NUTRICIÓN Y SUS BENEFICIOS

Tuberculoss (TB) s a respratory system nfecton whch chldren consdered severe. Tuberculoss was, however, less prevalent among chldren of prmary school age. Durng the entre ethnographc research, only one chld who extensvely partcpated n the study had tuberculoss. Nevertheless, eght of the twenty-four chldren (33%) who extensvely partcpated n ths study were at a hgher rsk of contractng tuberculoss snce they were caretakers of adult kn sckly wth HIV/AIDS, nfected wth an opportunstc tuberculoss nfecton.

In two workshop dscussons on the common medcnes used at home, one chld brought wth hm Rfampn tablets whch he used for hs cough. In hs presentaton of the medcnes, he argued that he had been ordered to stop usng cwiny lapena and cwiny kalatuc at GRRH when he had been dagnosed wth aona opiu (tuberculoss), and the only medcne for t was Rfampn (Rfampcn). Thrteen year old Okello also argued that he “had used those yat acholi (herbal medcnes) for a long tme, sometmes even usng the green capsules (commonly Imodum) and red and yellow capsules (Amoxclln or Tetracyclne) for my cough, but I dd not get better”. Followng Okello’s statement, varous chldren focused ther dscusson on the severty of aona opiu and how t spreads, advsng Okello about what he should do, and what other remedes he could use n order to recover. Ths partcular workshop turned out to address the severty of tuberculoss, ts perceved dsease aetology, and how Okello could stop spreadng tuberculoss to others. In ths dscusson, chldren’s perspectves about tuberculoss were detached, focussng on dsease aetology. It s lkely that ths s due to the fact of ther experence- dstant perspectves. The tone of the dscusson portrays the tuberculoss vctm as the ‘other’ and the chldren seemed not to comprehend Okello’s realtes. Ths dstant stance n chldren’s vewponts was, however, not observed n dscussons on any other nfectous disease which children identified as common. This also tells us about the information avalable from much anthropologcal lterature whch exhbts an experence-dstant assessment of the ‘other’s’ llness experences, wth the man focus on personalstc dsease aetologes

One twelve year old boy elaborated on the severty of tuberculoss whle gvng ths account:

Aona opiu (tuberculoss) s a very serous dsease. In Pece, there s one man whose wfe ded of slim (AIDS), butfor hm he was healthy for sometme. He even remarred. But wth tme,

he started coughng, and hs coughng was very persstent. He tred to purchase for hmself varous medcnes but dd not recover. However, when he went to Lacor Hosptal, he was told that he had aona opiu. Although he was gven so many types of medcnes, he stll coughed persstently, sometmes coughng just blood only. That s how I know that aona opiu s a very serous dsease.

One thrteen year old grl shared an experence of a neghbour’s daughter who had tuberculoss n order to show ts severty:

Her mother says that Acen s about threty-two years old. The reason why Acen was brought back to Gulu from Kampala was that she was sckly wth aona opiu. When she was taken to ot yat adit (GRRH), she was admtted for a short tme and told to go home. She was, however, stll coughng. She s very thn and needs help to stand from her bed. She had aona opiu. Although she takes medcnes lke those Okello has, she does not recover. Neghbours, however, keep gosspng about dangers of gettng aona opiu. Some people say that someone could get aona opiu by just crossng the compound and comng close to the hut where that woman sleeps.

In varous focus group dscussons wth chldren aged nne to sxteen years, sometmes dsaggregated by gender, the predomnant theme among all chldren was that aona opiu was a serous dsease. Furthermore, tuberculoss, the chldren argued, was caused by the swallowing or inhalation of cat fur. In one session, five boys aged twelve to fourteen years specifically asked Okello whether he had a cat at home, and if so, advised him to get rid of t. Okello, however, nssted that he dd not have a cat n hs home or hs neghbourhood. In the same dscusson, chldren narrowed down ther ‘advce’ for Okello to what to do n order not to spread aona opiu:

He should not st close to others. At home he should sleep n a hut alone. He should use hs own cup, plate, and blanket. Above all, snce Okello’s medcne seemed to work for hm, he should never mss a day wthout takng any of them.

By the tme Okello’s response below was completed, there was a pecular slence n the classroom. Here s how he shared hs experence:

Perhaps I got ths aona opiu when I was takng care of my mother last year [2004]. She ded of

aona opiu. Some neghbours say she ded of slim [HIV/AIDS], snce even the solder whom she

had a child with also died last year. It was the child she gave birth to who first died, then later

my mother. However, I had to take care of her at hosptal. Durng that tme, Ajok was always takng care of my younger ssters and brothers at home. She would also cook and brng food to hosptal daly. But I cannot do all what you are tellng me to stop aona opiu from gettng other people at home. We have only one hut for all of us. We have just two blankets for sharng by

five of us. We have two cups and three plates. We have been sharing all this. There is no one at

home who has got ths dsease!

The complete slence whch followed Okello’s narratve was only nterrupted by one outspoken eleven year old boy who began by argung that perhaps Okello had already

nfected hm wth aona opiu. However, he added that he may not have, snce people often told hm that he s very strong (resstant to dseases), and much as the people around hm at home sometmes fell sck, he remaned healthy. Other chldren present for the dscusson hypothessed that t was because they had not shared cups, plates, or pens wth Okello that they were stll healthy. Most mportantly, they dd not have aona opiu because they dd not have cats at home, and nether dd anybody n ther neghbourhood.

I closely montored Okello’s medcal records whch he regularly took wth hm to Lacor Hosptal when he went to collect hs medcnes. Over a sx month perod when Okello took Rfampn tablets he exhbted complete adherence. In my follow up vst to Gulu n May 2006, I vsted Okello and hs health condton had deterorated substantally. Together wth hs sster they narrated how, after the sx months of takng hs medcnes, he was told that hs chest had not responded to the medcnes. The x-ray result showed a black thng n hs chest. I organsed to take Okello to Lacor for check-ups, and the clncal officer confirmed yet another case of multi-drug resistant tuberculoss (MDR-TB). The hosptal was, however, stll awatng the arrval of another lne of drugs to combat t. I felt helpless, like the children and the clinical officer and other people who had gathered to watch us. Nevertheless, Okello was agan regstered for Rfampn medcne, ths tme wth strct advce for hm to adhere to the schedule and tmng n takng them. In another follow up vst to Gulu n January-February 2007, I traced Okello agan. To begn wth, I discovered that the brother of their landlady, Alobo, had instructed them to find somewhere else to lve as they were becomng a danger to hs chldren, snce he had also developed tuberculoss whch had been dagnosed at Lacor hosptal as MDR-TB. Ajok and Okello were therefore now lvng at the extreme end of the vllage wth vrtually no neghbours. Accordng to Okello, the brother of Alobo – havng learnt that the tuberculoss they had was not curable and that there were no medcnes n the entre country – nstructed them to leave the neghbourhood. He had demolshed ther huts. That s how they moved to the extreme end of the vllage to rent a pece of land from the present land owner. Okello and Alobo may therefore have been mportant sources of nfecton for MDR-TB. Due to hgh loss of adult lves n Gulu and northern Uganda, a unque scenaro has developed whereby t s chldren who are the prncpal caretakers of HIV/AIDS vctms, and snce HIV/AIDS clents frequently have tuberculoss, t s lkely that such chldren are also exposed to t. Nevertheless, there s hardly any data about the dangers of such chldren’s

exposure to tuberculoss.

Whle lvng n solaton, each of the famly members had a card and had to regularly report to Lacor Hosptal for isoniazid prophylaxis. Okello had recovered remarkably compared to my judgement of hs condton n May 2006, snce he could move unaded and had ganed some weght. Durng another vst n September 2007, each member of the family had a certificate of completion of isoniazid, and “Each of them had no traces of actve tuberculoss and had perhaps recovered”, sad one medcal doctor durng ntervews.