Big-Bellied Baby

One of the most confronting things to see at the hospital is children with malnutrition. There are always small babies and young children at the PCM (protein and caloric malnutrition) ward; some are too weak even to cry.

Just the other day, a mother brought in her one-year-old baby with paraphimosis, a minor condition that is easily treated. Upon undressing the baby, it was apparent the baby was severely malnourished. With wispy hair, swollen arms and legs, and a huge abdomen, the baby had all the classic signs of kwashiorkor. Upon further questioning, the heavily pregnant mother revealed that there are two other children at home. When asked if they are okay, the mother said, “Yes, they are healthy.” But to her, healthy probably just meant not acutely ill. If her one-year-old baby didn’t develop paraphimosis, she wouldn’t think to bring the child in to hospital. A brief examination of the mother revealed a picture of clinical anemia. So, after treating the paraphimosis, we admitted the baby to the PCM ward, where he was put on a feeding program to nurse him back to health. The pregnant mother was given iron, folate, and multivitamin supplements.

It is often frustrating to see how the combination of cultural, geographical, and economic factors conspire together to keep the cycle of poverty and malnutrition going. There is no real economy to speak of in this area besides fishing; villagers otherwise occupy themselves with subsistence farming. Education is often not placed high on a family’s priorities. Children are raised, and sometimes educated, until they reach puberty, then they are considered of marrying age. Many people become parents in their teens. The low social status of women means that decisions of reproduction are often made by men, who sometimes would compete with other men to see who can have the most number of children as a way to prove their virility. So the usage of contraception is out of the question. Even if a couple wants to use contraception, the remoteness of this area makes it difficult for family planning clinics to reach. The high number of children in each family and the perceived low value of an education often mean children don’t go to school, even when primary education is free. The number of mouths to feed, the lack of income, and the monotony of a subsistence diet directly contribute to the malnutrition of both babies and adults. The lack of an education confines the people to doing unskilled work, keeping them in the lowest rung of the socioeconomic ladder. Each factor is both a cause for and a result of the other factors; all of them are tightly intertwined to form a straightjacket that binds the people in dire poverty.