Sunday, May 18, 2014

Global Health Critical Reflection #4

One day during my Peace Corps service in Sierra Leone, I was walking home from school and as part of my daily ritual, I walked to my principal’s house to spend time with his eight month old daughter, Fatima. But that day was different. When I went to see Fatima, her eyes were glazed over and her skin was looking pale and yellow. Her mother informed me that she had vomited earlier in the day and had diarrhea. I didn’t think much of the sickness since children seemed to be sick all of the time in Sierra Leone. The next day I was awoken in the morning by one of my fellow teacher’s informing me that Fatima had passed away in the night.
I walked over to my principal’s house and was greeted by the many friends, family members, and community members who came to give their sympathies. I walked straight up to my principal’s wife, Mrs. Turay, who was like a mother to me during my time in Sierra Leone. I went to hug her not even hesitating to think if this was a culturally appropriate gesture. After the embrace, she looked me straight in the eyes and in perfect English said, “Rachel, Fatima was taken from me.”
The child mortality rate in Sierra Leone is the worst in the world (At a glance: Sierra Leone, 2013). During my service, I was constantly hearing about a child dying in my town. Even though I heard about these deaths, I still felt detached from these morbid statistics. When I saw Mrs. Turay in so much pain over her lost daughter, this child mortality rate became a reality for me. In the U.S., if you know a family who has lost a child, it is one of the most traumatic events that affects not only the family but the whole community. I know families in Madina that have lost up to three children. The pain these families bear is unremarkable.
Fatima’s passing is one of the reasons why I am in this class. After witnessing how the death of a child can affect an individual, a family, and a community, I wanted to better understand the root causes of those deaths and what can be done to prevent these tragedies. In Dr. Bhutta and Dr. Black’s article “Global Maternal, Newborn, and Child Health – So Near and Yet So Far,” they outline the social determinants of health that contribute to this severe data – access, the environment, poverty, education, conflict, and gender inequity – just to name a few, each aspect sets the stage for despair amongst millions of families around the world (2013). As I was reading this portion of the article, I was shocked to think that all of Mrs. Turay’s children survived the 11-year civil war, but her youngest daughter could not survive the water the whole family drinks every day.
As I try to understand the complexities of child mortality rates, I often question the validity of the data. Dr. Bhutta and Dr. Black noted that most deaths are confirmed through “oral autopsies” and “in 2010 only 2.7% of the deaths among children younger than 5 years of age were medically certified” (2013).  Therefore, most children are dying in low-income countries and we are not certain what they are dying from. We can extrapolate assumptions based on prevalence of infectious diseases, but is that enough? The need for accurate surveillance is critical and resources most be adequately appropriated to improving these measures.
In terms of interventions, the authors explained the importance of community health worker trainings and toolkits (Bhutta & Black, 2013). Investing in these trainings and resources can be beneficial in poor communities, but for real change, there needs to be a shift in attitudes. Children dying in Africa should’ve never become a norm and families and parents, like Mrs. Turay, should be given time to grieve and process the loss of a child. As I continue the process of developing into a public health professional, I will be reminded of those families who have experienced the tragic loss of a child. I will use those emotions to demand for change, because although I could not help Fatima, there are more Fatima’s and more Mrs. Turay’s who are also demanding for a change.


At a glance: Sierra Leone. (2013, December 27). Retrieved from UNICEF:

Bhutta, Z., & Black, R. E. (2013). Global Maternal, Newborn, and Child Health - So Near and Yet So Far. The New England Journal of Medicine, 2226-2235.

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