Our volunteers have always included men, about one male to every three women. When there aren’t enough men in the groups, the women complain because it becomes more difficult to have a significant impact if men are not involved. Having men also sends the message that this is an important activity.
Lately we have been attracting more older men, or rather the communities have been selecting more older men as their volunteers. At our most recent training course for volunteers, 8 of the 24 new volunteers were men, and six of the men were over 60.
Their contributions have been spirited and thoughtful. The most engaged, revered, funny and thoughtful fellow is 78 and addressed by everyone as Mzee. Mzee is a form of respect in East Africa. Julius Nyerere, the former President of Tanzania is called Mzee. It is that kind of respect that the honorific carries.
In one drama, Mzee played a woman with a breast abscess. With his shirt stuffed with newsprint, cradling the painful, swollen area, he created such an accurate depiction that he had the whole group transfixed in astonishment as he discussed his problem with the man playing the volunteer. People were riveted by the role play, waiting in earnest anticipation to see if he was going to get the advice he needed and there were whoops of delight at the end.
Mzee exhibits all the characteristics that are said to be necessary for a healthy old age. At the beginning and end of each day, he has been chosen by his peers to say prayers. He has many friends among the volunteers, young and old, often staying afterwards to talk with others. Along with all the other men, he rides a bike to and from the training each day, a winding, up and down ride of more than ten miles. He comes from a home with a child under five, that being one of the few requirements the project makes. From his responses in groups, he appears fully involved in child care for his great grandchildren as well as in the running of the home. He teaches others informally and in the small groups. And he volunteered for this job which requires as a minimum for him to visit all the homes of children under five in his village at least once a month in addition to other activities, and this is a very hilly area.
He is slight, of medium height and carries himself erect with a closely cropped head of white hair and alert, inquiring eyes. When I talked to him about why he had volunteered, I noticed he had marked dimple-like depressions equidistant from his nose in about the mid point of his cheeks. I had seen this before in the Keewatin region of the North West Territories, or what is now called Nunavut.
Dr. Otto Schaeffer, an Austrian-Canadian internist who devoted his professional life to the Inuit, first identified this rather distinctive loss of facial fat in the Inuit who had survived the great famine that occurred in the early 1950s in the Canadian Arctic. For some reason both seals and caribou, which provided the staple food of these northern nomadic hunters, did not appear in the usual places or numbers for a couple of years running in the 1950s and many Inuit died.
Canada was slow to respond to the famine in the Arctic but eventually a decision was made to relocate what were at the time a nomadic people, into a few, scattered, small hamlets around the shores of Hudson’s Bay so food could be provided more conveniently and the children who survived could attend school. The houses built were inadequate for the arctic winter and crowded and the services were poor or non-existent. This is the simplified version, but simple or complex the story is not a pretty one.
Farley Mowat has written evocative fictional versions of some of what happened at the time. People of the Deer and The Desperate People. His work isn’t appreciated by the Inuit partly because in fictionalizing events he was not seen as “telling the truth”. Hamlets such as Rankin Inlet, Whale Cove, Chesterfield, Eskimo Point, Belcher Islands, Coral Harbour and Baker Lake, as they were called for a number of years later, were established as settlements at that time.
Dr. Schaeffer wrote about a number of his observations, becoming an expert on childhood nutrition, bottle caries, breast feeding, severe cold and respiratory disease. He wrote a number of papers that spanned a whole range of topics but I don’t think he ever wrote about the facial results of starvation.
However, he often showed slide shows to physicians and nurse practitioners who worked in the north and was instrumental in educating us about northern health. When I did my MPH at Johns Hopkins, a nutritionist who mentioned something similar in South Americans was so interested when I told him about Dr. Schaeffer’s observations that I obtained copies of some of Otto’s pictures for him. But I don’t recall anything coming of it. A curious observation, a strange finding it has remained.
Now here I am looking at something similar twenty years later in Africa. So I get someone to translate for me, although Mzee appears to understand English somewhat.
I ask, “Was there was ever a time when you were starving, not just hungry but starving.”
The translator asks, “You mean like famine?”
“Yes,” I respond, recognizing that with the banana wilt, many people are hungry a lot of the time here right now, “a long time when there was no food.”
Mzee appears to be following this exchange carefully and replies unequivocally in Runyankole as soon as the translator is finished, “1940”.
“What happened in 1940?” I inquire.
“The locusts destroyed everything.”
I work out that he was 11 at the time and want to ask more but I can see he is affected by just telling me this much. If it was anything comparable to what happened in the Arctic, many died and no one there at the time was unscathed.
The devastating impact of such starvation hits me full force. Working thru a translator, with the extra pauses that result before I can fire off another question, often has that effect on me. It is as if the pause ensures that I absorb the message with my whole body.
Mzee watches my face carefully, his eyes questioning. So I explain that I have seen the same thing in Canada in the north where people had really starved. He nods, interested, and we seem to be back on comfortable ground.
Later I share the story with George, a pediatrician and Ernest, a Ugandan public health specialist who have come on the last day of the workshop. George worked with Otto in the Arctic and knows about even more amazing observations that Otto made during his remarkable career.
I sigh, “Sometimes it feels like we are long past the time when it matters if we, as physicians, are close observers of our world”
“Not so”, protests Ernest and tells us how patients with HIV/AIDS in Uganda are noting that they have both unusual loss of and different accumulation of fat.
“Really?” says George and the three of us are off on another tangent.
Photos: Men Group; Role play; Men's bicycles under the tree; Placenta Pit becomes a project, Herb garden