David Heiden

Literacy and public health

Major General Mohammed Siad Barre, President of Somalia from 1969 to 1991,was a dismal tyrant who left a legacy of civil war, clan violence, and massstarvation. Ironically (and perhaps unintentionally), he also presided over asymbolic milestone in public health. n nUntil 1972, Somali was not a written language. The literacy rate in Somaliawas 5%. Siad Barre introduced a Roman script and ordered the writing ofgovernment documents and educational material. Then, in August 1974, in a“Campaign Against Illiteracy,” he temporarily closed the schoolsand sent the teachers and students, more than 20,000, back to their homevillages and nomadic tribes to teach their brethren basic literacy. n nWe think of clean water, good sewers, and immunization when we think ofimportant measures for public health. But education is the key event andeffective education begins with literacy. In numerous studies, literacy itselfhas been linked to reduced childhood mortality, reduced maternal mortality,effective family planning, and even a reduction in the prevalence of dentalcaries in children.

Culture and one child's genetic abnormality.

We first saw this child in 1995 and again in 1997, read the textbooks about her problem, and consulted famous eye plastic surgeons. We learned that its impossible to make her eyes anything close to normal and unlikely that we could permanently improve her vision much. We debated trying to improve one eye, but were dissuaded by Dr Palden, a Tibetan doctor. He explained that with her appearance, she would have a secure life as a beggar and wed destroy that if we operated.

A patient remembered.

Sith Nihm was a Cambodian refugee, the wife of a high-placed official who had been murdered by the Khmer Rouge. She was near death when she arrived on the ward. Malnourished and diabetic, she had tuberculosis or multiple bacterial lung abscesses or both (we were never sure), and a terrible breast infection. Her damaged grace and vulnerability seemed to embody the Cambodian refugees we were trying to help. n nWe gave her high doses of penicillin intravenously for the lung abscesses and triple drug therapy for tuberculosis. We administered insulin and developed a schedule so that different family members and even other patients on the ward took turns feeding her and helping her walk around the ward. Finally, after a mastectomy (even with antibiotic therapy her breast infection could not be controlled), she started to regain her health. Her breast was still bandaged a week after surgery when I made this photograph. n nLike many physicians, Ive had patients that become part of the landscape of my memory—vivid figures that never entirely leave my life. I dreamed about Nihm, the first dream I had after I returned to San Francisco from Thailand, A month later, a colleague returning from the Thai-Cambodian border called to tell me that Nihm had relapsed and died.

Clothes, poverty, and the global economy

A photographer for National Geographic told me about fighting with the picture editors when he returned from an assignment in rural Africa. They wanted images of Africans in “traditional native dress,” but in his pictures, people were wearing western castoffs, such as worn-out rock concert t-shirts. Ive seen the same thing, such as an elder of the Karamoja tribe in the wild Northeast corner of Uganda attending a tribal rain ceremony wearing nothing but a womans tweed, oatmeal-colored winter overcoat that Ill bet was worn previously by an elderly woman in Chicago. n n n nClothes travel and the journey tells a compelling story about the global economy. From the sweatshops of the developing world, shirts, jackets, trousers, and skirts make their way to the shelves at Walmart and even the boutiques of Fifth Avenue and Rodeo Drive. After they are worn out or unfashionable, we dump them in thrift shops for a tax writeoff and, finally, the cycle is completed when the residue that no one in America wants is sold by the ton and shipped to the rural markets of Africa. Clothes are an emblem of the westernization of the world and the reach, power, and inequity of the global economy.