One of the hardest things about doing pediatrics in Zambia is not being able to communicate directly with the children. I can smile and wave, but must have an interpreter to ask them their favorite color. I can’t ask about their favorite superhero or cartoon character. And the interactions usually are not “friendly”. Most of the children where I’m working rarely visit the doctor and almost none of them interact with white people. However, when they do it is usually in a medical setting, which they associate with needles and very uncomfortable feelings. So when I approach the children to listen to their heart/lungs and do other (non-invasive) components of the physical exam about 70% of children under 4 years will begin crying as if I’m some scary monster. It’s definitely understandable, but not something fun to deal with.
Something that is very difficult to deal with in Africa is the magnitude of poverty and apparent lack of resources available for those in need. Poverty here is much different than in the US. In the US, poor areas and wealthy areas are generally well separated, and the “projects” are generally hidden and you almost have to go out of your way to see them if you live in the suburbs. Learning about Apartheid (in Afrikaans it means “the status of being apart” and was government sponsored segregation which ended in the early 1990s) and seeing how poor blacks were manipulated, taken advantage of, and treated inhumanely, was devastating. In Cape Town, South Africa, the highways are lined by townships, which are areas filled with hundreds of family homes consisting of cinder block walls, dirt floors and corrugated steel roofs, about 16’x10’ in size. In 1960s blacks were forcibly (and “legally” because of Apartheid) removed from areas “reserved” for whites and forced to move to these townships. I’d encourage you to read about District 6 in Cape Town, a zone in the city where all non-whites were forcibly removed (>60,000) in the 1970s with most ending up in townships. Poverty in Africa is also different because of the extent to which it affects children. In the US I can never remember encountering a homeless child on the street begging for food and money. At least 40% of those I encountered begging in Cape Town were children.
Here are photos of townships I took from a major highway through the middle of the city.