Liverpool. I cried every day and was devastated when I returned and discovered that she didn’t recognize me. Over the years, I knew my children, Anna and Alec, who were then respectively eight and five years old, had become used to parents with alternating travel schedules. After Alec was born, it was my turn to hold down the fort while Jim, who worked as an Indigenous land claims historian and travelled extensively to Indigenous communities throughout North America, moved to Toronto for several months for a Supreme Court land claim trial. And so, with Jim’s encouragement and reassurance that he could handle my absence by rearranging his schedule to work from home, and after a discussion with my children that Mum would be away for a little while, I knew I could go.

What I didn’t know was that answering Katja’s phone call that early morning would change the way I worked for the rest of my life.

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Deep Water Dream

Deep Water Dream

A Medical Voyage of Discovery in Rural Northern Ontario
also available: eBook
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Section One
WABANONG / wah-buh-noong / Spirit Keeper of the East

Chapter 1: Baptism, 1973


“Abinoojii.” “To be lifted up” is a better explanation than “child,” which is another translation. An Anishinaabe phrase from Wikwemikong, a community that is home to three languages, Bea Shawanda spoke it firmly. She was directing me, as a child, to find my own inner strength for what was ahead. This simple but powerful expression said to her lovingly by the family, Sophie and Eli, who raised her was now said by Bea to me, “Child. You will be lifted up.” She was trying to prepare me to go up north.

But Bea still had questions.

“Why do you think we should let you help us? What gifts are you bringing to us? I am the bridge between the people and you coming to us to help. I need to explain you to the Chiefs. If we bring in non-Native resources, like you in health and social services, we have to help you bridge.” She spoke angrily.

I felt threatened. I had never been up north, in isolated First Nations’ communities. I knew nothing about these communities. I had met Bea when I was volunteering with her group in Toronto, working with homeless Indigenous people. She had asked me to help with Grand Council Treaty No. 9, a new Indigenous organization representing the northern half of the province of Ontario, in Canada. Its goal was to set up a First Nations paramedic training program for a group of OjiCree communities in the Windigo Tribal Council, north of Sioux Lookout, in northwestern Ontario, and to set up alternatives to jail for addicted youth. She had invited me to this Chiefs’ Conference in Thunder Bay to start meeting the people I would be working with. It was true. What gifts did I bring?

We were in our hotel room. I was rocking one of Bea’s kids, Maheengun, in my arms, swaying rhythmically and pretending not to feel worried about my inexperience. I kept my face neutral and left the hotel room, still rocking Maheengun. Pint-size dynamo (maybe five feet?) Bea still argued forcefully beside me, asking me about my commitment as we took the elevator to the large conference room on the ground floor.

I looked across the room and shook my head, tossing my dark blond hair loosely over my shoulders. There was one other non-Indigenous person there, a good-looking, dark-haired guy with a moustache. I couldn’t help but notice him. He wore a green plaid Viyella shirt with brown corduroy pants and closed-toe wooden clogs. He nodded at me, unsmiling, from the other side of the large, smoke-filled room, as a confusion of voices — Cree, OjiCree, English — hummed through the haze. He seemed totally unfazed by the chaos. I had no idea I was staring at my future husband.


I had started off as a physical anthropology student at the University of Toronto planning to study primates in Gibraltar in the summer. Instead, I switched to social anthropology and had sessions that looked at various ethnic minority cultures around the world. One day, a guest lecturer, a Cree leader, spoke of the symptoms of the pain of his people, violent and accidental deaths, drinking, and drugs, babies born with fetal alcohol syndrome. I went up to him after the lecture. “Is there anything I can do to help?” He looked down at me, grinning broadly. “We actually don’t need your kind of help. But if you’re serious, call Bea Shawanda. She lives in Toronto. She is the new head of the Treaty No. 9 health program. But I am pretty sure we don’t need more anthropologists. Ever thought of becoming a doctor? That would be more helpful to us. Till we train more of our own.”

I left, making room for the throng of mostly female students crowding around him, being charmed by his smiles and tanned coppery-skinned good looks.

I took his advice. I did look up Bea Shawanda and worked with her for several months. I met her kids, Byron, Elizabeth, and the baby Maheengun. Bea invited me to prepare to go farther north. And I applied to medical school. So I was there, in Thunder Bay, at the Treaty No. 9 Chiefs’ Conference, at her invitation from a few weeks earlier. At the conference for the Chiefs the sessions moved slowly, with translation back and forth between Cree, OjiCree, and English. About ten of the one hundred people in the smoky room were women. The men were all clean-shaven, except for that white guy with the moustache. A few wore beaded deerskin jackets. I was trying to take in every detail. I kept Maheengun in my arms, as Bea was busy building relationships and camaraderie, laughing with the Chiefs, engaging them with her ideas for social programs, drug and alcohol worker training, and a paramedic program. Abinoojii. Did I have the skills to rise to this challenge?

I survived that first difficult week. Back in Toronto, Bea and I met at her home. Bea explained: you need to be confident that you have skills to share with us. You need to know that people may be angry with you as a non-Native person helping us. “I needed to see how you would react. What you’d do if people in the communities say challenging things to you. You will not be working for the white world. You will not be staying with the teachers or at the nursing station. You’ll be living and travelling with our people. Our people have a lot of anger with the white world. I, myself, had bad experiences in the residential schools. I went to school when I was four and a half. These schools were used as orphanages. It was there I first experienced violence. My mom had died when I was two, and I was adopted within my family. I worked through those difficult years by becoming an activist. That was part of the healing process for me.”

Bea looked up at me, a novel experience as I am only 5 feet 4 inches tall myself. She had had tuberculosis in her spine as a kid. She spent months in the TB sanatorium. She remembers feeling frightened of the janitors. She couldn’t walk for a while and was told she could never have kids. She proved the doctors wrong and had borne the children she was raising. She sure was raising me in a new world, too.

“I think you’ll be okay because you are working for us. I was taught that in the first five years, a child receives what they need, including courage of heart. Abinoojii. I hope it is the same in your culture. You should have the strength you will need.”

I “passed.” Bea and the chiefs had agreed I could travel and work as a volunteer for Treaty No. 9. My travel expenses were paid and were extensive as most of the communities are fly-in.

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