Body in Motion


To walk in another’s shoes
September 5, 2009, 8:00 am
Filed under: development, health, malaria, poverty

I recently found myself in a village on the doorstep of a community health worker with two colleagues, a Malawian and an expat.

We found a woman and her two children in the house, the younger of whom was of indeterminate age, a sure sign of malnutrition and growth stunting. These children have an eerie look about them: a larger head with an older face upon a tiny wiry body. This child was 2 1/2 but probably weighted what most one-year olds do. We were told the child had been in and out of the nutritional rehabilitation program multiple times. The child was the last in a line of 7 or so children and the father had died the previous year. No, we were assured, the mother tested negative.

The community health worker believed the child had malaria. The nearest health center with drugs to offer was 15km or a two-hour walk away. There is no motorized transport in this tiny village, only a 20-minute drive from the main road. A bicycle taxi would have cost 500 Malawi kwacha or $3.50.

Community health worker bike

Community health worker bike

The mother opted to sit in the dark cool of the community health worker’s house.

My colleagues and I drove away.

Among us, the Malawian has what most of us would call a desk job, though make no mistake of how integral she is to all that we do. The expat is more of an old hand at what life and health looks like out in the bush. We sat in the car, rehashing the situation.

“If that were my child,” says the Malawian, “I wouldn’t care if it were a 2-hour walk. If my child needed care, I would go.”

“It’s not that simple,” says our bush-hand. “It looks as if that is a problem mother. Plus it’s not just the walk – she will have to carry the child there and back herself.” There are structural issues. What will it cost the mother to go, even if the medicine is free? Will she not be able to collect firewood for the evening? Will she have to bring her other children with her on the walk? Did the nurses yell at her for her stunted baby the last time she went?

“Besides,” I say, “I don’t think the child has malaria.” It’s dry season and we are high above the lakeshore. In fact, many studies have shown that only 1 of every 2 people treated for malaria in sub-Saharan Africa actually test positive for the parasite. Malaria is a catch-all for any unexplained fever.

“I would still take my child,” insists the Malawian. “In my village [where her family is from; she grew up in town], the community would organize men to go with her, to carry the baby.”

I listen to my colleague carefully.

There are two truths before me: 1. My colleague and I have a more common perspective than she shares with a villager, despite their nationality; and 2. Structural issues, lack of malaria and all, if it were my baby, I would walk too.

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