Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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The characteristic American behavior called volunteerism got its start with Benjamin Franklin's Junto, and has been a source of comment by foreign visitors ever since. It's still a very active force.



On 23rd Street, right next to the home of the First City Troops, is another organization of quite a different character. This is MANNA, which stands for Metropolitan AIDS/HIV Neighborhood Nutrition Alliance. This group was founded in 1990 by members of the Presbyterian Church at 21st and Walnut but has become independent and non-sectarian. It has an annual budget of over $3 million, a hundred paid employees, and a thousand volunteers. They deliver meals to people who have been referred to them by physicians as suffering from AIDS, and agreed by the social workers on the staff, to be poor. Last year, they delivered 650,000 free meals and spent a lot of effort fund-raising to do so. About half of the funds come from the government, quite a bit from private foundations and individuals, and a lot from six annual fund-raising events. One of the six events is to sell pies at holidays, one is a Ballet Performance. There's a black-tie dinner, and so on. So the organization is a curious mixture of Show Biz and earnest volunteerism of the old Philadelphia spirit and style.

One might suppose from all this that Philadelphia is riddled with AIDS, and of course we do have a discouragingly large number of afflicted victims. However, there are a million people in the USA with HIV, and only 20,000 are found in Pennsylvania By contrast, New Jersey has 50,000 victims. And all of that is almost trivial compared with 40 million known victims worldwide with probably a lot more who are unrecognized as sick. The World Health Organization has found cities in Africa, Mombasa for instance, where 90% of the babies born in the hospital test positive. It is reasonable to suppose that Africa will be totally depopulated in a decade if matters continue unchanged.

So, in the meantime, until someone figures out something better to do, Philadelphia is responding to its problem in a traditional and typical way. The writer Susan Sontag has been saying that nothing short of a religious crusade for monogamy will save the undeveloped world, and maybe she's right. At least, people are thinking about the problem and trying to do something, however inadequate, to help.

Originally published: Monday, June 26, 2006; most-recently modified: Thursday, May 23, 2019