I did my elective in Niger, a landlocked, Muslim-majority West African country straddling the Sahara. It is large, about twice the size of Texas. It houses a population about three times that of Wales. Most of the locals rely on subsistence farming, and food is only plentiful when the harvest comes in.
I was there in the coldest season, when the 'Harmattan' winds blow strongly. Visibility falls, the air is choked with dust, and all the locals pull out their woolly hats and winter coats. The Hausa word for wind, 'iska', is also the word used to describe measles, as the measles season coincides with the wind.
My first week in outpatients brought in several children with measles: spluttering, red-eyed, dazed, rubbed raw by the wind on their peeling skin. I was shocked. I had always put measles on a par with chicken pox - some annoying illness that was, at worst, itchy. However, what I saw was something quite different - something threatening these children, something that knocked the most vulnerable down ruthlessly, and did not stay to see if they would rise again.
While I was in Niger, I had the opportunity to see some of the country. During my travels, I attempted to visit Agadez, a town in the north. Instead of waiting two days until the next bus, I decided to go by the lorry leaving the next day. Having been warned that the journey took twelve hours, I packed a loaf of bread and a bottle of water to take with me. I had not been informed that I would be sitting on top of all the sugar cane in the back, or that I would have 50 travelling companions. Moreover, the twelve-hour journey lengthened into over two days as the sandy track caused our wheels to keep falling off. I was miserable: frozen by night, scorched by day, cramped, unable to move, hungry and thirsty.
On the same lorry was a child suffering from measles. She had no jumper to keep the wind away. She had no water bottle, no food packed in her bag.
As we pulled into Agadez in the middle of the night, her mother said that she was dead. There was no reaction from the rest of the travellers. After a few minutes, a man got up and shone his torch on the child. 'She's not dead', he stated, and sat down.
Niger has the highest under five's mortality rate in the world. It is an accepted fact that nearly one in three children will die before the age of five 1. Death is seen as inevitable, Allah's will. Counting children may be seen as tempting fate. This attitude contrasts strongly to that seen in our society, where life is grasped and held at all costs. We constantly struggle against death, we have difficulty accepting its presence, and we have forgotten our mortality.
There must be a third way, one in which we can balance the acceptance of death with prevention of needless death. Physical death is simply a natural progression from the rest of life. It may be speeded up by illness or accident, it may be slowed or shelved for a future time, but it may never be conquered simply by medical care. As Christians, we recognise that physical death is not the death we should be fearing. It is not the end. It pales beside the spectre of spiritual death. We have a duty to practise medicine as Christians who are doctors; not to prevent physical death alone, but to maximise spiritual life and prevent spiritual death where possible.
1. 'WHO: Situation des Enfants dans le Monde' 1995 Geneva; World Health Organisation
I was there in the coldest season, when the 'Harmattan' winds blow strongly. Visibility falls, the air is choked with dust, and all the locals pull out their woolly hats and winter coats. The Hausa word for wind, 'iska', is also the word used to describe measles, as the measles season coincides with the wind.
My first week in outpatients brought in several children with measles: spluttering, red-eyed, dazed, rubbed raw by the wind on their peeling skin. I was shocked. I had always put measles on a par with chicken pox - some annoying illness that was, at worst, itchy. However, what I saw was something quite different - something threatening these children, something that knocked the most vulnerable down ruthlessly, and did not stay to see if they would rise again.
While I was in Niger, I had the opportunity to see some of the country. During my travels, I attempted to visit Agadez, a town in the north. Instead of waiting two days until the next bus, I decided to go by the lorry leaving the next day. Having been warned that the journey took twelve hours, I packed a loaf of bread and a bottle of water to take with me. I had not been informed that I would be sitting on top of all the sugar cane in the back, or that I would have 50 travelling companions. Moreover, the twelve-hour journey lengthened into over two days as the sandy track caused our wheels to keep falling off. I was miserable: frozen by night, scorched by day, cramped, unable to move, hungry and thirsty.
On the same lorry was a child suffering from measles. She had no jumper to keep the wind away. She had no water bottle, no food packed in her bag.
As we pulled into Agadez in the middle of the night, her mother said that she was dead. There was no reaction from the rest of the travellers. After a few minutes, a man got up and shone his torch on the child. 'She's not dead', he stated, and sat down.
Niger has the highest under five's mortality rate in the world. It is an accepted fact that nearly one in three children will die before the age of five 1. Death is seen as inevitable, Allah's will. Counting children may be seen as tempting fate. This attitude contrasts strongly to that seen in our society, where life is grasped and held at all costs. We constantly struggle against death, we have difficulty accepting its presence, and we have forgotten our mortality.
There must be a third way, one in which we can balance the acceptance of death with prevention of needless death. Physical death is simply a natural progression from the rest of life. It may be speeded up by illness or accident, it may be slowed or shelved for a future time, but it may never be conquered simply by medical care. As Christians, we recognise that physical death is not the death we should be fearing. It is not the end. It pales beside the spectre of spiritual death. We have a duty to practise medicine as Christians who are doctors; not to prevent physical death alone, but to maximise spiritual life and prevent spiritual death where possible.
1. 'WHO: Situation des Enfants dans le Monde' 1995 Geneva; World Health Organisation
