A few of my colleagues and fellow travelers bear special remembrance after leaving us too early. While nothing here can do the memory of these exceptional people justice, I hope to give people a glimpse at these wonderful, talented and missed colleagues and friends.
I met George during on of my first trips to Kisumu, probably in around 2010. At the time, I was working closely with a new colleague from the area, Thomas Odeny, on examining loss to follow-up from HIV treatment programs. George was quiet, and at first glance, looked frail – thin as a rail, and soft spoken. But within moments of exchanging a few introductions, I was aware that I was in the presence of a giant. At the time, he had already risen from a peer educator to become a part of the leadership of the Family AIDS Care and Education Services Program. George had a steadiness and seriousness that reflected his own experience of someone who had been living with HIV for many years, and never lost sight of that even as an implementer and leader of a public health program.
George was recognized as a man of great insight. He had insight into the geography and the locations of the region, and so programs seeking to locate patients often sought his advice. He had insight into the programmatic systems and structures and so understood what resources public health could offer to which patients. He had great insight into the experience and behavior of living with HIV, and picked up on subtle but critical elements of what challenges in an individual’s life were present. But more than anyone else, George understood how all the pieces of this puzzle – the HIV epidemic and its public health response — came together in the lives of individuals. And as such, he never lost sight of the notion that systems are meant to serve people and was uniquely positioned to help them do just that.
George was also a creative thinker and researcher. Often when we intersected, he would toss out a few thoughts about things he thought should be studied, and they were always brilliant. Long before the recent differentiated service delivery mantra, he felt we should simply ask patients when they wanted to come back to clinic and give them that appointment interval, rather than impose a visit schedule. That is a great idea – still waiting for someone to test that idea. He wanted to compare doing something intensive in patients starting treatment and then backing off to the current approach of doing light touch counseling followed by tracing for non-return. That’s another critical question for public health.
George passed in early 2021 after an illness.
https://www.uab.edu/sparkmancenter/honoring-the-life-of-george-owino
Dr. Czaicki was one of my earliest mentees when she was a doctoral student at UC Berkeley working with myself, Nancy Padian and Sandra McCoy. She was a vibrant and dynamic addition to our team and emerging work with partners in Zambia – Carolyn Bolton, Charles Holmes, Izukanji Sikazwe, Kombatende Sikombe and others. She was a natural bridge for our research collaboration between UCSF (where I was faculty at the time) and the Centers for Infectious Disease Research in Zambia, and split her time between the Bay Area and Lusaka. She contributed broadly to many research studies examining retention in HIV services, novel models of service delivery and the patient experience.
She is remembered by colleagues not only for the work she did, but also for the way she did it. Working on health across national boundaries is always accompanied by important dynamics to acknowledge. Working in Africa on health must address important inequities in opportunities between North Americans and young professionals in Africa. Americans have more opportunities to enroll in degree conferring programs, access to scholarships, and privileges than young researchers and professionals in Africa. While these disparities are due to many factors in a post-colonial world, and can’t be remedied early by one person, Dr. Czaicki’s day to day work acknowledged and tried, to the extent that she could, ameliorate these differences. This was expressed in her collegiality, access, eagerness to teach and share what she knew and commitment to equalizing health around the world.
After finishing her doctoral studies, she planned to relocate to Lusaka with her fiancee, Dr. Jake Pry, also an epidemiologist. Dr. Czaicki passed away after an accident in early 2017. A fund has been created by her family to support causes she was dedicated to. She is remembered by so many who worked with her.
Dr. Bosco Mwebesa Bwana was one of loveliest people I have ever known. I recall sitting with in in the old clinic in Mbarara not long after meeting him ( ~ 2006). It was late afternoon, he’d seen maybe 40 patients, no lunch, few breaks, in an exam room uncomfortably warm in the afternoon sun. I had the greatest admiration for his presence as he greeted the 41 patient of the day with the same calm voice, unhurried questions and dignified manner that he greeted the very first. He asked questions, listened carefully to the patient’s responses, documented, reassured and prescribed. It was the picture of dedication, of care and of respect. I’ve practiced medicine in lots of places in my life and that memory sticks out to me as emblematic of what being a doctor is all about.
When I was in Mbarara more often than I have been in recent years I would often find myself at Bosco’s and Annette’s (his wife) place for dinner, with an added privilege of seeing his lovely children grow up. I think the last time I was there, we took a walk down the road from his house, and he showed me various fruit trees growing on his property. We admired some I think it was maybe passion fruit. He described with great care how he was building out different parts of his home, with great pride, as well as the trees and fruit in the vicinity. The house was an oasis of calm and care, capturing this spirit in every way.
A couple of years ago we were at a scientific meeting in Kenya. At the time, the US CDC was pushing this “new thing” in the HIV clinics– “differentiated service delivery” which included various models of care that sought to reduce the frequent of contact with the clinic (and thereby lessen the burden of encounters on patients many of whom were healthy and did not need them). We were having mid-morning coffee at one of those stand-up break-time tables. Bosco told me how for years he would give couples who were both getting ART alternating 3 month drug pick ups so each could deliver the medications to the other and therefore each come to clinic only twice a year. He’d been doing DSD for a decade by the time the donors caught on. We both chucked about the CDC contingent descending onto the clinic to promote this new donor-driven “innovation.”
Dr. Bwana passed in 2020 from a sudden illness. He was 44 years old. He fought the good fight every day. He is much missed by a huge community, including colleagues and friends who had pleasure of worked with him – a group in which I humbly claim membership.