Dear all:

The current discussion of weights has put me in the position that I remember from one of my 
early surveys in the Andes where I sat and listened to a mother complain about the mother's 
groups in her town because her perceptions varied so much from those who attended the group.  I 
remembered her again when my son went to nursery school and I found myself speechless and 
bored when hanging out with the other moms who talked about Prada bags.  I got over it by 
considering them an anthropological learning experience that would teach me about my clients 
and ultimately discovered that more was going on underneath the discussion of Prada bags.

So here is where I feel deviant right now.  I have NEVER considered the scale a medical device.  Its 
use predated medicine by a long shot.  As humans we have used tools to compare and measure 
far millenium.  Think about the development of scales for commerce.  Many items for sale or trade 
were weighed.  Ditto the "monetary" unit such as gold.  

In our modern society we have scales in our grocery store to "weigh" our vegetables, fruits, nuts 
and meats.  All of these items are subject to variation.  The size of the nut shell, the amount of 
gristle or bone, the thickness of the skin will cause variation in terms of the actual edible part of 
the food.

Our postal systems use scales to weigh letters to determine the amount of postage to charge.  My 
husband always weighs letters.  I waste more money than my husband because I just add extra 
stamps if I am in doubt. 

We use weights and volume in cooking.  Here again, some cooks learn how to eyeball the quantity 
and taste of the food and dispense with measurement. Again I'm an eyeballer, but not that great a 
cook, so my imprecise method sometimes ends in disasters that would not befall a better cook.

Women have always measured the growth of their infants.  I'm thinking about the strings tied 
around the bellies of babies in many areas of Africa as one method of measurement.  This is but 
one of many ways women have to observe and judge their infant's health.  

My first exposure to the fact that health care practitioners in the United States, and now it appears 
that some areas of Europe as well, consider this to be a "medical" device was when I heard a 
midwife who was a part time lactation consultant say she wouldn't use a scale because she didn't 
have the skills that an MD might have, I was totally and completely floored.  By that time I had 
observed enough of how my son's pediatrician's office and heard enough from clients about how 
their pediatrician's office conducted anthropometric measurements to have reached the conclusion 
that any one of the NONMEDICAL survey workers I and others had trained in our nutrition projects 
in developing countries would have done a far superior job.  In terms of using the scale for 
decision making, it sounds as if many of the illiterate women in Tanzania could do a far better job 
using the information for decision making than the system of weighing that Magda Sachs 
describes.

I've said it before, but I'll say it again.  If illiterate Tanzanian women can learn to use a piece of 
information provided by a scale to make informed decisions about how best to feed their babies in 
the context of all their oher observations and knowledge about their infants, you can also figure 
out how and when a scale might or might not provide useful information for you.  Even if it is 
merely to determine that it is not useful, but there are certain cases where you might refer to 
someone else who actually uses the scale in context of all the other information in an appropriate 
manner that empowers women to better care for their infants.  So, if nothing else - you should be 
ensuring that any referrals are to specialists that look at any of their tools as but one piece of the 
picture in a fuller context.

Best regards, Susan Burger

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