A Memorable Moment ...

Jay is an incredibly committed, compassionate member of the health care team here is Malawi. 

He is a third year medical student.  He put his formal education on hold and gave up a year of his life to come and serve these rural communities.

This image above presents his typical mode of engagement.  For hours and hours, he speaks with mothers, grandmothers, and other caretakers who fear for their children's health.  Each day, he reviews case histories and nutritional assessments for hundreds of young children.

A few days ago, I watched Jay work, documenting the interaction with a video camera.

I remember a unique moment when Jay lifted a bright eyed, four-year-old Malawian girl up to the bench in front of him.

The young girl smiled and turned from the embrace of her mother to face her unknown, white doctor.  She was calm.    Her faded, slightly torn, silk blue dress with a tiny white collar reflected the bright light from the morning sun.

Jay reviewed bits of information on the young girl's medical card and then assessed her weight, arm circumference, and height measurements.  

He checked the charts for normal growth and body mass.

He checked for edema (swelling) and other signs of malnutrition.  

He checked her eyes to look for iron deficiency. 

She was thin, but she did not seem to be in nutritional crisis.

After a pause, Jay raised his voice and expressed his positive assessment: 

"Alibwino,"  all is well!

Then, the girl's mother spoke.  She shared a new concern.  

She told Jay her child's genitals were very swollen and inflamed.  

Jay asked permission to examine the young girl in the midst of of the public courtyard.  

Hundreds of other mothers and screaming children waited patiently in long, winding lines through the surrounding area.

Without hesitation, the young girl's mother expressed consent.  

Public displays of breasts and other "private" areas one's anatomy are omnipresent here in Malawi.  Underwear is optional.  

Jay asked the girl to stand on the bench.  He lifted the bottom edge of her dress to determine what the mother's concerns might be.  As the girl's dress slid over her hips, it was clear the medical situation was much different than anticipated.

The "swelling" and "inflammation" of concern turned out to be a normal part of the male anatomy.

Apparently, this mother was not sure what to expect as her child grew older.  

She did not have other male children.  She was uncertain what normal development might look like.  

She told Jay she did not have enough money to afford boy's clothes.  

A simple solution evolved for this family.  Clearly, an old, available, slightly tattered dress provided basic coverage.  None of the African women nearby seemed surprised or concerned with this choice.  One of the other doctors on our team told me these situations are common. 

When faced with extreme poverty, African women work with whatever is possible.  

After the shock of the gender discovery was over, Jay worked with a translator and encouraged the mother to take three important medical steps.  

One, he asked her to continue to feed the child with as balanced a diet as she can afford.  

Two, he asked her to return to the nutritional clinic in a month for further testing.   

Then, he smiled.  

He recommended she trade the old blue dress for different clothes that are "good for boys." 

The boy's mother offered a bit of laughter and her thanks.   Then, she held her son's hand and walked off toward her village.

Makes one think about the resiliency of the human spirit, the power of education, and the challenges with deep poverty.