Love and Healthcare in the Third World

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It almost appears that parents in the African bush don't seem to care when flies crawl over their child's face, or when their children play in contaminated water or sleep in flea-infested dirt-floor huts or catch diseases long eradicated here in the "developed" world.

But too often these images are aired to advance specific agendas. So, I wanted to check out at least some small part for myself, up close, not filtered through someone else's lens. I always thought the more I experience the landscape of human condition, the better I will be at nursing.

Nearing the end of five months on a journey across Equatorial Africa, I found myself with two nurses dispensing vaccines outside the village Jinka, Ethiopia. I rode with them through a parched landscape. The riverbeds were bone dry and the sun unremitting. We visited adobe-type huts filled with families. Children played and laughed. Babies were swaddled in colorful cotton, wrapped tightly against their mothers' backs. It is said that the feet of an Ethiopian child never touches the ground for the first year.

Here, in the USA, we worry about VAP rates, and we should. There, they struggle to maintain the integrity of vaccines without reliable refrigeration. Here, we worry about childhood obesity, and we should. There, they worry about malnutrition and dysentery. These nurses were like primary care physicians. But there are so few of them. The pay is desperately low and the supply chain for medicine fragmented. Much care is provided by foreign organizations.

We discussed the need for education in these rural areas. But in a country of more than 77 million people, there are only seven schools that offer a Bachelors of Science in Nursing. This results in a nurse-to-person ratio of about one per 4,900. Obviously, misery exists and the challenges are daunting. But, here, in this collection of huts, I saw love in the eyes of the mothers and the of play joy in children.

Outside one hut, I heard the rhythmic grinding of stones. Through the portico entrance, I saw a wrinkled neck of a woman. In her hand, she gripped an egg-shaped stone. She was crushing grain against a much larger large flat stone.

"Teanaste'lle'n", I said, "hello" in Amharic. She smiled and ushered me in. In some silly western way, I wanted to show her I wasn't there to gawk and snap photos. I motioned for the stone. In short order, my muscles ached and my sweat dripped into with the grain. I felt like a first-class fool.

I wished I could have told her what dignity I saw in her people. I wanted to discuss how many of us take things for granted and why it sometimes seems that the accumulation of possessions, like a parallel line, never seems to bisect the lines of contentment. I wish I could have asked her about all those television images of despair.

No, I see no exotic glamour living a life devoid of running water, electricity, or one with a healthcare net consisting of a single thread. We can argue whether our lives would be richer and we more sensitive healthcare providers were we to spend part of them without material comforts. Or whether this woman's lack of access to first-world medical delivery systems somehow reduces the amount of hope she has for her children or the amount of love she offers knowing they may die before their time.

I did know that I could not look at our healthcare system the same way. I knew that what we offered some of our patients in our ICU, at least provided the chance of a life that afforded the possibility of happiness--that Holy Grail of human desire.

And I knew that, in large measure, love and caring was not dependant upon what we possessed, what we knew, or what we could achieve.

Love and Healthcare in the Third World

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