The fragility of life

"It's not like Europe, so many people die in Africa. I don't like it". So said a choir friend this evening, simply expressing a deep sadness. For context, practice on Monday was cancelled due to another set of requiem vigil prayers being said.

Life expectancy here is 54, which is rank 166 out of 188. By contrast the UK is ranked 16th, and Ireland (another small country and former colony) has a life expectancy of 80. In The Gambia the top three causes of death are, in descending order, influenza/pneumonia (13.2%), malaria (11.6%), and diarrhoeal diseases (9.2%). Life expectancy is an average figure, with high infant deaths dragging the expectancy down. If a child survives to age five their life expectancy rises to around 66, depending on gender.* "How do you want them to go?" asked another friend. "When they're old. 50 to 60 is no age to die."

I left, declining an invitation to stay and chat ("wahtan" a word I've forgotten six times). With Howells's Requiem in my ears, I considered why I hadn't stayed just for a while. Am I avoiding getting deep into the problems here, avoiding hearing people's views and experiences about living with death as a next door neighbour? Is a funeral just another cultural event to me, rather than the heartbreaking loss of a dear friend, made worse by being far too soon?

I have witnessed friends lose their parents too young and I have lost friends myself. Everyone is linked here and so every loss is like those few times in my life I have witnessed and felt real grief, but so much more frequent. Yet surely, in the bigger picture, it is this which illustrates the development I'm working for, not for economic growth as an end but for an environment in which people bury their loved ones when they are old, not simply because they died too soon.

And so solutions begin to emerge for me to investigate. What works? What worked in the UK? Should I be thinking about and devoting time to any of the following, that I have learnt in my career?
- Public health initiatives, preventing problems before they arise, such as access and proximity to green space reduces heart disease, or ensuring landlords are required to keep homes decent reduces asthma, and maintaining sewers to prevent dysentery .
- Educating women. The emphasis is on women not because of any special quality but because of the culturally prescribed roles they often play in caring for children and families, though of course the right to an education for its own sake is vital to well being of all people;
- Having a welfare system that supports incomes, employment, health, sanitation and education. does this need to be based on full or near full employment to be effective and to ensure people still have individual freedoms to decide other aspects of their lives?

And, in light of this what am I actually doing? Which piece in the huge developmental humanitarian jigsaw am I attempting to fill? Perhaps the first step is that, next time, I stay to wahtan.

* Figures from http://www.worldlifeexpectancy.com/country-health-profile/gambia, accessed on 5.6.13.