As I experience more of life in Kenya, I begin to understand the realities that lie behind the words “morbidity” and “mortality” that we so often use to describe the effects of disease.
Mortality – death – is the most definitive and the most sobering way to measure the effects of a disease. Simply put, how many people die because of it? 1.8 million children die from diarrhea worldwide each year. In 2010, malaria killed about 655,000 people – mostly children in Africa. These numbers are large and sobering, but in reality the simple number on a page doesn’t elicit much of a reaction, especially if you happen to spend a lot of time reading about such horrible things for your job (as I do).
But living in the midst of it is quite different. The town mortuary is right across the street from our lab and next to our apartment, and is regularly surrounded by crowds and buses and parades of mourners. Families bring a coffin to bury their loved one, usually strapped to the top of a car or sometimes the back of a motorbike. Sometimes I can’t walk to work without tearing up as I witness the ebb and flow of loud singing, at first seeming celebratory, and softer mournful hymns. But the thing that gives me goosebumps is the regularity with which the family is bringing in a small, child sized coffin.
Over the next few days Tim is going to be in Kisumu doing some training on verbal autopsy – an interview with the family of the deceased so that if a child who is part of our study dies, we can try to understand the causes. It is so devastating to consider that we have to prepare for these children who are not yet even born to die. I am glad that we will be able to look at the causes of mortality in this study to help prevent other children from dying in the future, but I hope that Tim has no use for this training.
As awful as it is to dig into mortality, morbidity is a more silent but still insidious force. Mortality is very clear cut and easy to measure, and we tend to assume that as long as someone recovers from their illness everything will be fine. But in reality even a complete recovery from illness can leave detrimental effects, and all too often there is lasting damage that has been done to a person’s body or mind by the trial they have suffered. Over the past few days I have been so struck by what an impact illness makes on work and productivity. Today it seems like half our staff is sick at the doctor or are taking a child to the doctor. Malaria and GI illness are the biggest culprits. Last week one of our staff was out with “a little malaria and a little typhoid.” He returned to work the next day because he said he was bored at home, and it is a regular occurance for staff to come into work with malaria. Despite this generally strong work ethic, 7 out of about 70 employees are out sick today. The cost to organizations and families of this lost work and productivity is enormous, and the loss of income due to illness can be devastating here as it is anywhere.
I don’t mean to be depressing, but I think it’s important to recognize the stark realities and upsetting facts behind the numbers. Understanding the sobering reality gives a purpose to what we do, and make me grateful to be a part of a group of people that are trying to change that reality. The numbers are impressive and maybe that should be enough to galvanize a response, but the reality is that there is nothing like living next to the mortuary in Kakamega to show you the true impact of preventable disease.