Who’s my COVID-19 neighbor?

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In early March, you and three friends were able to buy a round of golf on an island in Charleston, South Carolina for $ 6,500, accompanied by a former NFL quarterback or maybe even Chris Tomlin. When the sun set behind moss-covered living oaks and black water swamps, you could retire to a country club to enjoy cool drinks and a private show with the Grammy-nominated band Needtobreathe.

And in the surreal psychology of philanthropic events, you could have done all of this in solidarity with some of the poorest people in the world. Your fee will improve health care in places where a bite from the wrong mosquito or a sip from the wrong tap can end your life.

At least that's how OneWorld Health, a Christian medical nonprofit, marketed its big spring fundraiser.

Until mid-March, however, no amount of money could secure you a place at a charity golf tournament, gala, or silent auction across the country. Virtually all were canceled. COVID-19 burned itself around the world and, as far as is known, was just waiting to squeeze the meat at such gatherings in VIP circles.

OneWorld Health canceled their Needtobreathe Classic on March 13th. "It was an easy decision to make the right decision," said general manager Michael O’Neal. "But it certainly leaves a hole in terms of resources."

The economic impact of the coronavirus pandemic threatens to decimate nonprofit groups. Churches that are forced to broadcast live streams or to permanently cancel services wonder what will happen if the offering of plates cannot be passed on. Mission groups forced to stop international travel ask how long they can survive without sending workers into the field. Everyone is worried about how big donors will react when investments dissolve and corporate profits disappear.

But the pandemic is a two-front war for organizations like OneWorld Health, which operate a dozen medical facilities in Central America and East Africa. Your fundraisers will be wiped out as you strive to stay ahead of an expected rush of virus-related cases in the countries where you operate. "We are trying to prepare," said O & # 39; Neal. "But we will all see a decline in the next 18 to 24 months."

Global health experts are particularly concerned about the effects of COVID-19 in developing countries where health systems are already tight and absent in many places. Millions could die. If a nation as powerful and widespread as the United States has not got the virus under control, the signs are not good for regions with high population density, cultures of coexistence and poor water and sanitation systems.

O & # 39; Neal knows. He and his wife moved to Uganda to help OneWorld Health 2011 open its first medical center. "It will have a huge impact," he said. "In a country with more than 36 million inhabitants, there are 55 beds in the intensive care unit."

Doctors in other countries wish they had it so well. Martie Wahl works in a private doctor's office in Windhoek, the capital of Namibia, and has not shredded any words: "Our health system will not be able to cope with a large number of people who need ventilation," she said. "It will collapse in a few days."

For months now, international groups have been calling on poorer nations to prepare for the worst. As early as February, countries like the UK started providing millions of special assistance to help people with fragile health systems fight the outbreak. The United Nations released $ 15 million in early March and asked for additional $ 2 billion in aid. Other groups such as the International Monetary Fund and the G20 have followed up with their own proposals.

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The concern is clear: wealthy countries may be too exhausted to fight back the inferno in their own backyards to run towards smoke on the horizon. In a firestorm, it is only human, even careful, to take care of your own home and that of your neighbor. The lesson from the pandemic in a globalized era, however, is that there are no clear boundaries between neighborhoods. Flames not only jump on streets, but also on continents.

"We know that diseases like these are only as strong as your weakest link," said Ed O & # 39; Bryan, OneWorld Health co-founder and doctor and director of global health at South Carolina Medical University. Taming COVID-19 in China, the U.S., and all of Western Europe doesn't matter if it's still raging and possibly mutating in Africa or Russia, he said. "It will come again."

IIn Namibia, the government has ordered social distancing, but Wahl has doubts that this will be possible for one of its employees, who lives with five siblings and their children in a tiny house in a poor part of the city. In Liberia, where there is no emergency medical service, a missionary is worried about how the sick can get to the hospital because public transport has been restricted. Street sales, which many depend on, have been banned, and formal markets can now be checked.

And everywhere in societies in which elders take special places of honor, people fear a virus that primarily falls victim to the elderly.

"It is often the unfortunate case that grandparents are the grandchildren's breadwinners and carers," Wahl said. "We would have many orphaned children, more than we already have."

When the COVID-19 pandemic hits wealthy nations, it hits many poorer people like a demolition team. Foreign investment is fleeing, oil and tourism revenues have evaporated, and unemployment has risen to dangerous levels. All this in places where most people have little or no savings to cushion their fall. Days before Pakistani Prime Minister Imran Khan ordered his 210 million compatriots into their homes, he complained that "this would save them from corona on one end but die of starvation on the other."

For missionaries and helpers, it goes without saying that growing desperation and malnutrition crouch just around the corner.

"It says," If the United States sneezes, Latin America will get pneumonia, "missionary Kevin Abegg, who oversees the ministry in the region for the United World Mission, wrote to the donors provide significant protection that is not available in the Central American countries where we and our fellow missionaries serve. "

In a globalized era, flames leap not only on roads, but also on continents.

Developing countries are not monoliths; Some quarters are better equipped than others to fight the virus, which has crossed almost every geopolitical boundary. In low-income countries outside of Southeast Asia, fewer daily flights depleted passengers from sources of infection. This gave some leaders time to watch how the rest of the world reacted to the pandemic. Sudan closed schools and banned large gatherings after only reporting two COVID-19 cases. Haiti closed its airports after announcing its first pair of infections.

In parts of Africa, new memories of past epidemics such as Ebola have prompted many countries to respond quickly and vigorously. Liberia's first positive test for COVID-19 was at 4 a.m., and at 10 a.m. that day, the president closed the schools.

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The mood here is "pretty tense," said Rick Sacra, a mission doctor at the ELWA hospital in Monrovia, Liberia, who survived Ebola after being infected in 2014. He assured his colleagues that COVID-19 is not like Ebola, in which half was killed by anyone who infected it. "Some of the employees, just like during the Ebola, tried to put on personal protective equipment and felt claustrophobic and just couldn't handle it."

However, the reactions were very different. On the other side of Africa, Tanzania had already reported 12 cases in which President John Magufuli smiled calmly and promised a cheering community not to close any churches because COVID-19 "could not survive" there. "It will burn." Across the Atlantic, thousands of Nicaraguans were walking on the streets, while much of the world was closed indoors to aid coronavirus victims. (Nicaragua reported its first infection three days later on March 18.) Further south in Brazil, President Jair Bolsonaro dismissed the virus as a "bad cold" while the nation's reported number of infections exceeded 2,000.

"From a public health perspective, there are some things that are very scary for us," said O & # 39; OneWorld's Neal. His organization operates several medical centers in Nicaragua.

In most countries, doctors told CT, governments are taking the lead in testing for COVID-19 and preventing it from spreading. But almost everyone in peels, whether in hospitals or NGOs, is preparing for an overwhelming number of cough and fever patients. "We'll be hit hard when it starts," said Sacra.

Picture: Brian Stauffer

This is not least because COVID-19 has almost become the unique focus of the global health community, but more threatening diseases such as tuberculosis and infectious diarrhea continue to occur. This includes less sensational diseases such as pneumonia, the world's leading child killer, killing more than 800,000 people under the age of five every year. "Just because you fight it, malaria doesn't go away," said O & # 39; Neal.

COVID-19 has left many puzzles all over the world, and doctors are not sure what will happen in developing countries. Perhaps it will be less deadly among Africa's young population. The virus may be exposed to headwinds in tropical climates if there is a possibility that it may not like warmer temperatures. Perhaps, in a tragic turn, all of these benefits will be nullified in malnourished bodies.

What countries are never likely to be sure of is the death toll. However, the scarce test stocks in poor countries in the US are becoming much smaller, said O'Bryan. "You will see higher mortality rates, but these do not necessarily have to be attributed to the coronavirus. You will see many patients who die from an unknown respiratory disease."

D.ieudonné Lemfuka has no illusions about human strength in the face of pandemics. The surgeon spent a month in quarantine in 2014 after fighting the Liberian Ebola outbreak at the ELWA hospital (short for Eternal Love Winning Africa) in Monrovia. "The best way to pray," he said, "is to ask the Lord to stop this disease if possible."

Prayer is probably as much as most of us – if we can do anything – in response to the news of epidemics and disasters on distant shores. But it is noteworthy that even Western Christians have criticized prayer as an inadequate response to the crisis after a plague has entered our home. "Mostly, I think the groups I'm working with would say" pray and work "to solve the problem, Southeastern University pastor and theology professor Chris Green told Associated Press in March.

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We were flooded with news of what this work looks like domestically. Without a pop-up PSA for Do the Five, no Google search or news binge is complete. Compulsive hand washing, keeping a distance and worshiping stuttering video feeds no longer require imagination. The idea of ​​how to stop COVID-19 overseas is more difficult.

Volunteering for medical travel is probably not the answer, at least not for the time being. The usual countries sending medical teams are so desperate for staff at home that they ask retired healthcare workers to volunteer locally. For the foreseeable future, trying to travel internationally will require navigating through a variety of restrictions, exposure to crowds where the virus may be lurking, and potential quarantines. And if hurting hospitals are marginalized, they don't have the resources to host hordes of foreign volunteers.

"Just because you fight it, malaria doesn't go away." -Michael O’Neal, OneWorld Health

Lemfuka will tell you, like other global healthcare professionals in the US and abroad, that money and resources are critical. Everyone interviewed for this story expressed extreme concern about the lack of personal protective equipment for medical personnel and intensive care equipment for patients. When supply chains tighten upstream in rich countries, they dry up to dust in places like Liberia. Lemfuka sees this as a planet-sized opportunity to show the love of Christ. "But how do we show that without supplies?" he asked.

He answered his own question: "If they really have this love and compassion," Christians could "donate and support us with this equipment".

If you can get it. Collecting donations for public health overseas is an ascent even in happy times. If it were easier, preventable diseases like tuberculosis, which is expected to kill more than 10 million people in the next ten years, would have disappeared. Experts estimate that the disease could be eradicated for a cool $ 65 billion – small potatoes when stacked against the more than $ 2 trillion the US government spends on its economy during COVID-19. To stimulate the downturn.

The Church is unlikely to use such resources (though Rotary International, certainly a less impressive entity than the global bride of Christ, has raised nearly $ 2 billion and brought the world to the threshold of polio eradication). And leaders in developing countries are not naive – they know that many of their cries for help will be lost under the roar of appeals, as the usual "donor countries" take care of their own needs first.

In the West African Ebola outbreak that Sacra endured, "only these three countries were affected," he said. "We had entire containers of protective equipment on the way." He doesn't expect this kind of help from COVID-19.

Which raises questions: Would it be fair for doctors to expect such help from Christian strangers around the world? People are finite; We can only juggle so many worries at the same time. How much are we obliged to help others when we need help ourselves? Jesus praised the widow for giving her mites. But would he have asked her about them?

James Thobaben is a medical ethicist and theologian at Asbury Theological Seminary. He juggles high public health issues with his more personal concerns – such as whether his daughter, a doctor in a St. Louis hospital, is safe. He understands scientific ideals like utilitarianism and helps as many people as possible, even if some have to make sacrifices. But he also has strong words for anyone who would endanger health workers like his daughter without adequate protective equipment. "It is morally wrong," he emphasizes.

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He referred to 1 Timothy 5: 8: "Those who do not take care of their relatives and especially their own household have denied faith and are worse than an unbeliever." World have: “You have a greater duty towards your nuclear and perhaps extended family than towards an otherwise unknown stranger. The same higher level of duty applies to the visible church. "

It is true, said Thobaben, that theologically everyone in the world is a Christian's neighbor: a brother or sister in Christ or a victim on Jericho Road of Life. However, effectiveness is important when we help others, and we are generally most effective in helping those who are closest to us.

How much are we obliged to help others when we need help ourselves?

Thobaben added a restriction: Christians are also a people on a mission. That means we are constantly expanding the group of people we consider to be narrow. "If I don't help at least some outside of my immediate community, I can't get the gospel," he said. "Part of a Christian's regulatory obligation is to decide how to use or even use what you have when there isn't enough to go around."

In our globally networked age, people – and especially Christians – have flaunted our ability to extend the definition of "neighbor" to the extent that an Internet connection or a Boeing 787 supports it. One way out of the COVID 19 crisis is that our bragging rings are hollow. We are clearly still the most responsive to events in our own back yard, and it is very likely that the pandemic will drive the world inside into a new, self-centered era.

However, the proximity is both geographical and relational. Perhaps our shared experiences with this virus – rich and poor nations – will all bring us a little closer once we emerge from the haze of self-isolation. Perhaps the next time we hear of faceless people in the world suffering from an invisible, enigmatic predator, these people will not be so faceless because we will see ourselves in them.

For his part, Michael O’Neal hopes that this can happen because he and his family are spending time at home in Charleston – at least in time for the next OneWorld Health golf tournament, which he has postponed for October. "Be compassionate," he said. "Remember how it was."

Andy Olsen is Managing Editor of Christianity today. Susan Mettes is a researcher and writer based in Washington, DC. She lived in Burundi for two years.

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