It’s one thing to understand an issue or fact intellectually, another to experience it first-hand. That’s been made clear to me twice recently concerning health care here in Nepal and what are sometimes called ‘social determinants of health.’
One of my current projects is reporting about malnutrition during Covid-19. I contacted the Nutrition Home close to Kathmandu hoping to speak to the guardian of a child who had been admitted because they were malnourished.
I did meet the mother of a toddler and sat down to talk, with the aid of a nurse who agreed to act as interpreter. It quickly became clear that what this young mother wanted to discuss was how her husband had physically abused her and managed to isolate her in their village so that she felt she had to escape with her child. Here in the capital she was alone and looking for support.
“The boy became malnourished because the mother was overwhelmed trying to find a safe space for them to live and could not feed him properly.”
Luckily, the manager of the centre was sympathetic and had started consulting her network to see what assistance she could find. Meanwhile, she would let the mother and son — the boy became malnourished because the mother was overwhelmed trying to find a safe space for them to live and could not feed him properly—stay there until they found an alternative.
A few weeks later the manager called to say that another mother had arrived with her malnourished daughter, and we again scheduled an interview. As we talked, I learned that this woman’s husband had left her soon after the baby was born. He seemed to be her only support and so she was forced to start looking for her work quickly, as a cleaner in private homes.
Mother has multiple health issues
Where she found a job, the main meal of the day was eaten only in early afternoon, after her daughter had left for school. That meant the girl ate only snacks in the morning, said the mother, and whenever they were outside the house her daughter asked her to buy the shiny packets of food displayed at local stores they passed.
Not only did the woman’s precarious economic situation make it difficult to feed her child well, she was also HIV-positive and on top of that, needed an operation for uterine prolapse.
Speaking with the nutrition home manager later it dawned on me that in both cases, the issues that led to malnourished children were not strictly nutrition-related. It wasn’t that the kids weren’t eating a balanced meal because guardians didn’t know how to prepare one, or that the family was too poor to buy the appropriate food. Rather, the children had not eaten well because their mothers were occupied dealing with other social and economic issues — the so-called social determinants of health.
This is a revelation to me only, of course. Many people who work in health care have long been arguing that governments should provide better social and economic support if they want to have healthier populations. I’ve been reading about this for some years now, but I had to see this phenomenon in practice before I truly ‘got it’.
Read part 2: No magic pill for Nepali women who give birth at home.