Ethiopia is one among the developing countries in Eastern part of Africa, with a total population of about 96M people. The population momentum of the country is still increasing due to the high infant mortality rate, which is 55.77 deaths/1000 live births, hence resulting into women giving birth to more children to increase the chances of children surviving. Currently the total fertility rate of Ethiopia is 5.23 children per woman, (The World Fact Book). One of the major reasons for the high rates of infant mortality is the poor practice of breastfeeding. Most women especially in the rural areas of Ethiopia discard colostrum, which is the milk that is produced by the mother in the first few days after birth. The thick yellow nature of colostrum is often perceived as ‘bad milk’ hence considered to be harmful to the baby’s’ health. Colostrum contains an array of immune boosting and growth enhancing substances that are highly valuable hence early initiation and exclusive breastfeeding during the first few months of life is one of the best ways to improve infant nutrition and reduce child mortality (Korhonen & Marnila, p. 75).
The Health Problem
Kossoye Development Project conducted a research in a rural region in Ethiopia called Kossoye, which had the lowest colostrum breastfeeding practices (Rogers, p.2030). This research showed that women discarded colostrum because they thought it was dirty thus causing stomachache, abdominal cramps and diarrhea to their babies. Furthermore, they identified the practice of discarding colostrum as part of their culture (Rogers, p. 2032). The results of this survey show that in order to promote colostrum intake among women in Ethiopia, the Bio psychosocial Model of health status has to be applied.
The Bio Psycho Social Model
Although this model is widely used to address mental health issues, it can also be used to address other health problems such as combating infant mortality rate in Ethiopia by promoting colostrum intake. One aspect of the model includes sociological factors, and this can be addressed by ensuring that both women and other members of community are educated about the importance of colostrum breastfeeding. This will promote encouragement and support from other community members to the mothers to breastfeed the babies with colostrum. Furthermore, since it is part of the culture to discard colostrum, culturally tailored educational programs should be conducted to all the members of the community in order to prevent ruining social interactions in case the mother feeds her baby with colostrum while the rest of the community disagrees with that practice. In addition, other prelacteal feeding practices of coffee or butter should be discouraged since they may be harmful to the baby.
Since the mothers delay breastfeeding initiation, there is a high probability that there will be a delay in breast milk production thus encouraging more use of prelacteal products and longer delays in breastfeeding. This can be categorized as a biological aspect of the model and in order to address this, mothers need to be encouraged to initiate breastfeeding soon after birth in order to promote more breast milk production. The early initiation of breastfeeding will increase colostrum intake among infants and reduce use of prelacteal products since the mothers can produce enough milk.
Additionally, the psychological aspect of the model can be applied by ensuring that the mothers do not become mentally stressed by fear of breaking the cultural practices and norms of the community. The community should also be well educated about the importance of colostrum in order to reduce the misconceptions and stigma about colostrum.
Health Impact Pyramid
In order to further promote breastfeeding of colostrum, the health impact pyramid should be applied. According to the article of A Framework for the Public Health Action written by Thomas Frieden, the health impact pyramid can be applied either by increasing population impact or by increasing individual effort needed. Since the discarding of colostrum is very culturally embedded, it is important to increase population impact by beginning to provide education and counseling to mothers and midwives about the importance of colostrum. Community health workers who have strong relationships with the community members can be good agents of providing counseling services through house visits or small group meetings. To expand the program, clinical interventions such as training of community health workers and fathers can be employed. Community health workers (CHWs) can assist in providing educational programs to the community through various workshops, attending deliveries and ensuring that the women breastfeed their babies with colostrum. Due to poor health some women may fail to produce breast milk, hence provision of free nutritional supplements to the mothers will be part of the clinical interventions to ensure that the women with poor health are also able to produce milk and breastfeed their children. CHWs can also conduct follow up visits to ensure that the mothers are reminded about the negative impacts of other prelacteal practices.
To ensure the promotion of colostrum breastfeeding is a long-term sustainable practice, the fathers and other members of the community should also be educated through different workshops or programs in order to ensure that every member of the community is knowledgeable about the importance of colostrum intake. Some women in Ethiopia expressed fear of their husbands incase they found out that they breastfed the babies with colostrum, thus if the fathers are educated, they can be the supporters and motivation for the women to breastfeed their children with colostrum. Once colostrum breastfeeding is accepted in the community, the new generations will keep learning from the older generations about the importance of breastfeeding their babies with colostrum and thus the individuals’ default decisions will be to breastfeed colostrum.
Another long-lasting protective intervention is task shifting. In the article of Pharmacy on a Bicycle, Bing and Epstein show how task shifting can help to solve the long-term problems of health. If the community health workers and midwives in Ethiopia are educated about the safe delivery practices as well as pre and post-natal care, then there is a high chance that there will be a reduced number of infant mortality and also an increase in colostrum intake. When the knowledge about the causes and solutions to other diseases among infants such as diarrhea is passed down to the community health workers, then they will be able to deal with such situations in their communities. Moreover the CHWs will be the sources of that acquired knowledge to the mothers in the community hence reduce the misconceptions of colostrum being the causative of such diseases.
In spite of the emphasis on increasing population impact by beginning with changing individual behaviors, a structural intervention is also necessary to reduce child mortality in Ethiopia. According to the article of HIV Perspectives after 25 years by Blankenship, Dworkin and Mantell, structural interventions are public health interventions that promote health by altering the structure context within which health is produced and reproduced. Due to the poor educational background of the Ethiopian community, increase in colostrum intake could be seen as panacea for child health problems, which may cause the women to neglect other healthy practices towards their babies. Therefore it is necessary to employ some structural interventions such as ensuring that every member of the community has access to education in order to reduce the illiteracy rates. The education curriculum should also comprise of health topics such as maternal health and child health so that the community understands the health problems they face and the possible solutions to solve them, for example to reduce child mortality they should increase colostrum breastfeeding.
Moreover, addressing the three delays may also be part of the structural intervention. First of all, provision of education about the importance of health care can help to combat the first delay to seek health care. Secondly, the government and ministry of health should ensure that there are available health centers in order to eliminate the delay to access health services, and finally there should be more training of skilled health attendants, which will eliminate the delay to provision of health services. Funding can be provided for medical students in order to increase the health workforce, but also the community health workers can be provided with various incentives such as badges that indicate their position and accomplished work in the society so that they can continue to offer their services to the community.
Poverty also plays a role in the high infant mortality rate because of poor sanitation, low education status as well as poor health of the mother that can contribute to poor breast milk production thus failure to breastfeed the newborn babies. Another structural intervention that can be used to address this problem is the use of microfinance. UNIFEM suggests that the use of microfinance targeting women will increase their participation in the development process, and eventually combat poverty in a community. If a household has both the man and the woman earning some income, then the poverty levels will decrease but also women will gain more power in decision making hence they can choose the number of kids they want, and at what pace which will eventually improve the health of the women. The healthier the women are, the more likely that they will produce rich and healthy breast milk and will breastfeed for a longer time allowing their babies to grow stronger and healthier. CIDA recognizes in its gender policy that, “Attention to gender equality is essential to sound development practice and at the heart of economic and social progress.” (UNIFEM)
Social Determinants of Health
Nevertheless, in order to ensure that the intervention to increase colostrum intake in Ethiopia is successful, social determinants of the health problem should be considered. “Populations are not merely collections of individuals, however; the causes of ill health are clustered in systematic patterns, and in addition, the effects of one individual may depend on the exposure and outcome for other individuals” (Frieden, 2010 p.592). In this case, the social stratification that exists in the community places women in an inferior social position where they are not able to make decisions about their reproductive health. In this case, these women are exposed and vulnerable to violence from their partners as well as impregnated with a very short pace between one child to another thus deteriorate their health as well as the health of the babies who do not get to breastfeed from their mothers for the time period required. The consequences for this situation includes poor health of the mothers thus failure to produce rich healthy breast milk, as well as increase in infant mortality rate. This leads to the vicious cycle of increasing birth rates to compensate the deaths and increase prelacteal feeding which delays mothers breast milk production and also deteriorates the health of the baby. Therefore, addressing the social determinants is very important to change the cycle outcomes. If women are empowered through education and microfinance, then they will have more power autonomy and will be able to make their own decisions concerning their reproductive health. This will place women in a less vulnerable environment for violence and therefore improve the health of the mother. A healthy woman will be able to breast feed their child and have another child when they are ready thus the community will have less infant mortality and improved health conditions.
Whilst colostrum is associated with bad milk due to its thick yellow nature, it contains a lot of nutrients, which are very good for the newborn babies. Studies have shown less colostrum intake among infants in developing countries such as Ethiopia. In order to promote breast-feeding of colostrum, various cultural and social economic factors have to be considered in the intervention programs. Since community oriented interventions have prove to be successful in various settings, promotion of colostrum intake also requires the involvement of the community health workers. We can ensure sustainability by employing the existing available resources
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It was red. The word, ‘Rescue’ on the big post of the Durham Rescue Mission thrift shop was in red.
This semester I joined a writing class on Aids, Charity and Giving. This topic was interesting to me because firstly, as a Tanzanian citizen I am an indirect recipient of Aid through health care systems, infrastructure and other Aid programs from developed countries. Secondly, my education has always been through scholarships and financial aid thus I felt very related to the topic and I wanted to understand deeper about the issues surrounding aid, charity and giving. Part of this class is to volunteer in a humanitarian organization and have first hand experience on how it works. I, together with a pair of other students in my class chose to volunteer at the Durham Rescue Mission. The reason I chose this organization was because the volunteering hours for this organization fitted with my schedule, thus I was neither happy nor sad when it was confirmed that I could volunteer.
Durham Rescue Mission is about ten minutes from the East Campus of Duke University. On our first visit, I felt very nervous because I had no clue of the task they would assign me to do. Back in the years when I volunteered, I knew my role thus this was a different experience. Usually I would sit at the front seat of a taxi but I chose to sit in the back. My heart had a slow beat as the taxi started moving and before I knew it, my head was filled with deep thoughts that my friends’ conversation sounded like a distant buzz. Eventually we reached the Durham Rescue Mission and it was a big shop. In Tanzania, it would have been called a mall but it is a thrift shop. A big thrift shop.
Our role as volunteers at Durham Rescue Mission is to arrange clothes in stacks in the rainbow order. The idea of arranging clothes did not seem too bad for the first fifteen minutes but that changed as we began feeling bored and tired. My shoulders began to ache and after forty-five minutes I sat down on the dusty floor with my legs stretched forward. I was really tired. The stacks of clothes hid me so the floor manager and other workers could not see me sitting down, but I did not want the customers who were moving around the stacks to see me either so I stood up. We kept working on the stacks for three hours. Few times the floor manager came to check on how we were doing. Her name is Michelle Williams.
After a few visits, the three of us decided to request an interview with one of the Durham Rescue Mission employees because we had a couple of questions and also we wanted to get some insights on their experience as workers in the shop. It was a rainy Thursday and I was sitting on the front seat. The driver did not talk much and my two friends were busy with their phones. When we approached the shop, I looked at the big post attached to the shops wall written Durham Rescue Mission. However, this time I realized the word Rescue was in red. My eyebrows twitched as I looked at this post. I wondered why they bolded it in red and what effect they were aiming for. Immediately after getting out of the taxi, I took out my phone and took a picture of the post. The woman who stood next to me as I took the picture gave me a sharp look that I felt she was thinking I was weird. Anyway, I ignored her and enter the shop. As we stood waiting for instructions, the woman entered the shop too. She stood and gave us another gaze but this time with a fading smile. Immediately Michelle approached us and exchanged a few words with the woman, then asked her what she wants us to do on that day. Turns out the woman also works at the shop and has a higher authority than Michelle. As weird as it was, we said hello to her. She did not respond but turned to Michelle and said we can do the same task we do each time we volunteered. Michelle looked at our faces and it seemed as if they had a big post, in red saying, “OH NO!” so she asked us to follow her and she can find a new task of arranging toys. We had a sigh of relief and proceeded to follow her as she moved towards the back of the shop. We reached the area with toys and listened to her as she explained how we can re-arrange it according to their categories, for example games, cars, dolls and so on. This sounded exciting to me because I love toys and I wouldn’t mind arranging them because I can play with them while doing so. When Michelle was done with explaining, she smiled and said, “Hope you have fun.” Michelle was not very nice to us on our previous visits. She hardly gave a smile and only spoke a few words when explaining the tasks. However, we got lucky to see that bright side of her and I was very happy to be there as a volunteer. So before Michelle left, I asked her if she was willing to answer a few questions we had about the organization, and she agreed. So we all opened our small notebooks and gripped our pens ready to record the interview.
Michelle told us the history of the Durham Rescue Mission and how it has helped millions of people who “have gone the wrong path.” As she was talking, I tried to keep my head up once in a while and make eye contacts with her because I wanted to make her feel that we were paying attention and listening to her. She knew we were listening because we were all scribbling down what she was saying but I thought a little nodding and eye contact would be nice. She seemed to like it. Michelle kept explaining to us about the various programs that are associated with the Durham Rescue Mission including the religious aspect of it. The people who had lost their homes or those who wanted to change their lives as addicts were being ‘rescued’ by this organization. I interpreted this as the reason why they bolded the word, ‘rescue’ in red. Red could also signify the lives that were once in pain or danger but now being rescued. The interview was going well with the all the questions and answers from Michelle, until she said something that not only made my eyes pop out but also made my head fall down immediately. This time my head was not down because I was scribbling something down but because I was too shocked and hurt that I did not want her or anyone to see my face, which was too obvious. My hand was not moving, and her words kept echoing in my head, “People buy things here and send it back to Africa because people there cannot afford anything.”
I did not want to be there anymore. She must have thought I am black American to say those words. In fact I was mad that she generalized life in a few countries or perhaps regions to apply to the whole of Africa. Africa is a continent and not a country and it is not true that everyone in Africa is dying with poverty that they cannot afford anything. In fact the thrift shop sold things for a very cheap price that even the poor can afford. The stereotype of all Africans being poor is one thing I have always tried to escape and it felt as if she threw it right on my face. When I lifted my head up, her smile was no longer sweet and warm, in fact the more she smiled, the more I felt that she was laughing at me, at Africans. I felt that she felt very proud to be who she is, maybe an American, and so sorry for those too unlucky to be born Africans. Every time she mentioned how Durham Rescue Mission is helping people, I interpreted it as, ‘this organization is saving lives of poor dying Africans.’ All I wanted was the interview to end, but Emre and Willa who are my fellow volunteers had more questions to ask. If they asked me if I had more questions, I would only ask if she has ever been to Africa.
We got back to our task of arranging the toys and I kept looking at the broken cars and dirty dolls and wondered if indeed that is what the African kids would want, or if that is what they deserved. I was just heart-broken. I was once a kid in Africa and it is true I did not have much of what I wanted, but I had what I needed. That alone excludes me from the generalization of Africans cannot afford anything. In fact when I looked at the broken toys, I preferred my maize cob dolls I made at home.
This interview has completely changed my experience at the Durham Rescue Mission. I am affected in a very negative way. I do not feel happy being there and because of that one statement, I have become very judgmental about the whole organization. I think I am looking at the organization with my African lenses, not as a Duke student or a woman or anything else. The interview was a great turning point.
What is today? Is it the date that matters?, the event?, the memories?, the mood? what is today?
For the years I have lived, I have seen a lot happen- from birthdays to deaths, I have heard of war and peace, seen funerals and weddings, indeed I have bore witness to a lot. The same me, a girl, young, I have been to different places in the world, from villages, towns to cities, I have been in love and out, and yes I have some bits and pieces of experience. However, none of what I have witnessed, heard, felt or experienced has been able to answer my question of what is today?
Some have said,
-“Oh, not today” while others go
-“Today is a good/bad/slow/long/short/happy/sad/ugly/bright day.
What about yesterday? What about tomorrow? Well, the reason I think today is important is because I think as humans -all we have is today”. All we need is today. Today is the day to do what was impossible to do yesterday. Today is the day to do what you gotta do to make that tomorrow a better day. Today is the day. Today is a gift and a favor. God gives us one more chance to accomplish what we failed to accomplish yesterday, one more chance to be in love, one more chance to make it right, one more chance- TODAY.
Even non believers know that when today is gone is gone, and there is no better chance than today. I thank God for Today, just for the gift of today, because all i need is this day.
So it is Christmas, and everyone is looking forward to meet their families, friends and loved ones. It is truly dear and amazing, to see the smiles, the lit faces of old and young! Christmas is here- Celebrations everywhere. I walk down the streets and it is so beautiful. All the trees are decorated, there are lights everywhere. Carols singing, women choosing gifts and the men toasting their glasses of wine for a great year. The smell of pie, cookies fill my nostrils, it is Christmas, Smiles everywhere.
It is Christmas at home too. It is Christmas in Tanzania. I throw back and see myself right there; a young girl happy for the holiday. She is looking at her mum smiling; she knows today they will eat a very good meal. There is nothing much happening and the little girl wants something to happen. She asks whether they will go out for some drinks or dinner and well- they will not! They will stay home for Christmas. She moves around the house, and there is nothing different. In her heart, she is wishing for a Christmas tree, or at least lights or maybe some joy feeling going around. Christmas was just like any other day except no one went to work. Christmas only meant a good meal- more meat, more rice, more drinks! She did not grow up believing in Santa, in fact she grew up thinking Santa lived abroad- that Santa did not deliver gifts for a girl like her, her house did not even have an address, how will Santa get there?! She only saw the joy of Christmas on television. Little she was, and all she wanted was a Christmas gift, a Christmas tree and some Christmas spirit!
Today, I am here and this is my first Christmas away from home, far away from home. I am very happy. I have seen the Christmas trees, I have received the Christmas gifts, and the Christmas joy is everywhere. However, I cannot stop myself from thinking of many other girls and boys back at home. Those who are now where I used to be; wishing that Christmas were different. I think of those whom Christmas does not even mean more food, those who Christmas to them is nothing at all. Those left in the streets, those abandoned, those suffering. I think of how they wish, how they hope that Christmas was little different, at least a different day. Those whose whole families have gone- who do they join this Christmas? Will this day be any different to them?
Come Merry Christmas- Come with all the Merry…Come to Everyone!!
The society has and still is seeking answers to the questions of what is just and unjust, and what is right and wrong. However, I have come to realize that, it is not the answers to these questions that matter, but the reasons as to why we ask these questions. Development and growth of societies has come along with different controversial issues such as dual citizenship, illegal immigrants and refugees, and conservation versus development. Through debating, reading and discussions in the Public Policy and Cultural Anthropology courses, I learnt that what is just and unjust varied between different groups and individuals. Moreover the rule of ‘majorities win’ is in itself unfair because the interests of minorities are ignored. So even democracy, which is the most popular ideology of fairness and equality, is promoting inequality in a sense that the minorities’ interests are depreciated. Hence one is not wrong in saying democracy is a quantitative ideology than a qualitative one. Thus, finding answers as to what is right and wrong will not solve these disputable issues, but I think that finding the reasons behind these questions could help us understand the roots of the problems.
Understanding the roots of these problems does not necessarily mean solving these problems, but it will help us to interpret and analyze the various interactions and relationships between communities, the environment and other bodies such as the government and non-governmental organizations. Furthermore, it is through the Ethics and Leadership Focus cluster that I discovered the inter-relationships that exist between different communities in relation to the environment. Significantly, I have learnt how these inter-relations work and how they affect different decision-making and livelihoods.
The Public Policy course explains how different national policies can affect other different groups of people in the country and outside the country, for example, if the US decides to outlaw dual citizenship, then millions of dual citizens in the US will have to give up their other citizenships hence other countries will lose their workforce, and the contributions that these dual citizens made to those countries. More interesting, the course challenged me to go deeper in researching and understanding how these policies came into place and how they have raised profound questions and discussions such as does a country need people with divided loyalties and allegiances and which country will dual citizenships support if their two countries were to go into a war or simply play a football game? The course began by exposing us in analyzing questions like ‘what is citizenship’ to more deeper discussions of ‘immigration policies and their effectiveness’. Also through these challenging discussions, I learnt more on how globalization plays a major role in fuelling movement, interactions and information.
It was through the development and growth of these movements and flow of information that places like Ecuador and Madagascar have been invaded with high influx of tourists, and mining companies as discussed in the Cultural Anthropology course. This course expanded my knowledge on societies interactions in relation to their environment. How different groups of people have different perspectives and how these differences in perspectives affect the use of resources. These discussions made me reflect back on the issues of the Public Policy course such as; what policies should be designed to balance the goals of democracy while valuing the rights of minorities like indigenous people, and on what grounds will these policies descend from? Most importantly it raised questions of how my decisions as an individual are shaped by the society, and the effect of these decisions.
The Ethics, Leadership and Global citizen focus cluster has helped me develop a deeper understanding of various issues facing the society, and a skill of viewing these issues from different perspectives. More over, it has helped me understand myself as an individual in relation to the community around me. Today, my identity is not only one single circle, which represents me as a Tanzanian, but a series of concentric circles which identify me as a woman, a student, and a global citizen. My home is not defined by political boundaries, but where I am and whom I identify as. In Tanzania, I am a Tanzanian, at Duke, I am a Duke student and anywhere in the world, I am a global citizen.
My desire and inspiration to be educated at a high level stems from being raised in an under-privileged environment. There were so many things I could not do and so much I never knew existed, yet I was aware that there was a bigger world out there, just waiting to be explored. In school, I learnt that being under-privileged exists only in one’s mind. It is how one uses available resources to create opportunities for himself or herself that matters. This is what inspires me to work hard, be it in class, in a specific field, or in community service. I want to earn my success and become a useful member of the Tanzanian community.
Duke would enable me to not only continue with my studies, but also learn about how to help my country from a global perspective. The knowledge and experience I will gain will become valuable tools in developing Tanzania, and convincing others to pursue higher education. The ability to think critically will enable me to recognize the challenges that Tanzania faces, and develop effective ways of solving them. The opportunity to intern at companies in Africa will help me to start initiating projects and running workshops. As my mother is retired, she cannot financially support me and so the pursuit of my dreams relies, as it always has, on me being resourceful.
I feel so fortunate to be where I am today, to have discovered the arts and a world of knowledge; a world in which, no matter what I do with my life, I want to continue sharing with those less fortunate than myself.