June 17, 2010
On Thursday, Yiwen and I went with the “mobile clinic” nurses to a village called Dzama, 19 km (about 10 miles) from St. Gabriels. We hopped in the back of the pick-up truck with two nurses, and drove, slowly, though the countryside and small collections of houses over the bumpy red dirt road. With us we took syringes, a mechanical scale, immunizations, a blood pressure cuff and some record books. Along the drive we pick up a few more community health care workers.
Once we got there, we were greeted by a long line of mothers, all either pregnant, with their small children or both, standing outside the school house. (school is only Monday –Wednesday here) My job was weighing all the pregnant mothers on the scale and recording their weight in their “health passports”; yellow books especially for womens health, with sections for general health, family planning, ante and post natal checkup etc. Other things done that day were providing DPT (diphtheria pertussis and tetanus ) vaccines, weighing children to see if there are malnourished. All the pregnant mothers went to a back room for further exam, I don’t know what of.
Some babies on seeing me, especially if I waved at them, would turn towards their mothers and cry. A few even called out “mzungu” (foreigner) in fear. Most however are quite and curious. After all had been treated, I stepped outside to see a small crowd of young girls. I walked toward them to offer my hand for a hand shake, and it took awhile for a few to be brave enough to shake my hand. Soon though, with the help of some interpretation, I was teaching them how to play “red rover” and “duck duck goose.” Mothers gathered around to watch us. After games, the girls taught us their dances, and Yiwen and I danced with them. I bet we looked pretty silly but everyone was having a good time.
The pregnant mothers ranged in weight from 41 kg (90lbs) to 80 kg (175 lbs), however, this last mother was a bit of an outlier from the whole group. Almost all of the mothers were shorter than me, at my medial 5’7’’, even when they were standing on the scale. It seems like many of the women here are smaller in stature. It is difficult to tell if they are underweight because of the layers and layers of fabric they wear. Perhaps their smaller stature arises from consistent malnourishment, which is a problem here. When we were driving through the countryside there were many “feeding programs” organized through schools and some of the pediatric patients come in with little fuzzy orange-ish hairs on their heads, which, I think, is an indicator of malnourishment.
Malnourishment is an interesting problem that presents in all societies, even still in the overfed US. In medical anthropology, our class discussed some theories of malnourishment and there are even some, although not well respected scientists, who argue it is not detrimental to development. Here though malnourishment puts people and much greater risk for infection from things like a common cold to HIV. It creates a vicious cycle of malnourishment, weakened immunity, infection, increased caloric needs which in turn, exacerbates malnourishment.

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On Friday we tested the oxygen concentration sensor that was brought last year. It still worked well with both machines used in pediatrics to concentrate the oxygen. The technician says they use them about once a month when they are doing their routine checks of the oxygen concentrators. Since the O2 cartridges still seem to be working pretty well, we just showed the techs how to replace them once they start to perform less well. We are giving them a card with instructions on how to tell when it is going bad, how to replace the cartridge and how to recalibrate the sensor if necessary.