No Easy Answers

Here is a story 

to break your heart.  

Are you willing?

Mary Oliver, Lead

The irony was not lost on me when I returned from Malaria Boot Camp and found my very pregnant host sister Diabou sitting in her room with her head in her hands, her temperature through the roof.  There was no one else around to talk to about taking her to the health center for a malaria test, so I acted on instinct and demanded she come with me to get seen right then.  Which implied that I would pay.

To get seen at the health center, you have to purchase a ticket, which, depending on the time of day costs the equivalent of either 20 or 40 cents.  Then, if needed, you will be charged for medication.  Some medications, such as those for simple malaria, are provided free from the National Malaria Control Program and their international partners.  However, other medications like fever reducers cost around $4.  With the issues of language barriers between the providers, who primarily speak Wolof or French, and patients, who speak Malinke and are often illiterate, a lot of confusion exists around medicine and their prices.  This is a tough issue because reticence to go to the health center obviously can exacerbate the health issue, but also carries an economic cost.  In the case of malaria, if you wait long enough for it to develop into complicated malaria, you have to get treated with intervenous quinine, which costs around $10, plus the other medications that they will give to you during your hospitalization, versus the free 3 day treatment with pills for simple malaria.

  Pat and I had previously paid for health center visits for Kharifa, our other host sister's four year old and for Sadio, our host mom, when they clearly had malaria and weren't going to get tested/treated a few months ago.  As I walked with Diabou to the health center, I tried to ignore the thought that they had waited for Pat and I to get back into town with the hope that we would take care of things for her as well.  

  

Because of her pregnancy, her case was automatically considered complicated malaria.  Her fever was high enough that the midwife told me to run to the pharmacist's house to bring him to the health center so that we could get the medication she needed.  It ended up costing about $26 just for the initial medicine.  I didn't know what to do besides just pay for it, since the situation was so scary.  As this was all unfolding, I felt myself retreat into robot mode. I did what was asked of me and went through the necessary motions, without allowing myself to really feel or process the situation.  This is a trend that I have noticed in myself as my service has progressed.  In life before Peace Corps, I was a person that felt things, both positive and negative things, very strongly.  I wore my heart on my sleeve, and my emotions were not kept from anyone.  Here, I have found myself retreating away from strong emotions, becoming numb to things that would hurt too badly if I let myself feel them at my normal rate of feeling.  

All in all, Diabou was hospitalized for about four days, and everything turned out ok.  However, in the midst of her illness, I just barely took note of Alamuta, her two year old daughter, and the bandage around her finger.

Let's just be honest.  Alamuta (on the left) is my favorite of all the kids.

A few days after Diabou was released from the hospital, a team of doctors from Chicago came to our site as a part of a project called peacecare (blog about the peacecare project coming soon).  The group normally ate at the health center during the stay, but we arranged for them to have a real Malinke culinary experience one day, and they came to have lunch with our family.  Alamuta came out of her family's hut holding her hand   at an awkward angle next to her chest and grimacing.  She no longer had the bandage, and now it was plain to see that her middle finger had a nastily infected wound, and her hand was swollen to twice its normal size.  The doctors took a look at it and said that she should be taken to the health center to get it lanced and drained.  I relayed this information to Alamuta's parents and grandparents and was assured that they would take her that evening--the sun was presently too hot.

When I went back to check that evening, they said they would take her in the morning.  Her father, Sambaly, who is deaf, shrugged sadly and rubbed his fingers together to suggest that it was a money issue.   A slightly different version of the same interaction continued to unfold when we would check in each morning and evening for the next several days.  Pat and I found ourselves faced with a moral dilemma.  Taking her to the health center ourselves would alleviate both her suffering and our consciences, but would continue on the path to creating a dependency on us.  It didn't feel like either answer was right, and I felt like I was robbing myself of my humanity but not responding to Alamuta's cries for the sake of sustainability. How could I be ok with myself for not paying an amount that was nothing to me while it clearly presented a major obstacle to my family?  On the other hand, we had just heard the story of another volunteer who had returned to his village to the news of his little host sister's death from malaria.  When he asked why they hadn't taken her in, the response had been that he hadn't been around to take her.  Thinking back on Diabou's condition when we had arrived from Kedougou the last time, it was scary to think about not drawing a clear line and potentially creating a situation where they would wait for us before taking action on scary health situations that occur all too frequently here.

So, as the time passed, we waited, agonized, and tried in vain to convince them to take her in.  Finally, after about three days of this, and a week after the initial injury to Alamuta's hand, Pat couldn't take it any more.  When Sambaly said there was no money, Pat pointed angrily to the building where he runs a barber shop(the cost of a hair cut is more than the cost of an appointment at the health center).  He was told that no one had gotten their hair cut that day.  "Then cut my hair!" he yelled.  He put the 500 cfa piece directly into Alamuta's undamaged hand and accompanied mother and daughter to the health center.  I got back from doing a cervical cancer screening in a distant village and met them on the road, feeling relieved at the semi-solution Pat had found of paying for a service but ensuring that the money went where it was needed.

Since we work so closely with the health center, Pat was able to just go find Elodie, one of the nurses and a dear friend, and have her look at Alamuta immediately.  Upon seeing the condition of her hand and learning how long it had been since the initial wound, Elodie chastised Diabou for waiting, saying that it could have been possible for Alamuta to lose her hand or even to die from the infection. (It was all in French, so the words weren't understood, but I think the tone carried the message.)  Then Pat had to hold Alamuta's entire body as she thrashed and screamed while Elodie lanced the infected finger.  I have never heard cries like that and had to leave the room.  I can't imagine having to watch your own child go through that, but Diabou kept a straight face and later teased me about crying.  I guess I'm not as numb to things as I had thought.

Alamuta was given a prescription for oral antibiotics, but Diabou wanted to go home without stopping at the pharmacy.  She didn't have any more money.  Not wanting to start the whole charade over again, I said that I would pay for it as long as I they paid me back.  It cost $4, and they paid me half of it back that night.  I also had a conversation with Diabou about how if she would just go in earlier, she would have to buy less medication and then pay less money.  Although this seems like a basic logical principle, it's not as simple when you haven't had any education.  She acted like she was hearing this information for the first time, and that the wheels were turning...let's hope they turn into action next time.

The crisis at hand seemed to have been averted, but we still were worried about the next time something happened.  We pay 20,000 CFA ($40) as a family contribution for food, etc each month, and Pat had the idea that if we increased that by about $10 (which we usually give anyway in direct vegetable contribution), we could put it in a special envelope that was designated particularly for visits to the health center and medication.  It would serve as a health insurance for the family that we paid into at a set amount each month. That way, since they would have the money, there would be no excuses for not going to the health center, but it would still feel like it was costing them something from this special fund that was now theirs.  I'm very interested to see how this works out.  It seems like a great idea, but many great ideas here just don't work.  At this point though, I'm willing to try anything.

These are tough issues, and there are no easy answers.  My struggles with guilt over my own affluence are sometimes all-consuming, but how to best deal with that guilt?  By solving the short-term problem and relieving the guilt right then or by somehow working toward lessening the problem in the long term?

I started this tale of infection and woe with the beginning of a Mary Oliver poem, and I'll finish it with the end of the same poem.

I tell you this 
to break your heart,
by which I mean only
that it break open and never close again
to the rest of the world.