Recognize Ways to Save Children

Two recent columns treated child deaths. The sad fact is that, worldwide, 19,000 children die every day—mostly in poor regions, and mostly related to inadequate nutrition.
The first article told the story of two boys I took care of in Nicaragua when I was in medical school. Miguel hadn’t been fed enough protein and recovered with good food. Van was just skin and bones, and died from starvation.
The second article mentioned that there is hunger in the USA. Our country doesn’t have a universal safety net to catch people in need.
Sending food to poor countries does not help in the long run, because it increases people’s dependence. Indeed, well-meaning people may do more harm than good. This is made clear (in a religious context) in the book “When Helping Hurts”. It points out that many actions that might seem helpful have the opposite effect.
Unfortunately, despite the best of intentions, transferring technology from rich to poor countries can have bad effects. Supplanting breastfeeding with artificial formula is a good example. Contaminated water may be used to mix the formula, and poor parents cannot afford to buy the formula after breast milk has dried up,.
Nepal, where villages had an epidemic of deaths, provides another example of unintended consequences. Metal cookware appeared to be a boon to the Nepalese because food cooked more rapidly than in old-fashioned earthenware pots. This meant less denuding forests for firewood and less smoke from cooking fires. But it also meant that pork wasn’t uniformly well cooked. Pork tapeworms lodged in people’s brains and killed them. Fortunately, cooking pork adequately can prevent this disease, cysticercosis. Sanitary toilets are also important in separating human waste from pigs. We must try to foresee and prevent unintended consequences when trying to help others.
There are many examples of programs that are very effective in reducing child deaths. Brazil, which has experienced a remarkable transformation, is one.
Nancy Scheper-Hughes first went to a favela (Brazilian shanty town) in 1964 as a Peace Corps volunteer. She is now a professor of medical anthropology. Her article “No More Angel-Babies on the Alto” is available at: http://clas.berkeley.edu/research/brazil-no-more-angel-babies-alto
Nancy found that many babies in the favela died, and she was shocked that their mothers didn’t grieve their deaths. The average woman gave birth to 8 children, of whom almost half died. One woman put it this way: “Why grieve the death of infants who barely landed in this world, who were not even conscious of their existence?”
When Nancy returned to Brazil recently she was surprised to find that the under-five death rate in that same city had decreased from 110 to 25 per 1,000. How had this radical drop been achieved? She cites several factors. Brazil’s president’s wife was a strong advocate for women’s rights. They started a system of care for all, including “barefoot doctors” to identify children at risk. The “zero hunger” campaign provides food for the most vulnerable. Safe water supplies and prenatal clinics improved the health of pregnant women. Women’s literacy is a universal theme in social change, especially for improving child survival.
Along with the decrease in child mortality has come an amazing decrease in family size. The average number of children a Brazilian woman will bear is 1.8—less than in the USA, and less than replacement. Each child born can be expected to live to adulthood and is therefore valued from birth. This favela has gone through the demographic transition in less than 40 years!
What is the difference between good aid programs and not so good? The best programs tune in to what the local people want rather than imposing agendas that are not culturally sensitive. They are sustainable—meaning that the aid recipients will be motivated to maintain the work with little or no help from donors.
Back to Nicaragua. People there are still impoverished; it is the second poorest country in the Western Hemisphere, with 80% living on less than $2.00 per day. Fewer than 40% of people in rural areas have improved sanitation. Fortunately the country is receiving sustainable assistance. El Porvenir (a non-profit organization) partners with rural Nicaraguans to build sanitation and pure water infrastructure and protects the water supply through reforestation. Their school hand-washing facilities make kids healthier and increase school attendance by 20 to 30%!
These improvements have raised the standards of living and health. Better-educated women have healthier and fewer children. Development has helped Nicaraguans in many ways, including reducing the average number of children a woman has from 7 when we visited in 1968 to just 2.6 now.
© Richard Grossman MD, 2013