A Desperate Triage

Go read this. Go on now, go:

As a journalist turned graduate student in public health, I am in Uganda for five weeks as part of a research team investigating whether “food insecurity” — a persistent difficulty in finding enough to eat — undermines the effectiveness of H.I.V. treatment.

I am interviewing dozens of patients — anonymously, as is standard in such qualitative research — about what they eat, how much food they have, whether they grow it or buy it and whether the side effects from the medications are worse if they take the pills on an empty stomach. Our team also wants to know whether costs related to treatment limit their ability to cover basic foods and whether hunger forces women to offer men “live sex,” or intercourse without condoms, in exchange for food or money.

. . . . . . .

To make ends meet, parents have to engage in a desperate triage, navigating between bad choices and worse ones.

If they let their hungry children eat everything that the family grows, they will have nothing to sell at the market. If they do not sell part of the harvest, they will not have cash for the monthly clinic trip for the medication that keeps them alive.

But every time they go to the clinic, they lose a whole day of gardening or other work and spend cash they could otherwise use for the children’s diets.

“I feel bad that I have to spend that money for transport when I could have spent it on something else,” one mother says. “And then the days I’m at the clinic, of course, I come knowing that I won’t do anything that day.”

Listening to the accounts of poverty and deprivation, I feel helpless and miserable. I promise myself I will never again take a decent meal for granted.

I want to empty out my pockets and shove dollars at every patient I interview. Instead, I buy them a cup of chai, a milky African tea, from the clinic canteen. The chai costs 300 Ugandan shillings, or 18 cents in dollars. For most, that is a luxury beyond their means.

I wonder sometimes what is the point of researching this? Why not just give food to people so obviously in need? But international donors demand data and documentation. They want proof that an intervention will reduce the total misery index before they will shell out millions of euros for new programs, even if the need appears self-evident.

I get to return home when my work here is done. I will analyze my data, write up my findings and hope that what I have done makes some small contribution to change.

The women and men I have met will trek to the clinic month after month, if they can scrape together $5 or $8 for the bus fare. They will consult with the doctor, grab their drugs from the pharmacy and wonder where they will find enough beans and matoke to feed the kids tomorrow.