Pombe Problems

23 Nov

It's 10:30 am. i'm in a neighboring village doing an outreach project with the nurses. Pre-natal check-ups and routine child vaccines. women have walked for hours to meet us today because there's no regular healthcare offered in their village. the women arrive in la rge groups cheerfully chatting-- i think they enjoy the day off from the usual farming and household chores. i sit in the back room where women wrapped in rainbows of fabric shuffle in and out with various sizes of baby bumps. a woman wrapped from head to toe in a soft purple sits in f ront of me and flashes her gap tooth smile as i fill out her pre-natal health card: Name? Age? Number of pregnancies? A measurement from her pubic bone to sternum tells us that she's around 20 weeks pregnant. She's sent out and returns with a mug of murky brown water and i start to administer the sulphadoxine/pyramethamine (SP)-- a strong malaria prophylaxis given to women to keep them healthy during pregnancy. a routine question before giving the three pill dose is "have you had any alcohol today?" I was putting the pills in her hand when i looked up and she flashed me a guilty gap toothed smile adn raised her eyebrows indicating a positive answer. I tried to disguise my shock when i glanced at a clock that read 10:48. My nurses did not do the same as shame tends to be the preferred teaching method here. they asked the other women in the room if it was ok to drink this early in the morning and 'tsk tsked' the woman in lavender. as i closed my hand and retracted my offer of malaria protection (i think the drug must interact negatively with alcohol) i tried to explain in my kindergarted kiswahili the dangers of drinking while pregnant. she lowered her stare and nodded her head as my nurses reinforced my message.
alcohol seemes to be related to just about every health concern i've noticed in the two villages i've worked in. the parents may be too busy drinking to feed their children. the head of the household may find his money better spent on bottles of pombe than school fees, hospital visits or malaria nets. i'm pretty sure alcohol is involved in just about every exchange of STI's including HIV. not to mention the detrimental affect alcohol itself has on one's body and in some cases, the young body growing inside. i've seen a need for a standardized ruberic for pre-natal counselling and i've considered trying to write some basic guideliens for the nurses in my village, in which i would definitely include the dangetrs of fetal alcohol syndrome. that's an easy starting point for alcohol education because the consequences are so clear. when i look around at all the other ways alcohol addiction is hurting my community (one upside is that it's often a great source of income for women) i'm at a loss for how to help. certainly sensitizing people to the many ways alcohol is affecting their lives would be an excellent project. but when you hear some of these people's life stories, it's hard to blame them for using alcohol as an escape. for the same reason that recovery programs in the West are led by former addicts, change in alcohol behavior here in TZ is going to have to be initiated from the inside. in the meantime i'll be looking for resources to educate and support my villagers in recognizing the problem.