child not only with immunizations but also with prophylaxis against malaria, screened windows to protect against mosquitoes, bed nets, and safe water. The villagers could not do this for their children. They did not have access to such basic health practices. They had to spend the little money they had, the equivalent of $1 per day, on food and shelter.
While village life in Africa offered a predictable rhythm and the benefits of community, I was also struck by its limitations. People with wealth and education in a country like the United States can read about a new idea in the
New York Times
in the morning and be applying it in the afternoon. Those without education or money, whether in the United States or in Africa, cannot. Lacking the resources to change their future, they fall prey to a certain fatalism. Through the years I have come to see fatalism, the assumption that you canât really change your future, as one of the great challenges in global public health.
Another lesson I have learned over time is to respect culture as a powerful force; when you tangle with it, culture always wins. Thus, itâs essential to approach any culture and its customs with respect. An early demonstration of the power of culture occurred one evening in Okpoma. Some neighbors were visiting us in our courtyard. One of the women had been stung by a scorpionâa very painful condition but usually not fatal for adults. I offered her the usual medical treatment, an injection of a local anesthetic. She refused and instead wanted to see the local healer. We walked to his house and watched as he spit into the dirt to make a paste and applied it to her sting. From the standpoint of Western medicine, this treatment could have brought no immediate medical benefit, yet she immediately stopped crying and moaning. It was a dramatic example of the power of belief in the effectiveness of a traditional cultural practice.
While contact with other expatriates was limited, I did find a mentor in Nigeriaâanother former EIS officer, Dr. Herman Gray, who was doing missionary work. Paula, David, and I spent a weekend with him. Besides sharing many observations about diseases and their treatment under African conditions, Gray gave us a primer on snake bites. He had a collection of preserved snakes that he used as a reference to identify the dead snakes that people brought to him when they sought treatment for snake bite. The peopleâs well-justified fear of snakes made it even more astounding that they could find the courage to walk barefoot on paths after dark. We saw this fear demonstrated when our house-helper, Lawrence Atutu Ochelebe, on finding a snake in our house, beat not only the snake but also the broom into an unrecognizable pulp.
Figure 2.
David Foege and village children, Nigeria, 1965
After six months, Paula, David, and I moved to the medical compound at Yahe, and I began working in the clinic. In Yahe we still lacked electricitybut did gain the luxuries of running water and a bathroom. Here I joined three nurses in running clinics while putting my new language skills to use. In rural Africa, where separate languages coexisted in small geographic areas, learning one local language was only a beginning. At the clinic we might see patients from more than twenty different language groups in the course of a week. Sometimes three interpreters were required to communicate with a single patient, increasing the opportunity for errors of interpretation.
The combination of pathogens we would see in a single child was often a source of dismay. A young girl might appear at the clinic with a case of measles, but an examination would then disclose that she was also malnourished. She might also have malaria parasites circulating in her blood, microfilaria from onchocerciasis coursing through her body, blood in her urine because of schistosomiasis, and hookworms, roundworms, and whipworms in her intestine. Most of these problems could have
While village life in Africa offered a predictable rhythm and the benefits of community, I was also struck by its limitations. People with wealth and education in a country like the United States can read about a new idea in the
New York Times
in the morning and be applying it in the afternoon. Those without education or money, whether in the United States or in Africa, cannot. Lacking the resources to change their future, they fall prey to a certain fatalism. Through the years I have come to see fatalism, the assumption that you canât really change your future, as one of the great challenges in global public health.
Another lesson I have learned over time is to respect culture as a powerful force; when you tangle with it, culture always wins. Thus, itâs essential to approach any culture and its customs with respect. An early demonstration of the power of culture occurred one evening in Okpoma. Some neighbors were visiting us in our courtyard. One of the women had been stung by a scorpionâa very painful condition but usually not fatal for adults. I offered her the usual medical treatment, an injection of a local anesthetic. She refused and instead wanted to see the local healer. We walked to his house and watched as he spit into the dirt to make a paste and applied it to her sting. From the standpoint of Western medicine, this treatment could have brought no immediate medical benefit, yet she immediately stopped crying and moaning. It was a dramatic example of the power of belief in the effectiveness of a traditional cultural practice.
While contact with other expatriates was limited, I did find a mentor in Nigeriaâanother former EIS officer, Dr. Herman Gray, who was doing missionary work. Paula, David, and I spent a weekend with him. Besides sharing many observations about diseases and their treatment under African conditions, Gray gave us a primer on snake bites. He had a collection of preserved snakes that he used as a reference to identify the dead snakes that people brought to him when they sought treatment for snake bite. The peopleâs well-justified fear of snakes made it even more astounding that they could find the courage to walk barefoot on paths after dark. We saw this fear demonstrated when our house-helper, Lawrence Atutu Ochelebe, on finding a snake in our house, beat not only the snake but also the broom into an unrecognizable pulp.
Figure 2.
David Foege and village children, Nigeria, 1965
After six months, Paula, David, and I moved to the medical compound at Yahe, and I began working in the clinic. In Yahe we still lacked electricitybut did gain the luxuries of running water and a bathroom. Here I joined three nurses in running clinics while putting my new language skills to use. In rural Africa, where separate languages coexisted in small geographic areas, learning one local language was only a beginning. At the clinic we might see patients from more than twenty different language groups in the course of a week. Sometimes three interpreters were required to communicate with a single patient, increasing the opportunity for errors of interpretation.
The combination of pathogens we would see in a single child was often a source of dismay. A young girl might appear at the clinic with a case of measles, but an examination would then disclose that she was also malnourished. She might also have malaria parasites circulating in her blood, microfilaria from onchocerciasis coursing through her body, blood in her urine because of schistosomiasis, and hookworms, roundworms, and whipworms in her intestine. Most of these problems could have
Similar Books
