7.2.1. Prevalence, symptoms, and severity of ARIs from children’s perspectives
Epsodes and experences wth aona ki avuru (cough and flu) were a common occurrence. Chldren frequently named aona ki avuru as common llnesses whch they experenced, and by observaton n dsplaced prmary schools and nght commuters’ shelters, symptoms of ARIs were a common occurrence. In chldren’s narratves, however, they agreed that such llnesses were not severe, and frequently the two llnesses ‘got cured by themselves’. Ojok, n the prologue of ths thess, dd not make t explct that he had had cough and flu wthn a one month recall, yet n nght commuters’ shelters these nfectons were common, and he and hs three sblngs exhbted symptoms of ARIs durng all ntervew sessons between July and September 2004. One fourteen year old boy narrated hs story of aona ki avuru n ths way:
Aona ki avuru commonly attack me, but they are not serous. Often, for cough I only need to chew cwiny lapena or cwiny kalatuc (leaves of pgeon pea or eucalyptus plants) and I wll be cured. Sometmes I may take Acton tablets, smear Vickskingo or use Piriton for flu, but often t goes away by tself.
Although older prmary school chldren ensured some cleanlness durng tmes of llness through the use of handkerchefs, and some chldren were observed blowng ther noses or coughng outsde ther classrooms, some unpleasant practces were observed among younger chldren. Careless coughng, even wthout coverng ther mouths n densely packed classrooms, was a common scene, and these practces are lnked n ths chapter to the high prevalence of ARIs, particularly in classes with children of between five and nne years old.
Through examnaton of medcal record books at GRRH, Layb, Lalya, and Laroo outpatents unts, where malara was the most frequent dagnoss, n only a few nstances were ARIs also regstered. In October 2005, only four medcal records of chldren aged eght to sxteen years showed that Valum and Amoxclln had been prescrbed by a clinical officer for cough and flu, and durng ntervews about how chldren managed ther cough and flu, only twenty-two of the seventy-eght chldren n one class ndcated havng been told at Layb and Laroo health centres to purchase Septrn, Panadol, and Amoxclln capsules. Perhaps the relatve absence of ARIs n medcal records was
because chldren hardly ever sought specalsed care for them.
A substantal proporton of chldren named cough and flu as common llnesses, when lstng and rankng common llnesses whch attacked them. However, n one focus group discussion with twelve to fifteen year old boys at Noah’s Ark nght commuters’ shelter, they concluded that cough and flu were dseases whch were only serous n younger chldren. One fourteen year old boy told how t was only when the cough was very frequent, and there was pan n hs chest, that he bought the red and yellow capsules for cough.
In an exercse to dagrammatcally llustrate the common llnesses chldren experenced n dsplaced prmary schools, cough and flu featured as common llnesses n ther drawng. In one class of seventy chldren at St. Peters Bwobomanam, all chldren llustrated aona ki avuru as ndvduals wth ar droplets or partcles around the head regon. In ntervew sessons whch followed, many chldren asserted that at the moment of our dscusson they had cough or flu or both. However, the epsodes were not consdered severe snce they could stll perform ther routne actvtes. Chldren further told stores of how other chldren frequently developed a cough after sweepng the dusty classes and school compounds.
In Chapter Fve above, I provded an example of how one boy wrote about hs experence wth malara wthn a one month recall, even though at the tme of wrtng hs narrative he was experiencing flu and cough. When I nqured about hs selectve wrtng, he argued that it was because “flu and cough were not serious llnesses. Ths s because cough and flu do not make people weak lke malara does”. Further, he would probably not need medcnes n order to recover. Generally speakng, cough and flu were llnesses of lesser mportance to chldren of prmary school age, because even chldren who dscussed ther recent epsodes wth cough and flu had first discussed their experences wth other llnesses whch were regarded as severe n comparson.
In short, ARIs were hghly prevalent among chldren who partcpated n ths study. They were, however, not regarded as severe. The general agreement was that they were llnesses whch went away by themselves and whch dd not make people weak. Chldren even contnued wth ther normal ‘typcal days’ whle experencng epsodes of acute respratory nfectons. Chldren used both pharmaceutcals and herbals remedes n treatng ARIs, and data suggests the use of manly market drugs, ncludng
pharmaceutcals such as Septrn, Acton, Prton, Valum, Panadol, and Amoxclln. The varous herbal remedes used ncluded cwiny lapena (leaves of pgeon peas), kalatuc (eucalyptus leaves), and muyeme ki mupeera (mango tree and guava leaves). These three herbal remedes were outlned n llness narratves and durng presentatons n two workshops on common herbal medcnes whch chldren used for ther llnesses, yet they were not captured n the quanttatve survey data. Other remedes mentoned were green Pepsi, Vickskingo, Balms,and other unspecified ointments from India.
7.2.2. Using my experience to explore the management of ARIs
Durng one focus group dscusson wth grls aged ten to thrteen years, I was at the tme personally experencng cough and flu, and so I used my own llness to nqure about the severty and treatment of t. One grl aged thrteen years gave ths account n response to my nqury:
Well, you can pray about t. Prayers can heal all llnesses [here I request to be taught how to pray]. But I do not know how to pray. The prayers I was talkng about were those often done by the prest at Holy Rosary Catholc Cathedral every Sunday. He prays for the sck, and sometmes sprnkles water on them. But ths s how I deal wth aona ki avuru. I do not use any medcnes for those two llnesses. It s because they can be cured by themselves. Even now I have cough and
flu. I have not taken any medcne. But I can play, I have been comng to school. At home, I can do all the work whch they send me to do. I just leave t to go by tself. But when the cough takes a long tme, say one week wthout curng, then I can drnk kor muyeme (extracts from mango bark) or chew cwiny lapena and kalatuc (leaves of pgeon peas and eucalyptus plants). Another twelve year old grl added to the dscusson:
If the cough has taken long, or you are coughng frequently, then you can chew the cwiny lapena, cwiny kalatuc, or even drnk kado atwona (extracts from soda ash mxed wth salt). The cough
will go away within one day. The flu often disappears by itself. Cough and flu rarely make people very sck. You can have them but you wll have energy to dg, to cook, to go to school and do whatever you lke. It s only when chldren n class laugh at you and make bad comments when you cough that s when you feel bad.
On the same day, I posed the same question about my ill health with flu and cough n a focus discussion for boys aged eleven to fifteen years. One twelve year old boy first dsclosed how he had the same problem, and then mentoned how hs neghbour (who sold medcnes) had gven hm two Prton the prevous day, after he had fetched for hm a jercan of water. Another boy, fourteen year old Ojok, elaborated:
There are many medcnes you can use for cough and flu. You can drnk kado atwona (extracts from soda ash) mxed wth salt. You can use Amoxclln capsules f you have money to buy them. Also, other medcnes n the shop are Vickskingo, Acton, and sometmes Valum. But stll you can use cwny lapena, mupera,and kalatuc (leaves of pgeon peas, guava, and eucalyptus).
These are always sufficient in curing those dseases.
Snce Ojok was popularly known as ajwaka (ndgenous healer) by other chldren, I promsed to try out all the therapes he recommended, and so I pcked and tasted leaves of pgeon peas and eucalyptus from the school compound. I gradually got better snce the cough and flu appeared to be self lmtng, though Ojok was happy that I took hs advce. Other grls also kept nqurng whether they could brng cwiny lapena for me. I menton at ths stage that there was a deep nternal feelng whch I regstered as a result of the chldren’s care, whch I wll call the ‘unntended effect’n quests for therapy. For nstance, n usng the herbal remedes whch the chldren suggested and also brought for me, I perceved my recovery as beng more a result of the care they exhbted than from a belief about the efficacy of herbal remedes. Further, n the constant nqures from the chldren about whether I needed more of the cwiny lapena as opposed to the btter cwiny kalatuc, I felt and recognsed the mportance ofcare n stuatons of sufferng, whether wth nfectous dseases or emotonal sufferng. I wll return to the mportanceof what I call the ‘unntended effect’n quests for therapy for complex forms of psychologcal sufferng.
In a workshop on herbal remedes, twenty out of thrty-two chldren brought cwiny lapena and cwiny kalatuc as remedes for cough. For flu, only sx chldren brought Robb and Vickskingo. The thirty-two children mentioned that while flu may attack them frequently, t goes away by tself. Sometmes, however, f the chldren asked what medcne to buy for cough and flu they were gven Prton, Valum, and red and yellow or red and black capsules (Amoxclln or Tetracyclne capsules) from drug shops, clncs, or hawkers who sold medcnes n the congested suburbs such as Pece, Cereleno, Kanyagoga, and Kirombe. Only five children bought Vickskingo and Pepsi (hard green crystallne sweets) durng a one month observaton exercse n one drug shop at Olalong tradng centre n Krombe suburb. Each of them ndcated that the medcnes were for cough and flu upon nqury.