Health education broken telephone

June 8

 

The vehicle has gone to Freetown, so we had to wake up early to walk to the clinic. It takes about one hour to do the walk, and since we don't yet know the way, Amhidu came to meet us. There isn't a map of Koidu Town, but my plan is to wander around with my compass a bit and see if I can make a rough sketch for Katie, me and any future interns.

 

The reason we woke up early was to give education modules at the amputee camp nearest the clinic. It's called Dorma. Dorma has 16 houses, and is just ten minutes walk from the clinic. To speed up our progress, we split into two teams: Katie and Amhidu, Jalloh and me. The idea was that Amhidu and Jalloh would serve as interpreters from English to Krio. Of course, some of the amputees only spoke Kono and Krio, so sometimes we needed to add a third layer of translation. I'm not new to teaching material similar in style to the health modules, but I found it difficult to keep the attention of the amputees and their dependents while we played our game of health education broken telephone.

 

It's the planting season, so many of the houses were mostly empty. According to Bailor, the idea was that we would go from house to house, and give the presentation before a rapt audience of at most ten people. That way everyone would see the presentation and remain attentive throughout. In reality, the first presentation was well attended simply because of the "white man." (Katie is also a "white man" for many Sierra Leoneans, despite the fact she is Asian.) Note: Katie is also 'Libanese,' Bengali, 'Chinese Man!,' and 'White Woman!' as far as globalization goes, she's the real deal. But even that attendance was fluid and inconstant, with people wandering over and wandering away. The next three houses at which Jalloh and I presented were almost empty, with one or two people in them at most. There were also few people near by to bring over to listen. One house was inhabited only by a women in a multilayered pink and patterned dress. At first we thought she spoke only Kono, which was right, but when we found a young woman perhaps my age to translate, she explained to us that the real problem was that the woman's ears had been chopped off, and so she couldn't hear well. The young woman, Rebecca, didn't seem too interested either – she was holding a one month old baby wrapped up in cloth on her back.

            "I think we probably should make it shorter... there are two challenges, one is that the woman cannot hear well, and one is that she," Jalloh gestured to the rail-thin young interpreter into Kono, "will have to yell whatever we say to her [the older woman]." I nodded. Okay.

            Bailor had given us a pretty comprehensive outline of six modules to cover – malaria, nutrition, iodine, HIV/AIDS, family planning, and tuberculosis. I figured that the most important were probably malaria and nutrition, and Jalloh figured HIV/AIDS was also very important. So we gave the malaria module, alternating between my English, Jalloh's Krio, and Rebecca's shouted Kono. It was slow, and pretty much impossible to keep Digba's (the old woman's) attention. I was fascinated by how the woman had tied the baby on to her back – it was nestled in the small of her back, supported by a wide swath of cloth tied tightly around her middle. Rebecca herself had high cheekbones and a slightly listless gaze. For most of the time she seemed as if she wasn't paying attention, but every now and then she would spark to life and laugh at Digba's attempts to understand.

            "She no understand." We were asking about how HIV/AIDS spreads. Apparently Digba didn't understand the idea that it spread through unprotected sex.

            Before the HIV/AIDS section, we covered the nutrition section. A large portion of the nutrition section deals with the importance of breastfeeding.

            "How old is he?" Jalloh translated –

One month on the twelfth.

"So you breastfeed him?"

Yes.

"That's good... it's the safest, right? The breastmilk is completely clean, free from germs. And it's free, and easy to get, and it has everything the baby wants to be strong." Sometimes Jalloh's Krio phrasings slip into the English versions of the modules. I figure there is no point in using words like sterile, or nutrition, because Jalloh translates them down into terms like "clean" and "food to make you strong."

Rebecca nodded, slightly disinterested. She wasn't translating for Digba, because Digba was too old for children. We didn't argue.

"How long will you breastfeed him?"

A year and six months, eighteen months. I started to ask if she fed the baby water or food yet, but Jalloh translated something Rebecca had said.

"They are doing much education about this at the hospital now, that's what she says."

"Oh, okay. That's good. Well, ask her when she will first give her son food and water."

Eight months. That's perfect – in this place, the germs from food and water can prove too tough for infant immune systems.

"And when you feed him, make sure you use cup and spoon, not the hand, because the hand is dirty. It's much easier to clean the cup and spoon." Jalloh translated, plus adding in that another reason for using a cup and spoon is that with hand feeding you can sometimes choke the child. He turned back to me.

"She's going to translate for her[Digba]. It's the way of things here, you know. She might feed the baby, she has to know."

Rebecca shouted at Digba in Kono, then excused herself to put the baby to sleep. She returned shortly, now wearing a beige T-shirt like you would find at the Goodwill store.