Sunday, June 3, 2012

Development


There was a time back in college, when I first became interested in public health, when I wanted to become a nutritionist, a maternal and child health nutritionist to be exact.
Then I found out I would have to endure awful things like calculus and physiology, and as the good Lord did not bless me with such talents, I settled instead on the behavioral side of health. Instead of studying how nursing moms and babies metabolize fat and protein, I studied behaviors associated with contraception and pregnancy.

But there is still that part of me, the part that has spent countless hours babysitting since I was old enough to watch my little brother, which is fascinated by child development. I love babies right around the age of 6 months when they really start to interact with and react to the world around them. Movements are voluntary, emotions are dependant on more than hunger and fatigue, and independence is knocking at the door.

I’ve seen many a well cared for child in Gabon. Mamans come to PMI dressed in their stylish panje and jewels, their baby or toddler securely tied on their back. They place their carnets on the nurse’s desk and immediately tend to the child’s needs. They breastfeed, they coo, they talk, they tickle, they play. If the toddler whines or fusses, it’s that ornery temper of a child who is used to being spoiled to pieces and loved to death. 



But every once in a while you see a child, and you know from first glace, he or she is not progressing. You have that sinking feeling that something is not right. Maybe there’s a copper tint to the hair, maybe the eyes are a little sullen, maybe you have trouble distinguishing the age because a two year old just can’t be that small. And when you try to engage him or her in play, you get nothing in return. The child cowers in on him/herself and looks utterly too exhausted or bewildered. On a recent overnight trip to the village of Sindara, my friends and I had a veritable feast of fish, rice, eggplant, and manioc, while the child of the people cooking sat in the dirt on the side of the road and stared into space. I first noticed him when we arrived some 4 hours earlier, and there he was during our meal in the exact same spot doing the exact same thing. No stimulation, no human interaction. I tried to talk to him at some point and he just started at me blankly. It could have been my accent, but either way he didn’t make a peep.

Research in the U.S. has shown that children from lower SES backgrounds hear on average 1 million fewer words by the time they are five than their higher SES counterparts, rendering them less prepared for kindergarten and beyond. This is why Boston has programs like Thrivein5 and Reach Out and Read, because the U.S. is not devoid of child development problems just because we are “developed.” But to some extent in the U.S. we have the “luxury” of spending time and energy on helping children learn to talk and read. Here you focus on giving parents bed nets (and hoping they don’t use them for fishing) to prevent malaria. When survival is your highest priority, development is equal to years lived rather than milestones achieved along the way. I can’t help but think that we perpetuate and exacerbate the “developed vs. developing” country divide when we spend all our resources on “higher” order needs.

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