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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Coffin Row
November 21, 2008, 6:29 pm
Filed under: development, HIV/AIDS, lilongwe, Malawi, poverty

There is a place in Lilongwe called Coffin Row. Headstones with plastic flowers encased inside are displayed on the side of the road outside shops. When life expectancy for Malawians is around 50, the coffin business is a thriving one. One in every eight children dies before his or her fifth birthday and about 14% of Malawians are HIV positive.

It’s easy to see how hope gets lost. A church sign along Coffin Row cries “Winners’ Chapel: Home of Breakthroughs!” and I wonder how many people stop there on their way to find a coffin. Does that stop increase the odds of extra years before they themselves become the object of a coffin search? Do they realize their alcohol abuse and promiscuity deliver them closer and closer to the door of “Heaven-bound Coffin Parlour”? Or are they simply reminded of the beneficence of the creator, who will be waiting with open arms on the other side of the light?

Winners' Chapel

As I pass the House of Respected Last Homes, it seems the plastic flowers protected from the elements, enclosed in a tombstone, have a longer chance at longevity than that those who are alive in this country. In a malnourished country where billboards promote “Energy Coffins – 24 hrs!” and margarine as an energy source, that which should sustain us seems a mockery of a healthy life.

Energy Coffins

Living in a place where mangoes rot on the ground while children suffer from Vitamin A deficiencies pokes even further at the bitter irony of looking life and death in the face at every turn. Perhaps I’m due a visit to the Winners’ Chapel.

Mapping the war on poverty
June 5, 2008, 3:34 pm
Filed under: home, poverty

Having spent the majority of my adult life on African soil, trips back to the US are full of both nostalgia and contradiction. Visiting my mother’s workplace in the Bronx is one of the most dramatic of these contradictions.

The Bronx is the poorest urban county in the US, even including middle class neighborhoods like Riverdale. The public school where my mother works is just a few short blocks from what was at one point named the most dangerous block in New York. And yet as I drive to pick her up, I can’t help but notice solid brick apartment buildings (some with more charm than others) and clean streets with minimal graffiti. There are no garbage piles or street children begging by the side of the road. The kids walking past look well-dressed and well-fed.

But poverty in America isn’t about bellies bloated with stage 2 malnutrition. It’s about kids who grow up with at least one parent or close relative in prison, kids who are not hungry but survive undernourished on processed foods with no vegetables in sight. They go to a school where the janitor sleeps overnight for fear of being on the streets after dark. Just as children in the Malawian bush can’t imagine the development in Lilongwe, these kids have never seen a cow and don’t know that the bread they eat comes from wheat growing in the rich Midwestern earth. There are check cashing (at high interest) outlets on each corner and Popeye’s fast food where a supermarket might have been.

American poverty is buried under bright new sneakers and digital cable, hidden behind access to credit and fancy cellphones, when in reality, it’s the lack of the cultural capitol needed (like knowing someone who’s attended and completed college) and strong social supports that hinders people from finding a path to the American dream.

While many of the residents of this neighborhood are African, this isn’t Africa. It’s not one of the poorest countries ranked at the bottom of the human development index. Poverty alleviation doesn’t have to be about those living thousands of miles away any more than those living thousands of miles away are all poor. Each corner of the planet is filled with contradiction. Finding a way of out poverty is just as complicated.

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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