Year 25+

In the film "The Graduate" there was that one word- 'plastics'. The word has a great deal of meaning for documentary film, and Zambia, as well. Bear with the extended metaphor...
After my first trip to Zambia in 2005, I returned with thoughts of a documentary film exploring human resource issues in the developing world with Zambia as the case study, and the University Teaching Hospital as the place to film. In addition, a hospice I had visited seemed a place of great hope, as its program for HIV treatment was successfully reaching scores of people in a desperately poor community. To be honest, I expected a film to show how dire things are on the ground in sub-Saharan Africa. But returning to film this past February, a very different film came to be, and it continues to evolve in the editing. My preconceptions about the Zambian health care system were misguided. First, the University Teaching Hospital is only a small part of the health system; the vast majority of Zambians get their care in urban clinics or rural health centres (or community health workers). It made sense to extend the reach of the film to these other health settings. Second, things change quickly. The promising hospice program had shut down. But in the few short years CIDRZ (the Center for Infectious Disease Research in Zambia) had significantly ramped up treatment for HIV. This success also led to a degree of optimism in the film. I had gone to Zambia to show how bad things were in the human resource realm for health care. I returned to show how many good things have happened. My thinking had to be plastic, the film had to be plastic, and the editing- to properly tell the story-had to be plastic. Fixed ideas are the death to any kind of truth and reality ( I won't extend this point to any US government personalities, but....).
The other need for plasticity is in thinking about the improvement in health care in the developing world. As pointed out in the documentary film, one of the reasons anti-retrovirals have been so successfully rolled-out in Zambia is fluid thinking. The Zambian government has had a laissez-faire attitude in terms of the use of the public sector clinics in this regard. Clinics and communities could devise their own methods and protocols for treating and following AIDS patients. It has worked remarkably well. It is also an important lesson for those of us in both the developed and developing world trying to improve health care delivery. Top down money is not such a bad thing, but top down policy (with a few caveats on accountability) may not be such a good idea.
While plastics may have seemed like a horrible future for a graduate in the 1960s, plastics may not be such a bad thing now.