Sante Avant Tout

“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.