problems in the community

This morning, my electrical kettle melted the inside components of my wall plug. I only noticed this after the wall started smoking. Then, I noticed that my cell phone charger cord was cut in half. Bad start to a Monday morning and I contemplated not going into work. Guilt overrode me at last and I dragged myself up the hill to the clinic. Monday mornings are the busiest time at the clinic and all the women with malnourished children come that day to get their weekly portion of RUTF. RUTF is Ready to Use Therapeutic Food or in other words, a mixture of peanut butter with milk, oil and vitamins. It’s really good for the kids, super cheap to make, and the kids love it. Here in Africa, it’s the usual protocol for children with malnourishment and many NGO’s distribute it. In my community, we give RUTF every Monday to all children in the community malnutrition program. Usually, they’re supposed to be on RUTF for only around three months but since there’s nothing to go back to at home, they usually stay on it longer. One child has been on it for almost a year. When she came to us last year, we were shocked she was still alive. She weighed around 4.5 kg which is the weight of a one-month old baby. This child was one year old. We tried to transfer her to the hospital but they denied our request because they were out of the therapeutic milk. We have kept her on the RUTF for months now and just in the last three months, she has started to gain weight. Now, she is almost two years old and she still only weighs 5.9 kg. This child also cannot walk, talk and half of her face (and body for that matter) is asymmetrical like if she had a stroke. So, the mother and I decided to take her to the hospital again and this morning, we went through the paperwork of getting her to the clinic consultation room and then to the hospital. Unfortunately, the hospital had a staff of one today so he was too busy to see her. One doctor for a whole hospital! Usually, we have one doctor scheduled for emergencies, one doctor for consultations, one doctor-hospital director and one doctor to drive around the countryside evaluating the 14-so sector clinics. Since we only had one doctor, the woman decided to go home and come back tomorrow since she had left two small children at home alone. This woman also lives very far away, near the border of our sector. It’s probably over a two hour walk for her to get home but she’s coming back tomorrow to try to be the first patient seen. This woman is a good mom but she’s had a hard life. Her husband is abusive and I think he has since left her. She is the sole money provider for her kids and she has three of them. About half of the women in my sector give birth at home but she tried to make it to the hospital to deliver this child. Unfortunately, she lives so far away, she delivered on the way to the hospital. In other words, she had to stop in the middle of one of the goat paths leading to the hospital, squat down and have the baby. When the baby was born, she weighed only 2,6 kg.
Examples like this abound in my community and that woman is one of the main reasons I started a community-based nutrition program for the villages in my sector. Women like these have amazing strength and perseverance(Imagine walking eight kilometers in your ninth month of pregnancy) but they cannot handle it alone and many children end up malnourished. I have come to realize that malnutrition is not only a clinical problem or a poverty problem. It’s a social problem. Many of the women in the program have malnourished children because there are problems in the family. Now, I don’t want to criticize the men too much but I am just tired of seeing women coming to me with malnourished children because the fathers are such deadbeats. Either they drink too much, spending all the income on beer instead of food, or they take other wives, neglecting the first or second wife and her children. Sometimes, the fathers don’t work so that the wife has to farm the land and raise the children as well. In other cases, the fathers are in jail because they committed acts of genocide fifteen years ago. There are the war widows and old women who take in orphans because there are just too many children without homes. Then, there are the men who prohibit their wives from taking birth control so that women in the villages have five or six children on average. I heard a story of one woman who had the Norplant implanted in her arm under the skin. When she went home, her husband demanded she return to the clinic and remove it. She refused so the husband removed it himself. This is one reason why many women keep it a secret from their husbands that they take birth control. This is also one of the reasons why some clinics have birth control days on Wednesdays so the wives can tell their husbands they’re going to the market when in reality, they go to the clinic to get the Depo-provera shots. Recently, in one of my nutrition classes, a woman was beaten by her husband for bringing food to the cooking demonstration at the community health worker’s house. In another one of my classes, one of the women left her village after her husband left her and stole all her possessions. There are stories like these for every child in my nutrition program and the obstacles seem insurmountable. In my classes, I try to help them with the poverty problem. We give them chickens to raise and seeds to plant vegetables. We try to teach them how to cook healthy foods. The one thing that we cannot resolve however, is the oppression of wives by their husbands. That will take years of sensitization and it will take women being empowered enough to demand their rights. Still, there are bright spots to every problem. In one of my classes, my model parent is actually a single dad who raises his children wonderfully. In another one of my classes, one of the mothers could not come because she just gave birth, so her husband came to the class for her. For two weeks, he learned about family planning, hygiene, parenting and how to cook. The Rwandan government, as well, is working hard on raising gender sensitivity, empowering women, and lessening gender based violence. The government provides funds for empowerment and self-esteem camps for girls. It also is promoting a gender-based violence campaign with posters sensitizing men not to beat, bully or force their wives to have sex. The reason there was only one doctor in our hospital today was because three other doctors are in Butare training workers on gender-based violence. This campaign is a good thing and I hope people start catching on to the messages. Maybe, in fifty years, people will notice a decrease in malnutrition and poverty in the villages and maybe, they will put two and two together. When people are empowered, know their rights and support each other, you will see far fewer cases of malnutrition and poverty.