Survival of the Fittest
on Shona in Sierra Leone (Sierra Leone), 21/Jul/2011 19:37, 34 days ago
Imagine you are a child in Sierra Leone. Surviving childhood is a challenge. And there are so many challenges to get through. The first occur before you are even born. You are relying on your mother’s health, her education, her attendance at antenatal care, her compliance with antimalarial medication, tetanus immunisations and sleeping under a bed-net while she is pregnant. Then there is the challenge of labour and delivery. Will there be an obstructed labour? Will your mother develop chorioamnionitis? Will she present to health services at all? Will the midwife recognise a problem and alert the obstetrician if she needs a caesarean section? Will the midwives resuscitate you appropriately and take you to the S-C-B-U in a timely fashion? Or will your mother stay with a traditional birthattendant, in labour for days while the fetus (you) gets increasingly distressed, septic and hypoxic?And if you need admission to S-C-B-U for hypoxic ischaemic encephalopathy, or septicaemia, will you get your medications? Will you get fed? Will you be kept warm or will you die of hypothermia? Will you get an infection from the baby in the cot next to you? Will you die of iatrogenic causes such as hyponatraemia, hypokalaemia or gentamicin toxicity because we can’t measure electrolytes and drug levels?And if you are a premature baby your chances are even lower. However, the power for survival sometimes amazes me. We currently have a 700g baby said to be“9 months” (I don’t believe them, the baby is definitely premature and no one ever knows the true gestation). He is four days old and still remarkably feisty. He has a long long way to go, but it really is survival of the fittest.If you make it past all that you are doing fairly well to start with. Then you go home with your family, provided your mother has survived childbirth– she has a one in eight chance over her lifetime of not making it.If your mother hasn’t survived, you’ll be cared for by relatives, usually an auntie or granny. You won’t be breast fed, meaning you’ll probably get formula milk which has been watered down too much by unclean water. A recipe for malnutrition. And gastroenteritis. And if you make it to six months of age (starting complimentary foods) then you’ll have to fight with all the other children (once the men have eaten) for your share.Meanwhile, if your mother did survive and you’re being breast fed, that’s a good start. Next you’ll have to ensure you get immunised (protecting you against polio, various causes of pneumonia and meningitis, TB – to a certain extent, hepatitis B, whooping cough, diphtheria and tetanus). The next thing to worry about is that dreadedAnophelesmosquito. Have your family got an insecticide treated bed-net? Do you sleep under it, protecting you from malaria? Or do your family find it too hot (the most common reason cited for not sleeping under bed-nets)? If you develop a fever or have a convulsion, will your family know that might mean malaria or another severe infection? Will they take you to a health clinic or hospital? Or will they take you to someone in the neighbourhood with a supply of medications and give you an unidentified injection (which could be quinine or ampicillin or gentamicin or none of the above)? Or will they take you to a traditional healer, buy some“native herbs” and suggest you are a witch or that it is “devil business”? Will they take you early to health care or will they wait until you are unconscious and moribund?You’ve survived malaria/meningitis/typhoid/whatever severe infection you had (the hospital doesn’t really know what illness you had as they don’t have the lab tests, and anyway no one told your mother what was wrong with you). Next you worry about the terrible overcrowding in your house, the dreadful lack of sanitation and clean drinking water. Oh and in the rainy season all that extra water flooding into your house, along with all the sewage.Once rainy season is over you might start playing with friends, which means playing near open fires, risking massive burns. Or maybe you’ll play on the road and get knocked over by an okada or poda poda.Congratulations, you’ve made it to five years of age! You’re one of the lucky ones. You’re doing better than one in seven children in the country (this figure varies every time I read it from one in four to one in seven). Still you’ll probably get malaria several times a year, probably not as severely though. You’ll need to get to school, then your siblings are born (let’s hope your Mum survives those pregnancies too).Let’s say you get uneventfully through school, and into your teenage years. But your childhood comes to an abrupt end. Here comes the next challenge: pregnancy. And so it starts again….