It was a hot, windy August day when I visited a Somali village named Baagay, a site where Catholic Relief Services is distributing food and agriculture tools to hundreds of people who have survived the worst of their country's violence and famine. I stood there with dirt in my eyes, mouth and nose, trying to get some sense of how these people could live through such civil strife and destitution.
Then a beautiful woman, wearing brilliantly colored African garb, penetrated through the dust and pointed at a leg sore, over an inch in diameter, which had puffed her entire foot with infection. I turned to a fellow worker and asked him what it was and what could be done.
He advised her, in her language, that she needed to go to the clinic in a nearby town. Then he told me in English that she probably had tuberculosis and, even though she might be fortunate enough to get treatment, his experience was that people don't take the TB medicine as directed. "She'll probably die, I'm sorry," he said.
Then, another boy pointed out a similar sore on his leg. I stood there, looking at both of them, feeling emotions I had never felt. After finding out how to say it in their native tongue, I told them goodbye, which hit me as a cheap gesture, much less than what they deserved as human beings.
Later that day, I saw a physician working for Catholic Relief Services. I described the sores to her. That day she had seen some 40 similarly infected people in the village of Ideeda. She said the sores were not, in fact, due to tuberculosis, but rather were tropical ulcers, a sign of severe malnutrition. "If they are too infected, amputation is necessary, otherwise they'll die," she said.
As we were driving to an agricultural project near Baidoa, I asked a worker if there were any plans to open a clinic in the area. He explained that virtually all Somali doctors had fled the country, that it would be exorbitantly expensive for the agency to fund such remedial care, and that it would be much more cost-effective to focus on sanitation and nutrition while building local capacity for primary health care that could be sustained by the Somalis themselves.
I sat there as the pickup truck bounced down yet another dusty road, feeling slapped in the face by what seemed to be a well thought- out, but nonetheless brutal reality of proper stewardship of resources in emergency relief. I felt both angry and disgusted, but I had to admit that the reasoning of my colleague was sound.
I could tell that he, too, had struggled with it. I've known him for over a year and I consider him to be an incredibly compassionate, caring individual. He looked at me after a period of silence, and, in trying to hide his emotional discomfort, said, "It's a tough call, isn't it."
Two hours later, in a small plane flying out of the heavily U.N.-guarded airport, I found myself sitting next to a physician volunteering in the Baidoa hospital with the International Medical Corps, an agency specializing in emergency medical care. He works at a clinic in Baltimore and is on the faculty at Johns Hopkins University.
He informed me that he'd seen a lot of tropical ulcers and had performed an average of three amputations a day on people who were highly infected. He said the funding for his work at the hospital was tenuous, since there was virtually no local health-care infrastructure left in Somalia.
The question of sustainability of primary care haunted him, just as it did my Catholic Relief Services friend. "Sometimes I wonder if what we're doing here is futile, but I keep doing it anyway," he said.
After confronting that numbing reality again, I leaned back in my seat and, exhausted, fell asleep. When I awoke, night had fallen and the privacy provided by the darkness unleashed my emotions. My thoughts returned to the woman and the young boy and the poignancy of our goodbye, and I remembered something Mother Teresa had once said. Describing what it's like to hold a dying person in her arms, she stressed that it is important to help them die with dignity and to convey that they are loved.
Maybe that's the best we can do sometimes.
Joseph G, Bock is the director of development education at Catholic Relief Services.