“Health Comes First”
This past week we mourned the death of one of my 11th grade students, and the child of one of my 12th grade students, both of whom died after unidentified short term illnesses. I wasn't particularly close to the students in either case, but I was shocked by their sudden deaths. Hence, a reflection on perspectives of health and death in Burkina.
Dealing with Death
Death of a classmate isn't entirely uncommon in the USA. Indeed, most classes are rocked by a death of a classmate at least once during their four years of high school. These deaths are most often due to alcohol, an accident, or a long term battle with illness. In the USA it is incredibly rare to see someone die of a short term illness. What, with incredible medical facilities and endless batteries of tests that can be conducted on a person, doctors are skilled at pinpointing the cause of most illnesses and putting patients on a course of resolution.
Not the case in Burkina. In both of these cases the cause of death isn't known, nor will it ever be known. The doctors weren't ever entirely sure what the student and baby were suffering from, and autopsies are too expensive to be conducted in already overwhelmed medical facilities (except in situations where foul-play is suspected). The deaths were a surprise, but not as out-of-the-ordinary as back home. The statistics for Burkina say a lot: one out of ten children dies before the age of one, and another before the age of five (compared to 1 out of 100 in the US), the national life expectancy is just under 50 years (thirty years less than in the US), and less than half of the population is over 17 (in the USA the median age is 35). In addition to the student and baby this week, I went to three funerals in the past six months for men in their 30s that died after very short illnesses. After 18 months here, I am still surprised at how readily people accept not knowing why the person died. People don't search for the cause because there is nothing to gain by knowing it. There's nothing more to do for the deceased, and there's probably no way to prevent it from happening again. God gives, God takes, and there's no one to blame for it. Death, even of a young and healthy person, is just a normal part of life.
Health Comes First
The phrase “Santé avant tout” literally means “health before everything,” and is taken pretty seriously here. If you're not in good health you should stay home and get better. The theory certainly stood up when Jessi and I had dengué fever last year and spent 10 days in bed. The theory is, once your health goes, there's no way to get it back, which is truer here than back home. Little illnesses can escalate quickly anywhere. For Americans, this escalation means more expensive medical bills, a longer recovery, and sometimes long-term complications. Not the case here. Death is a real possibility, and given the limited medical care available, it is sometimes unavoidable.
Medical Facilities
The contrast between medical facilities couldn't be starker than between Burkina and the USA. In the United States hospitals are filled with the latest gadgets and instruments to poke and prod you until a diagnosis can be made. People in the worst of situations can often be kept (medically) alive almost indefinitely. Babies born well below their birth-weight or with serious birth defects can grow up to be healthy and strong kids.
Admittedly, Burkina is doing better at providing widespread health care to people than a lot of countries. In a city of 30,000 people there is one ambulance, one hospital, and one clinic, staffed by a dozen or so nurses and a doctor (in Burkina there is 1 doctor for every 25,000 inhabitants). There is no access to an X-Ray machine, respirator, stomach pump, ultrasound, or a medical laboratory. Simple surgeries can be performed here if absolutely necessary, but recovery time is incredibly long and risks of infection are high. The primary clients of hospitals are pregnant women and people hard-hit by malaria. For every-day illnesses people simply go to the pharmacy, tell the pharmacist their symptoms, and buy the medication on the spot. (You can actually just tell the pharmacist what you want, like antibiotics or cholesterol meds, and get them without a prescription.) The big medical miracles here over the past 20 years have been decreased mortality for mothers and babies during childbirth (still 1 out of 100 mothers die during childbirth, compared with 1 out of 5000 in the US), and the implementation of medications to combat serious cases of malaria, which are actually quite significant.
Mental Disabilities
Mental illness in Burkina is present in entirely different ways than back home. The prevalence of mental illness is exacerbated here by malnutrition and lack of treatment. Facilities for the mentally ill are virtually non-existent here. Most often people with mental illnesses do not have a family to live with and will roam the streets, partially clothed (at best) in dirt-brown clothes that have never been washed, yelling nonsense at passers-by, begging for food and money. As Jessi and I witnessed in horror, many of the mentally ill are abused by store owners and restaurant owners that literally beat them away so they won't bother their clients (these same owners can be very generous in giving left-over food and provisions to the same people under good circumstances). During my family's visit, we were walking down a street in Ouaga and my parents were shocked to see a man in the dirt-brown clothing scooting along the road on his hands, with the stubs of his legs dragging on the ground, begging for food and money. It's a sad, disturbing sight, but one has to wonder how much more humane it is to hiding the mentally ill in an asylum away from the public's eyes.
Physical Disabilities
Physical disabilities are surprisingly well supported for many people here. There are numerous associations that help people afflicted with physical disabilities gain access to the Burkinabé equivalent of a wheel-chair (which is actually more like a hand-powered tricycle, and is designed more for people to get around a village than inside a building). Many of the physical disabilities here are a direct result of polio, a disease which most Americans have been vaccinated against, though the vaccinations have only been in Burkina for a decade or two.
What to think?
Hard to know really. I could rant for hours probably without coming up with a conclusive commentary, so I guess I'll leave that for you to ponder. My one additional thought: in America it seems that people have come to expect medical miracles daily (and threaten malpractice suits if the miracles don't turn out right). Don't get me wrong, I appreciate medical miracles immensely, especially when my loved ones are benefiting from them, but expecting so much seems wrong after living in a place where one can't even imagine, much less hope for, such great things.
Saturday, January 22, 2011
Tuesday, November 30, 2010
The Spirit of Generosity
A ramble from Tyler
Generosity has always been something I felt pretty good at. I gave to charitable organizations, fundraised, volunteered, etc. It was one of those motivating factors for joining the Peace Corps too, no lie, but on the ground here it looks a lot different than it looked back home.
Someone once said it’s “good to make the poor feel uncomfortable in their poverty,” that this discomfort will motivate them to work out of it. Well, I’d agree a lot more with this statement in the United States than in Burkina Faso. On the contrary, a lot of days I feel rather uncomfortable with my wealth here, and even after being here for 16 months it’s been a struggle figuring out how to deal with that.
A dollar a day
We see the fabled people that live on $1 per day here in Burkina. They’re the subsistence farmers whose livelihood depends on the diminishing rains and depleted soils. They’re the elderly who are no longer able to work, who like 95% of the population do not have a savings/retirement plan, who are now dependent on their families and the generosity of others. They’re 75% of our neighbors here. The dollar a day scheme offers no safety nets, an unbalanced diet, and very limited access to growth opportunities. How should their poverty motivate them? To start a business? With what money? Send all of their kids to school? With what money? Get a job? With what employer? Aside from the civil service (which requires at least an 8th grade education), there are very very few employers in villages and cities, even in a city of 30,000 people like Tougan.
Six dollars a day – Wow!
For perspective, the Peace Corps gives us about $6 per day to live off of. Sounds pitiful, yet it’s more than adequate. We have never withdrawn money from home, and yet we’ve been able to eat at fancy restaurants in the capital, travel around Burkina and to the beach in neighboring Ghana, drink Cokes and beers more or less whenever we like, etc. But we don’t have to use our $6 for a safety net, as PC provides medical coverage, and we can always choose to pack up and go home to the land of plenty. Additionally, that $6 each isn’t responsible for feeding a half dozen children.
A penny for the poor
It isn’t uncommon for people in town to come up to us and ask for money, a sight seen in big cities worldwide. In a predominantly Muslim country, almsgiving is very important, so everyone carries a few coins in their pockets to give to beggars. But in Burkina it goes beyond that. From kids that come up to us asking for soccer balls and old toothbrushes, to people young and old coming to our door to ask for work, money or food. We’re reminded of our wealth on a daily basis as people ask for a chunk of it. While this phenomenon is exaggerated by us being white, in Burkina (and Africa in general) people aren’t too proud to state their needs and ask for things. Wealth and wellbeing are seen as community things, not personal. People are truly able to rely on their neighbors and families here if hardship falls, in a way we don’t often see in the USA, and I have to say it is a good thing 90% of the time. No one is immune to hardship here (the way people often are in the USA with insurance and personal savings), so the policy is “I’ll take care of you if hardship falls, and I know you’d do the same for me.” Community and people are valued more than self and personal gain, and I think we could use a little more balance back home.
Please Sir, I want some more: Oliver meets miserly Scrooge
But how does this play out for us? We feel pretty good about spoiling or neighbor kids who help us in our yard, and with our ‘family’ here. But it isn’t too hard to be kind to those who are kind to you. Yesterday an old woman came to our house asking for food. We gave here a couple pounds of rice and gave the traditional blessing. But it wasn’t finished. She said thank you for the food, and then asked for money. My internal American reaction was “What? I gave you something and you’re telling me it’s not enough? That’s insulting! Well, you can’t depend on me for everything, and look I already gave you food, which is being generous, right?” But is it? The Bible for one never puts limits on generosity. In American we would say “you can’t give like that all the time,” for fear that word will spread around and you’ll have people lining up outside your door, dependent on you. But here I have to question that. I don’t want people lining up outside our door, but if I were to give this woman $1 it would make very little difference in my day to day life, but a fair amount of difference in hers. The woman was absolutely right that the rice wasn’t enough, and that she did need money too, and I can’t fault her for asking. The countless kids that ask for soccer balls could bankrupt us, true, but isn’t it equally a crime that they’re growing up without something basic like a ball to play with?
Teach a man to fish – sustainable development
I feel that there is no way to figuratively or literally teach fishing (see aforementioned lack of opportunities). Everyone here is already farming, it’s just not enough. However, as a development policy handouts are frowned upon because they unsustainable and teach dependence. Very valid points indeed. But we have to consider that Africans have a system of interdependence, and I guess we’re now part of it now. Giving someone a hand may not be sustainable, but it can still be good thing.
It’s difficult to differentiate what feels right and what is right. It’s important to remember that the fundamental difference between my life and hers is where we each were born and who are parents are. I was born in the most powerful, opportunity filled country in the world, and she was born in the 3rd poorest country. As Mr. Smutzler often reminded me, “life’s not fair.” But that doesn’t exempt us from trying to do something about it.
Generosity has always been something I felt pretty good at. I gave to charitable organizations, fundraised, volunteered, etc. It was one of those motivating factors for joining the Peace Corps too, no lie, but on the ground here it looks a lot different than it looked back home.
Someone once said it’s “good to make the poor feel uncomfortable in their poverty,” that this discomfort will motivate them to work out of it. Well, I’d agree a lot more with this statement in the United States than in Burkina Faso. On the contrary, a lot of days I feel rather uncomfortable with my wealth here, and even after being here for 16 months it’s been a struggle figuring out how to deal with that.
A dollar a day
We see the fabled people that live on $1 per day here in Burkina. They’re the subsistence farmers whose livelihood depends on the diminishing rains and depleted soils. They’re the elderly who are no longer able to work, who like 95% of the population do not have a savings/retirement plan, who are now dependent on their families and the generosity of others. They’re 75% of our neighbors here. The dollar a day scheme offers no safety nets, an unbalanced diet, and very limited access to growth opportunities. How should their poverty motivate them? To start a business? With what money? Send all of their kids to school? With what money? Get a job? With what employer? Aside from the civil service (which requires at least an 8th grade education), there are very very few employers in villages and cities, even in a city of 30,000 people like Tougan.
Six dollars a day – Wow!
For perspective, the Peace Corps gives us about $6 per day to live off of. Sounds pitiful, yet it’s more than adequate. We have never withdrawn money from home, and yet we’ve been able to eat at fancy restaurants in the capital, travel around Burkina and to the beach in neighboring Ghana, drink Cokes and beers more or less whenever we like, etc. But we don’t have to use our $6 for a safety net, as PC provides medical coverage, and we can always choose to pack up and go home to the land of plenty. Additionally, that $6 each isn’t responsible for feeding a half dozen children.
A penny for the poor
It isn’t uncommon for people in town to come up to us and ask for money, a sight seen in big cities worldwide. In a predominantly Muslim country, almsgiving is very important, so everyone carries a few coins in their pockets to give to beggars. But in Burkina it goes beyond that. From kids that come up to us asking for soccer balls and old toothbrushes, to people young and old coming to our door to ask for work, money or food. We’re reminded of our wealth on a daily basis as people ask for a chunk of it. While this phenomenon is exaggerated by us being white, in Burkina (and Africa in general) people aren’t too proud to state their needs and ask for things. Wealth and wellbeing are seen as community things, not personal. People are truly able to rely on their neighbors and families here if hardship falls, in a way we don’t often see in the USA, and I have to say it is a good thing 90% of the time. No one is immune to hardship here (the way people often are in the USA with insurance and personal savings), so the policy is “I’ll take care of you if hardship falls, and I know you’d do the same for me.” Community and people are valued more than self and personal gain, and I think we could use a little more balance back home.
Please Sir, I want some more: Oliver meets miserly Scrooge
But how does this play out for us? We feel pretty good about spoiling or neighbor kids who help us in our yard, and with our ‘family’ here. But it isn’t too hard to be kind to those who are kind to you. Yesterday an old woman came to our house asking for food. We gave here a couple pounds of rice and gave the traditional blessing. But it wasn’t finished. She said thank you for the food, and then asked for money. My internal American reaction was “What? I gave you something and you’re telling me it’s not enough? That’s insulting! Well, you can’t depend on me for everything, and look I already gave you food, which is being generous, right?” But is it? The Bible for one never puts limits on generosity. In American we would say “you can’t give like that all the time,” for fear that word will spread around and you’ll have people lining up outside your door, dependent on you. But here I have to question that. I don’t want people lining up outside our door, but if I were to give this woman $1 it would make very little difference in my day to day life, but a fair amount of difference in hers. The woman was absolutely right that the rice wasn’t enough, and that she did need money too, and I can’t fault her for asking. The countless kids that ask for soccer balls could bankrupt us, true, but isn’t it equally a crime that they’re growing up without something basic like a ball to play with?
Teach a man to fish – sustainable development
I feel that there is no way to figuratively or literally teach fishing (see aforementioned lack of opportunities). Everyone here is already farming, it’s just not enough. However, as a development policy handouts are frowned upon because they unsustainable and teach dependence. Very valid points indeed. But we have to consider that Africans have a system of interdependence, and I guess we’re now part of it now. Giving someone a hand may not be sustainable, but it can still be good thing.
It’s difficult to differentiate what feels right and what is right. It’s important to remember that the fundamental difference between my life and hers is where we each were born and who are parents are. I was born in the most powerful, opportunity filled country in the world, and she was born in the 3rd poorest country. As Mr. Smutzler often reminded me, “life’s not fair.” But that doesn’t exempt us from trying to do something about it.
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