taking children to an African country while you conduct research

A couple of folks have asked me recently to share some insights about taking children to “the field” when conducting research. I can really only draw from my own experience, which is limited to a seven-month trip with a 14-month-old to Malawi in 2008. I’m also asking readers for help in sharing their experiences (ideally in the comments section below). The most important thing to remember when reading this post, however, is something a friend said to me when I asked for others to share “advice” for taking family to the field:

Giving advice is tricky… Everything’s subject to the particulars of your family, your fieldsite, your project, your level of tolerance for chaos, etc.

Thus, this is not an “advice” column. This is a “this-is-how-I-see-it” column.

I’ll start with my experience, since I know it best.

I knew before my daughter was born that we would be going to Malawi so I could collect data for my dissertation project. I estimated we would go when she was about 15 months old. My partner and I asked our pediatrician how we should prepare for the trip during one of the first well-child check-ups she had as an infant. Our pediatrician did some research on Malawi and decided what additional immunizations our daughter would need and came up with an abbreviated schedule for her standard immunizations and the extras needed for any toddler traveling to Malawi (e.g., getting both MMR shots and both Varicella shots before 14 months, her age when we were departing the US). We learned there was a pediatric version of Malarone and figured out how to get enough out of the health insurance company before we left the country (and have some mail-order delivered to a friend’s mom who could ferry them to Malawi for us later). I called a grad school colleague who had taken her son with her for fieldwork in Egypt and asked her advice. We arranged to have a friend pick us up from the airport because we knew that her vehicle would have seatbelts, meaning we could install our daughter’s carseat for the long drive from the capital to the first field site.*

We land in Malawi, tired after nearly two days of travel, and our bags are stuck somewhere in Johannesburg, with the potential of arriving in a few days time. We make do. My husband reminds me now as I write this just how incredibly lucky we were — we were in a place where we were essentially among family. A place where the Malawians knew us (we had been at the exact same field site, together, two years earlier and made friends) and liked us (or at least, they really liked my husband — and they all took to my daughter immediately). We also had an army of ex-pats staying there with us. Though most were clueless about what to do with a toddler, they were well-intentioned.

We ask around about a nanny. We find one. I realize pretty quickly after she’s started taking care of my daughter that she will be one of the most amazing people I will ever meet in my life. I know just how lucky I was to have such a person caring for the thing in the world I loved the most. One great thing about Malawi was that we could actually afford a nanny. When in the states, we were poor graduate students who traded off watching our daughter in our tiny one-bedroom apartment in Cambridge because we could not afford daycare. Take the same amount of stipend to Malawi, and you can have a big house with a live-in nanny. (Well, we weren’t in the house the entire time we were in Malawi, but a good chunk of it.)

A couple of weeks after we arrive, my daughter takes her first steps. In Malawi of all places! The place where I met and fell in love with her father. When we lived near the Shire River, we could hear hippos at night. A neighbor friend who acted like an older brother to our daughter could imitate their sound perfectly, and it would make her (and us) laugh. We drove her on a safari where we saw great elephants and giraffes and even warthogs. We carried her on hikes of Zomba Plateau and Mount Mulanje. She would dance when our nanny’s group of friends would get together and sing. It was all pretty magical.

Still, kids get sick. And this is what people ask me about the most — how to deal with taking a very young child to a place where many children don’t make it to their fifth birthday.**

In the seven months we lived in Malawi, there were three times my daughter needed a doctor. The first time she was really ill: fever, diarrhea, vomiting. We took her first to the district hospital and were attended to by the District Health Officer himself (he was a medical doctor in addition to being an administrator). There, she tested positive for Malaria. I was convinced the test was wrong. She wore long sleeves and pants all the time. She was taking a daily course of pediatric Malarone. She also either slept in bed under a bednet with us every night, or in a fully enclosed baby travel cot. I asked the doctor what the chances were of a false positive; he looked himself at the slide (it was a lab test for Malaria, not a rapid test) and decided that there was too much debris on the slide to give a conclusive answer. We tried giving her oral rehydration therapy and thought if it were a virus that she would slowly improve. She refused to eat and started to lose weight and by the end of the third or fourth day, she was lethargic. My insurance company (located in the states) wanted us to drive across the border into Zambia to an Adventist hospital (they didn’t realize how challenging that would be) and told us that if she wasn’t better by the next morning that they would medevac us to South Africa. I couldn’t believe there wasn’t a doctor good enough in Malawi to treat her and I didn’t think flying to another country (and the time it would take to do that) would help matters. I was desperate. So, even though it is NEVER a good idea to drive at night, that night a friend drove us to the capital (Lilongwe) where we met a friendly American doctor working in a missionary clinic. He diagnosed her as having a bacterial infection (even fancy hotels in the capital can give you food poisoning–as they can in the states) and gave her a shot and she was already getting better by morning. That doctor is the primary reason I stopped talking trash on missionaries in Africa (but that is for another post). I can’t imagine what we would have done without him.

A few weeks later, our daughter got sick again–this time with a terrible rash that would not go away. We were now in a different field location, far from the angel doc in the capital. I was told there was an excellent German pediatrician at the district hospital that was less than a two-hour drive from where we were staying, so I took her there. The people who told us the German doc was excellent were flat out wrong. We braved a much longer drive to return to the missionary clinic and again, the doctor was quick at diagnosing the problem and getting my daughter healthy again. In both of these situations where I disagreed with the first doctor(s), I am grateful that some wise woman once told me that mothers know their children best. In the first case, I knew she didn’t have Malaria, and in the second case, I suspected her illness was related to her course of antibiotics from her earlier sickness. Mother’s intuition and second opinions are underrated. I was lucky to have a well-trained doctor that I trusted in the country — even if it meant a long drive.

Finally, just a week before we left Malawi, my daughter tripped and broke her arm. On Christmas Day. We had a friend in country who was a doctor and who spoke with us over the phone to determine whether it was okay for us to wait a day to see a doctor (it was and I don’t know what we would have done if it wasn’t because literally no one was available). We went the next day to a major private hospital in Blantyre (the commercial capital in the south of the country) and because she was so young, we were referred to Beit CURE, where she got proper X-rays and a cast the same day.

Though we never managed to arrange having a go-to pediatrician during our trip in Malawi, we found two great docs when our daughter needed medical attention — one was a general practitioner at the missionary clinic (an American who had three young children himself) and the other was a fellow of the Royal College of Surgeons practicing pediatric orthopedic surgery at Beit CURE. Yes, it just so happened that when our daughter broke her arm in Malawi, she was attended to by one of the best trained doctors in the world (who also had three kids living in Malawi with him and his wife).

My daughter is now a happy and healthy six-year-old who doesn’t even remember being in Malawi. Still, the scares we had (particularly the first one) were enough that my husband and I decided we were not going to bring our daughter back to Malawi before she turned five. Since my Fulbright in 2008-2009, I have only made solo research trips to Malawi, never staying more than three weeks.***

Cultural anthropologist Alma Gottlieb has written a lot (I’m told) about her experience. I share a bit from her latest book, The Restless Anthropologist: New Fieldsites, New Visions, in which she talks about her experience living among the Beng in Côte d’Ivoire in the early nineties:

“…I also weighed whether our growing family could withstand another long-term residence in these relatively remote, medically underserved villages. During our last stay, we had brought our six-year old son Nathaniel with us, and in three short months, he’d lost 12 percent of his body weight. While Philip and I wanted to give Nathaniel a sibling before long, bringing another young child to the Beng region any time soon seemed an increasingly distant option. Yet my fieldwork had always been en famille. Inspired by the rural African parents I have known — who keep their children by their sides as they work, hold meetings, celebrate, and sleep — I have tried to blend the parts of my life that our society tells me I should separate. Never having considered doing fieldwork without my husband and child(ren), I felt in a quandary.”

Another former Aggie prof, Tracy Baker, has recently made the move to Addis Ababa with her husband and two kids. Her blog’s introductory post already seems like it would be relevant to folks interested in this topic. Tracy’s experience living and researching in African countries with her children in tow also includes experiences in Kenya and Ghana. When I asked friends to help with writing this post by sharing their experiences, this was Tracy’s response:

We’ve always had our kids with us doing field work. Oldest was able to help teach shallow well installation and soil texture analysis in the field last year. He helped dig soil pits at age 7 or 8 in Kenya’s Mau Forest, and now impresses people with his knowledge of ecology and landscapes. We lived in Ghana (I was preggers there with our youngest), Kenya, and now Ethiopia with extended field work in the Limpopo Basin. The oldest began solo nonstop travel from US back to Ghana when he was 12. We did not take our two boys for field work in the Sudd after independence, however. Our youngest is 3 and oldest is now 17, and I cannot imagine not having them in the field. I or my husband wear the lil one on our backs because he likes to “go to work” with us. Usually he has a nanny though. The oldest has had Malaria and Cholera and we think may now be indestructible after surviving.

So, when people ask me if it’s a good idea for them to take their family with them to the field, my response is usually silence. You’ve got to do what is best for you and your family. Will your kid get sick? Of course! Just like they would get sick if you didn’t take them to an African country. Because kids get sick everywhere in the world, not just in Africa.

So, if you’re one of those people who likes to prepare before you go, here’s a summary of the things I would do if I were taking a young child with me to Malawi (shared with the caveat that you can never be truly prepared):

Before you go: Contact researchers you know who have recently taken children with them on research excursions (ideally in the country/countries where you are headed). Get their insights — tell them you want the good and the bad.

Figure out the vaccination and prescription needs well in advance and discuss options with your child’s regular pediatrician.

Speak to your health insurance company about your pending trip and what they can offer in terms of medical evacuation, prescription medicines, etc.

When you land: Find a pediatrician. A good one. This is a priority. Many of us American parents will research the best pediatricians for our children when we’re here in the US, sometimes even before our children are born. There is no reason not to try and find one wherever you’re going. I found doctors in Malawi using a list provided by the US Embassy to traveling Fulbrighters. If you’re not going to Malawi, it’s worth asking whoever it is in the Embassy of the country you’re going to that helps with coordinating Fulbrighters if they have such a list (even if you’re not a Fulbrighter). The list was awesome because it not only had landline numbers and addresses, it also had cell phone numbers.

Perhaps to help you with the preceding point, find another expat mom in the country. These moms (just like the ones you meet at the library lapsit or the city park here in the states) can provide you with really great, hard-earned information.

I’ll just close with saying that I was lucky. Sure, my kid got sick — but she also got better. Though we lived in Malawi, we had the luxury of Western medical care. We had a great nanny. I got a lot of work done. We had access to safe, reliable vehicles. Most importantly, I am fortunate to have such a supportive partner who is a true co-parent AND who had the ability to go to rural Malawi for seven months without it having a serious, negative impact on his career/life.

For all you moms and dads looking to take your families with you to do research in an African country, I hope you’re lucky, too.

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* Road traffic accidents were the 9th leading cause of death in Malawi in 2011 and 26% of road fatalities in 2005 were of children under 18. Wikipedia has a page of countries by traffic-related death rates. As a comparison, the US had 12.3 road fatalities per 100,000 inhabitants per year and Malawi had 26.0.

** Malawi’s under-five mortality rate is more than ten times higher than that of the US.

*** This is largely possible because my two previous, more lengthy trips to Malawi in 2006 and 2008 allowed me to make really good friends with Malawians who do research for a living. I know now that I can count on them to carry out research I plan or design. They probably even prefer I not be in the field, asking lots of silly questions, even over dinner and drinks when everyone is tired and doesn’t want to talk about work.