What You Don't Know

Contrary to the idiom, we all know that what you don't know can hurt you. In fact, what you don't know can kill you. This is especially  true in regions of the world where gaining information critical to one's  health is often difficult to impossible for people living in rural areas.

Although our experience in the village of Kainga has made it clear that the women are eager to learn, when they are given an opportunity to share their understanding, we see huge gaps mixed with some misinformation.

Today at Kainga I shared the warning signs of dehydration in children and how to rehydrate a sick child. The women already knew about the packets of oral rehydration solution (ORS) because these are available at the clinics. I warned them that there is no time to waste when a child has had diarrhea and is dehydrated because a lack of fluids can kill a child within hours. At that point, the women told me that they had heard that giving a dehydrated person a mixture of water, salt, and sugar can cure diarrhea. When I asked them what proportions, they said a  heaping tablespoon of salt and a little sugar mixed in a glass of water. Actually, the formula they gave me is dangerous and can make the problem worse.

So, today, the women learned  to mix a liter of clean water with six level teaspoons of sugar and a level half teaspoon of salt. They really enjoy working together with hands-on materials  and having the opportunity to share what they have learned. Each group was given a picture of a child to label where symptoms of dehydration can be visible, then in small groups  they discussed all the symptoms of dehydration. Another very important part of the lesson was learning when to seek medical help.

At the conclusion of the lesson, I asked if there were any other medical concerns, and one young mother asked me what could cause her daughter's eyes to be jaundiced.  That was a very serious question that deserved a quality answer. I asked if she had other symptoms. Does she have appetite? Is she taking fluids? Does she seem ill in any other way?  She told me there are no other symptoms. Immediately, liver damage, hepatitis, and yellow fever came to mind. Any of these can cause serious illness or death. I advised her to take her child to the clinic immediately. I was surprised to learn that she already had taken her there and returned without a diagnosis or treatment. When I asked her to describe what happened at the clinic, the mother said she was told to give her daughter a mixture of  brown sugar and water, then was sent home. I  promised her that I would learn all I can that could help her daughter and that I will share with her what I learn. 

So, why did this mother not get the answers she deserves?  Malawi has a population of about 15 million people, but there are only 360 medical doctors in the whole country. To put this in perspective, one hospital in Winston Salem, a midsized city in the US, Wake Forest University Bowman Gray School of Medicine has more doctors than all of Malawi. Malawi has the highest  patient to doctor ratio in the world,  88,000 patients per doctor.  That means that on any given day, when a woman takes her sick child to a clinic, she will not  see a doctor.  Clinics are usually staffed by clinicians and  midwives.

All of this underscores the need for life-saving information in the rural areas, information that will help the women  make informed decisions about the health of their families.