Tuesday, September 19, 2006

Frontline health care in rural Zambia ca 1983





Everyone is posting cool pictures on their blogs, so I thought I'd go way back to 1983 and show a photo of a rural health clinic in Zambia. Mothers brought their under-5 children to have them weighed and innoculated. Children who were underweight were given a special high-protein supplement in an attempt to battle kwashiorkor. Traditionally, once mothers become pregnant they wean their children. The transition from mother's milk to maize meal is a difficult one for a two-year-old, given that maize has only about 8% protein.

The clinic is being held in a primary school in the Gwembe Valley near Lake Kariba that separates Zambia and Zimbabwe. It is an area that is drought prone and was also quite insecure (i.e., there was a lot of conflice between guerillas and Rhodesian fighters) until 1980 when the Zimbabwean independence war ended.

The second photo is a clinic built by the Salvation Army in the village of Chaanga, about a day's walk from where the first photo was taken.

2 Comments:

Blogger Dean Giustini said...

Great photos. Any idea what the information provision is like in developing countries?

This is an area of interest and concern of mine. Any insight,D.?

Dean

3:51 p.m.  
Blogger InfoLit Librarian said...

Hi Dean,

I can only comment on what I know of the situation in one small part of rural Zambia, 25 years ago (plus what I’ve learned since through reading). I suspect many things are still the same, although AIDS has added a sense of urgency to information provision.

A number of factors make information provision in rural Zambia difficult. First, Zambia has 41 languages (5 of which plus English showed up on the custard powder box) and estimates of literacy rates vary from 25% to 76% (presumably rural areas being lower than urban areas). Transportation is difficult. The roads are not well maintained and for most people, walking is their primary way of getting around.

The biggest challenges are cultural. Traditionally in Zambia, disease had (and still has) connections with witchcraft. If you get sick, you go to the local witch doctor/traditional healer (they tend not to distinguish between the spiritual and physical causes of illness) to find out who is trying to do you harm and then receive some sort of protection against it. Therefore, one of the biggest hurdles in information provision is overcoming what people believe to be the cause of disease.

An illustration of the difficulty. At the secondary school where I worked, we showed movies every Saturday night for the students and as many of the village kids who could crowd into the recreation hall. I had more than one student tell me that when he first started watching movies, he believed the people being shot were actually being killed. Now he is in high school taking biology class and the teacher shows him some bacteria through a microscope and says these cause disease. The images you see through a movie projector aren’t reality, but what you see through a microscope is. I’m not trying to say that the students didn’t believe bacteria cause disease, but it is important to consider how technology mediates information in different cultural contexts.

Other cultural practices have hastened the spread of AIDS (I’m mentioning AIDS because it is a far more deadly result of traditional behaviour than the various STDs that were common among our students and others). Traditionally, when a husband dies, his wife has intercourse with one of her dead husband’s male relatives (usually a brother) to “cleanse” her from the curse that has come from her husband’s death. If her husband died of AIDS then the “cleansing” serves to spread the disease.

Sex education is a possible solution, but even if you convince them that having multiple sexual partners spreads AIDS, they may still not feel the connection is strong enough to modify their behaviour. We are not that different in Canada. We know eating fast food is not good for us, but the connection between junk food, weight gain, and heart disease seems so indirect, that we push it to the back of our minds and eat on.

I’ll add a couple of links that give more information. The first describes the community care and education that the Salvation Army is providing in the area where I used to live. The second is an interesting set of research summaries from the University of Zambia.

http://hab.hrsa.gov/publications/palliative/palliative_and_home_care.htm
http://www.medguide.org.zm/aidsbibl/socio5.htm

12:31 p.m.  

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