The daily grind

We would generally rise between 4:30 and 5 am to be on the road to the next village and arrive by 7 am so that we could conduct the interviews before the women left households for work in the fields. We’d meet with the village chief to conduct formalities and then a community volunteer would take the team to the center of the village, where we’d number all of the houses in and randomly select the starting households for the interviews with mothers.


I would follow one pair of interviewers each day, observing the interviews and helping with the process of taking and recording arm measurements, answering questions from interviewers, and reviewing questionnaire forms for accuracy and completeness prior to leaving each household.





















It pained me to hear women report that they had lost children. What perplexed me the most was their seeming acceptance of such loss as God’s will, « the child was not meant to be here now ». My understanding, from conversations with people here, is that when one dies families rarely inquire about the cause of death. There are more children to be had. Successive children are sometimes named the same name as the child who died.

There were 20-year-old women who’d had 2 children, and 30-year-old women who had 8 children total but now had 6. It was devastating to watch a woman state her loss as simply matter-of-fact, as if she’d been asked if she had washing to do or a husband to feed. This makes the prevention of malnutrition especially challenging – in areas where child mortality is not viewed as preventable (or might be viewed as interfering with God’s plan), it’s extremely difficult to explain that it’s possible for a sick child to survive and for his/her health to improve with nutritional rehabilitation.

Women work relentlessly each day, carrying water or huge bundles of wood on their heads, caring for all the children and other family members, cooking, cleaning, and washing. In the early mornings I’d hear they rhythmic sounds of corn or wheat grinding with alternating thuds as the huge stick would pound into the wooden bowl. Seeing women laboring and caring for their families (while the men lounge in the shade and sleep or drink their tea), as well as the distances between some of the villages and the health centers, I have a better sense of why the nutrition services at the health centers appear to be drastically under-utilized : there are more children to take care of, there is more work to be done and it’s just not realistic to expect these mothers to travel with a child who is ill, leaving behind other children for days to sit in a health center (where there are no services for the mothers, like food and a bed to stay with her child). From some villages, we’d travel an hour in the car on a sandy road before we’d arrive at the health center. I can’t imagine how long the same journey would take by foot or by donkey cart, especially in 95-degree heat. And how disappointing to reach a health center where the supplies of fortified flour or a peanut-based food supplement have expired or haven’t been delivered for 2 months.

Still, I am amazed by the resilience of women and children in the villages. Despite having little or no education, few material goods or modern amenities, no running water, no electricity, suffered the loss of children, carrying out excruciating physical labor every day, and constantly deferring to a husband’s wishes, by and large, the women I met beamed with an unmistakable «joie de vivre» : they are blessed with children, surrounded by large, extended families, and they seem genuinely happy.



Despite this, there is still a need to improve the services available to people in these remote areas. Children are always coughing and have runny noses because of respiratory infections and have patches of hair missing or minor cuts that won’t heal on elbows or knees because of malnutrition. In each village, I saw children whose arm measurements confirmed severe malnutrition, along with swollen bellies and protruding belly buttons due to micronutrient deficiencies and/or parasites. I found it very difficult to estimate a child’s age – one infant in particular stands out in my mind because he looked like he was one month old, but the vaccination card confirmed that he was 11 months old.

Although intensive nutrition rehabilitation centers exist and there is clearly a need for these treatment facilities, the demand has yet to be created. Through informal conversations, it seems that one of the most realistic approaches to create awareness of the severity of malnutrition in Mali is through community campaigns that involve educating grandmothers, men, and village leaders to promote good health practices within their families and their villages. I watched women breastfeed an infant for 2 minutes and then resume working – no time to sit and nurse for 30 minutes, every 2-3 hours, for these women. Changes won’t happen overnight, but I also hear encouraging stories of women in villages demonstrating to other women the positive effects of improved health practices … the most credible community mobilizers!