Every day is a struggle
Mindy Elliason

It was just fourteen days, but it has changed the way I look at everything. The ease with which we, as citizens of a developed country, float by in life has been made blatantly clear to me. My words are ineloquent; they aren't enough. You have to experience the third world to understand it.

Every day is a struggle to survive in the Gambia, the smallest African nation. It is also one of its most poor, with a per capita income of $290 a year. I had heard that number prior to arriving and thought I grasped it, but the second you get off the plane it hits you. These people live on 79 cents a day. The shuttle driver at the airport looked at me and through broken English said, "Your people are dying, and our people are dying, but from different things." I

t was so profound, and his words would resonate with me over the next two weeks. He was right. If anything, here in America we are dying of excess; of health problems caused by obesity, of war and greed. It is the opposite there; they have nothing. Here, it is unacceptable to die from malnutrition and disease, but in Africa it is happening every day.

I don't know the cause of the poverty there, and I certainly don't know the solution. What I do know is what I witnessed with my own eyes; what I smelled, what I felt. The state of destitution there is beyond words, almost medieval. It is dirty. The smell of trash and sewage fills the air. There is no proper sanitation; toilets are holes in the ground, and while some homes are outfitted with faucets and shower heads, the water pressure is too weak for the water to flow. There are community taps with drinkable water, and the people collect water in jugs and basins and carry it back to their respective compounds. Once (and if) they have water, the women wash their clothes and dishes by hand, outside in that Sub-Saharan heat, their backs bent over buckets. If there is water leftover, they can bathe, but I don't think that happens very often. The government turns water and electricity on and off without warning. When I was there, we went without water for over 30 hours several times, rendering inconvenience of course, but also leaving people thirsty in 98 degree heat. A shop owner in Mansa Jang, Samba, told me that recently they have gone without electricity for 3 years at a time. If the power is ever out in the states, we are incapacitated and sometimes it is even newsworthy.

For citizens of the Gambia, surviving occupies all their time. It consumes their mind. We realized through our interaction with the Fula people that a primary goal in life is to have as many children as possible, regardless of whether or not they can take care of them. It seems so counterintuitive to me. One night at the clinic in Koina, we were there after dark and the little kids were alone with no parents in sight. Girls start having children at 14 and continue as long as they are able, hoping that their children will grow up and go to Europe or the US and send money home. There, the kids are skinny but have bloated bellies, their teeth are full of cavities, and they wear ill-fitting clothes and no shoes. But all the while, their eyes are full of life and hope.

My friend Lori had worked with Youth With A Mission (YWAM) and had been on the Mercy Ship's Anastasis a few years back. While with YWAM, she traveled to Africa and worked with a missionary in a small community called Mansa Jang, 6 hours and 3 ferries away from capital city Banjul in West Africa's "bush". Taylor and Miracle Iwodi and their children Bishop (7), Marilyn (3), and Berry (18 months) work in Mansa Jang and another community called Koina, where there is not one known Christian. The Gambia is 99% Muslim. Islam is the second largest religion in the world, and Muslims are predicted to outnumber Christians by the year 2020. Islam is a very works-based faith, founded on Five Pillars: Faith, Prayer, Charity, Fasting, and Pilgrimage (Rajj). We entered during Ramadan, the month of fasting by Muslims, which is considered self-purification and is paramount in their faith. The citizens of the villages, weak from fasting, lay under tin roofs in an attempt to keep cool during the day. There is a call to prayer five times a day, and every night we saw dark figures bowing, words in foreign Hebrew slipping from their lips. 

I worked at a makeshift clinic in a community called Koina, a round trip of 3 hours each day from Mansa Jang on the bumpiest, worst maintained road you can imagine. The door of our van actually opened up during the trip, spilling suitcases and pills along the road. The missionary's old Toyota van worked intermittently and the battery terminals came unplugged several times on the trip. I saw families of at least 4 people at the clinic, each member complaining of a fever and abdominal pain, a workup for which in the states would cost at least $500. There, though, I treated empirically for Malaria, Worms, Sexually Transmitted Diseases (in the Muslim faith men can have up to four wives and are not faithful even then), Malnutrition, Tinea, skin infections, Amebic Dysentery, Giardia, etc. My diagnostic tools consisted of my hands, my eyes, and my stethoscope. The translation was positively fatiguing; there were two translators, one spoke and Mandinka and the other spoke Sarahouli, and both spoke Fula. Several times I had a double translation, from Mandinka to Sarahouli. Coupling the ambiguous nature of the complaints with medically untrained translators was enough to make us give up, but we couldn’t. People waited in line all day for a toothbrush and some Tylenol, and the line never ended the two weeks we were there. The state of health is so poor, and I wonder if there is any end in sight as there is little to no education in place and the people are so poor. They can’t afford proper nutrition, which is paramount in health, and I have always exploited that. Even if they have money, the availability of medications is so limited, it is truly heartbreaking. Working there during Ramadan also posed several problems; even if I could give the patients medications they generally wouldn't take it as they would have to break fast. Real Muslims can't even swallow their own saliva.

My overall feeling about the trip is positive, and I am happy we were able to help those we did. But I don't feel like we made a dent, and I feel like what we did was fleeting. The needs are so great, and I don't know how a few naive, altruistic Americans could make a lasting effect on the lives of the people there. The problems there are fixable, like proper sanitation, nutrition, highway infrastructure, and health care. But they take money. More money than I've got. I realized on this trip that the only true lasting message we could leave them, the only thing that could make a difference, is the love of Jesus Christ.

The striking realization that I had is that we are so fortunate to live and work in America. Life is easy here and we are blessed. From a vocational perspective, we have so many resources to prevent and tools to diagnose and treat diseases: diagnostic tests, computers, and 24-hour pharmacies. This trip was very humbling for me, and I realized that no matter how educated I am, if I do not have the resources to treat a patient, I am nothing.

I always thought I grew up poor, but I don't think there is such a thing as "poor" here anymore. Poor by American standards is sheer opulence compared to a developing country; at least here when you are poor you most likely have running water and electricity and a balanced diet.  Looking into the eyes of the kids running alongside our van, reaching through the windows to touch my hands, I wondered if these kids would ever escape this life. I can't get over the fact that just by looking at me, at my white skin, the kids automatically assumed wealth. They followed me around the village. They fought to hold my hand. They gently stroked my hair, a smile spreading across their face. To them, white skin equals prosperity. I realized on this trip that I am blessed by virtue of where I was born, that I have done nothing to deserve the rights and blessings I have as an American. It is my duty to use the resources I have to help others. To whom much is given, much is required.

As I was taking a shower (dumping water over my head with a bucket) the day before I left Africa, I noticed something. The window looking over the street was split into two parts; one pane was an aged, yellow glass, the other side was just a screen. I realized that coming here has been like getting a new view of things. I didn't see things clearly before. I saw them through that distorted yellow glass. I was sequestered from the environment, and the way the people lived here did not seem real even though on some level I knew it was happening. Now I see things through the other part; my vision is clear. I can hear the voices of the people, smell the smells, feel the breeze. I am part of how this world operates and my eyes are able to see how a majority of the world lives. Poor, impoverished, fighting for survival. And no matter how hard I try, I can't block out those voices. I can't make my skin or nose not feel or smell. I can't ignore it.

posted [11.30.06]

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