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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Ode to Rubber
January 28, 2009, 9:22 pm
Filed under: foreign aid, governance, health, HIV/AIDS, politics

When I was younger (and I won’t say how young), condoms were not so easy to come buy. First of all, they had to be bought. I didn’t have a car and was more or less stuck with the local pharmacy where I was well-known. I remember a friend’s father noting that in his youth, condoms were behind the pharmacist’s counter because they were stolen so often, more out of embarrassment than anything else. But that was the option and when condoms were needed, at least we could get them.

Not so many years later, I found myself swimming in condoms and I still am to this day.

So what happened? I started working in international health. While the US federal government has done what it can to keep condoms out of the reach of ‘kids’ -going so far as to prohibit federal funding for school sex-ed programs that were not abstinence-only- the US government remains one of the LARGEST purchasers and distribution-funders of condoms globally. Go figure.

In my world, condoms are everywhere. In the bathroom at work, handed out at the health center and at concerts, on display in people’s offices. The irony, of course, is that I’m not longer so interested in them on a personal level.

I wish I could explain the bizarre anomaly that is the difference between US government foreign and domestic policy when it comes to these slippery little buggers. Whether you chalk it up to Americans’ puritanical nature when it comes to their own backyard, an altruistic desire to halt the spread of HIV/AIDS or a more nuanced drive to limit world population growth, the paradox remains.

Whatever the logic, it would be nice to see the new Administration* change the domestic climate so condoms truly are available readily and freely to those who want them.

It’s the demystification I’m looking for, outside of the small circle for global healthers with condoms taped to their office doors. The sense that condoms are normal and wouldn’t horrify someone if accidentally left on the dining room table.

But whether you get your condoms from the local pharmacy, a freebie at work or the Happy Banana condom shop in Lomé, Togo, don’t forget to put it on before you get it on!

*Obama’s Administration’s first move to put family planning changes forward has already been shot down.

The Face of a Dollar a Day
April 6, 2008, 4:27 pm
Filed under: africa, bednet, children, cholera, development, driving, health, malaria, poverty, roads, water

Since I was little, Sally Struthers has been asking us to sponsor a child somewhere in the world who is living on less than a dollar a day. I’ve been working in Africa for the better part of the last ten years and have become accustomed to what I see in the village -where most African still live- that once made me stop and think. Six year olds taking care of two-year olds. Kids running around with swollen bellies full of parasites and orange-tinged hair – a sure sign of malnutrition.

In the countryside after the rains, the fields are full of green green crops and overripe mangoes lie rotting on the ground, and I can’t help but wonder how people here can be so poor. The soil is volcanic and fertile. But it’s malaria season, flooding has brought cholera to the surface, and bridges to health centers have washed away only to be rebuilt after an interminable period of time.

Here in Malawi, 133 of every 1000 children born dies before they turn 5. Amazingly, this figure is down from 189 deaths in 2000. Forty-six percent of children are stunted from malnutrition, and only 64% make it through enough school to considered be literate. Over half of Malawians live on less than a dollar a day.

I was in the bush last weekend, face to face with a young man speaking decent English with a good head on his shoulders. He has 2 small children, his wife has passed away. His salary comes out to a bit over a dollar a day, making him just slightly better off than many others in the village. But averaged across his small family of 3, he and his little boy and girl are each living on about 35 cents a day. Even if his kids don’t go to bed hungry, any extra cost -a minibus ride to the health center, a few secondhand clothes- will seriously set them back.

Progress is made slowly, but today out of each thousand born, 56 more children than at the beginning of the decade make it to their 5th birthday. Each step, however small a stride in keeping those most vulnerable alive, is bringing us closer to a world in which a child can grow up to earn more than a dollar a day.

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Malaria makes the Big Time
February 2, 2008, 11:11 am
Filed under: development, foreign aid, health, malaria

For those of you who have been following along at home for some time, you probably already know that I’m a malaria geek. So when a new report hits the media with a lovely tale of how malaria is on the run in this part of the world, it’s really pretty exciting. In Rwanda, malaria deaths have dropped more than 60% in a few months, just by those in a position to do so making sure that enough mosquito nets and effective malaria treatments drugs reach the population.

Malaria has received more attention and consequent funding in the last few years than in has since the failed global eradication campaign of the 1960s and ’70s. The efforts of the Roll Back Malaria Partnership, Global Fund for AIDS, TB and Malaria, the World Bank Malaria Booster Program and the President’s Malaria Initiative have mobilized incredible resources and political support to half the burden of this disease.

Battling malaria should be a simple issue. The politics are not as controversial as with HIV/AIDS, the technical issues are less complicated than TB, and there are more resources available than clean water has. As the report says, all we need to do to get mosquito nets and treatment drugs to those who need them most: kids under 5.

I can tell you from first hand experience that this small feat is not quite as straightforward as it sounds. Even with the wealth of global funding available, there is often still not enough money to go around. It’s only recently that the mosquito net manufacturers have been gearing up their production facilities quickly enough to respond to the need for product. The new artemisinin-based antimalaria drugs need to be stored at cool temperatures – much cooler than health centers in the tropics where electricity is a constant challenge.

I spent most of my days trying to find a way to make things happen, whether it be ensuring that trucks have fuel to carry drugs to where they need to be or working with the Ministry of Health to determine which drugs to order in the first place. At the end of the day, it’s hard to believe I’ve accomplished more than a few sent emails. But reports like this one are enough to make one believe that baby steps will take you where you’re going. It just takes patience.

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Who you gonna call?
December 1, 2007, 11:26 am
Filed under: development, environment, Ghostbusters, health

It’s more than vaguely reminiscent of the 1984 classic Ghostbusters. The protective gear, the spray cans, the coveralls. Bill Murray wasn’t around to see it but this week, Malawi set off to rid herself of some demons: the female anopheles mosquito, carrier of malaria.


In Nkhotakota, one of Malawi’s lakeshore districts, 26,000 households will be sprayed with a biodegradable insecticide that should keep mosquitoes out of people’s homes through the wet season due to start any day now. Furniture and personal belongings are cleared out so the indoor walls of the house can be sprayed with a time-release chemical based on pyrethrin (think citronella). Because the Anopheles mosquito bites predominantly at night and rests on walls after biting (we all need a little digestion time), spraying is a good way to keep mosquitoes at bay.

Malaria is still one of the biggest killers of children in the world – along with diarrhea and pneumonia, poor nutrition confounding it all – and Malawi is certainly no exception. With about 6 million cases annually, the disease detracts from work productivity and school attendance, not to mention the cost to families.

Stay tuned to find out how much spraying really does cut the transmission of malaria around here. It’s the kind of thing that might just change someone’s life.

Congo’s plagues revisit
September 16, 2007, 4:08 pm
Filed under: DDR, drc, ebola, electricity, health, Malawi, water

While it’s a beautiful clear Sunday in Lilongwe, things back in Congo aren’t quite as sunny. What was initially reported as an unidentified disease outbreak in my old home province of Kasai Occidental is now confirmed to be Ebola Hemorrhagic Fever. Friends in the province report 170 confirmed deaths and about twice as many infections. Realistically speaking from my former life in hemorrhagic fever health communications, Ebola is a self-limiting bug, striking in remote places and killing most of its victims before they have a chance to pass it on to too many others. That being said, it still leaves a morbid wake in its path.


On the political side, Fred reports that Laurent Nkunda in eastern Congo is still standing strong against integrating his private militia into the national army. The rebel leader’s latest move in the Kivus has been to destroy both the power supply and cell towers in the area, a new low even for Congolese trouble-makers. (Though their mobile service is probably still better than the mangy service Celtel provides around these parts).

In better news, UNICEF reports that child mortality in Malawi is on the decline; welcome news for a country that generally ranks somewhere near the bottom of the Human Development Index. The decline is attributed to a variety of child-targeted public health interventions including increased immunisation rates, better nutrition and clean water. It is the most basic changes that can have the most impact in this corner of the globe.