She sat in the dirt in the small, dark room. Her face bright, she sang from a tiny Swahili hymn book. I learned my first words of Swahili that day – Thank You and Hello – I haven’t heard Swahili much in Malawi, but here in Zaleka Refugee Camp, the Chichewa that I know does not carry me very far. This woman is 65 and her name means Joy. She seems to live out joy in spite of her circumstances. The wheelchair in the corner and her legs crumpled beneath her skirt speak of a lifetime of disability, probably from late-childhood polio. And that’s just the beginning of her struggles. She feels weak, her heart beats fast, and it all seems to be linked to anemia from three-times-too-low hemoglobin, which in turn is due to dietary deficiencies. Most individuals in the refugee camp get a ration of porridge daily, but she relies on others to help her with cooking and preparing food. Today she has a gift of sweet potato greens from a friend, but she doesn’t get nutritious foods often, and she doesn’t have the strength to care for a garden. There isn’t much land in the refugee camp, anyway. Some people rent fields from the surrounding areas, but the camp itself is a food desert, a slum covered in dry earth, out of place in the midst of Malawi’s fertile green season. I see green all around, except here. Every road in the country is dotted with people selling crops of fresh vegetables, but here there are just a handful of half-rotten tomatoes on display on a few corners.
She’s been treated for parasites and told to take iron. Some years ago, when a program gave a handful of beans every day, her anemia was only half as bad. But now there are no beans. It’s difficult to problem-solve in a context like this. It’s hard to use local resources to solve a community’s problems when a community is artificially held in a setting with few resources. These people build houses with their own hands and educate their children in schools they manage themselves. They have vibrant churches and prayer outreaches and truly care for one another. But they can only farm if they rent land outside the camp from Malawian landlords. There’s not enough food, and it’s not nutritious. A family can use an entire liter of oil each week simply because their only other source of calories is cornmeal. And they are not legally permitted to take jobs, but can be sent to prison if they try to find income outside of the camp.
I recently reviewed a grant application to bring nutritious foods to underserved patients in Arizona. How much more do these people need a transformative program? I’ve been working to develop healthier resources for Lifestyle Medicine, but how can a community start when they can’t source fresh foods? I’ve been enjoying seeing patients in Lilongwe this week, but what can I do for patients whose nearest clinic has no medication? I saw a sick infant diagnosed with Malaria, who continued to get sicker because no malaria medication was given. Was it a language issue at the clinic, or the pharmacy was out of medicine? And then there’s this woman, Joy. A brief touch of my hand shows that her right sided pain is from her gallbladder. But what can we do about that? She can’t afford a scan, much less a surgery. So far, she can’t even manage to improve her diet. What can we do for a people like this? What should we do? For now, we’re praying. We do have some resources, we do have some training and expertise. We might not be able to catalyze development in this context, but we could probably bring some relief. Should we do that now? How can we be wise, and help without causing more harm to this community that has already been through so much?