As I’ve shared about life in the slum, I’ve focused on material things: homes, electricity, water, etc. With that stuff it’s relatively simple to measure the differences between life here and in the West.

But as you may have discerned from the incident with Alia as well as the boys on the train, there are many needs that have nothing to do with the material.

Medical access is a critical issue, and we should have plenty in our neighborhood. There’s a nice hospital across the street from us. Another just a little further down with a very nice diagnostic facility.  Walk a kilometer in one direction and you’ll reach a huge hospital. A kilometer in the other direction and you’ll reach two hospitals, one with beautiful facilities and the other the largest in the state.

Unfortunately, physical proximity isn’t access. That hospital across the street? It’s an costly private establishment. I know no one from my community who has ever used it. Further down the street? Another private hospital, cheap enough that some of our neighbors go there but not others. The nice facility a kilometer away? Of course that’s private and far too expensive for anyone we know.

Both of the big hospitals I described, a kilometer to either side, are public and many of our neighbors go there. But being able to go isn’t necessarily enough. How do you make the decision to go to the hospital? Few of my neighbors have ever had a family member or friend who was a doctor, or who had any systematic medical knowledge. So how do you know when you should wait it out and when it’s urgent? How do you know if it’s okay to wait for an appointment, and when you should rush to the emergency room?

This is why several people we know have died in their homes, not understanding the seriousness of the situation until it was too late.

If you do go, how will you be treated when you get there? In many hospitals there is a tangible difference between patients with means and patients who are poor. I’ve heard horror stories of friends waiting days with their loved one on a cot without an actual doctor seeing them. When the doctor does visit, the interaction may be short. He may not listen to what they have to say or take their concerns seriously.  He may be rude, and we have witnessed doctors yelling at or shaming poor persons. When he does give his opinion he may not share the diagnosis, just hand over a slip of paper with the prescription.

A close friend of mine in the slum was going to doctors for four years, on medication for most of that time, before I met him and was able to tell him that he had bipolar disorder. No one had ever told him the name of his own disease.

Abusive treatment at the hands of a doctor, including physical slapping, is why one young neighbor of ours refused to go to the hospital for her second child. That second baby, without medical attention, died 30 minutes after he was born.

This is what it means to lack social capital. Those of us who grew up in middle-class homes, who take general medical knowledge for granted, who have friends and family we can ask for advice, who don’t make life-and-death decisions based on what we can afford, who expect to be treated just like everyone else….we don’t realize how important social capital is.

Take everything I shared about lacking the social capital to receive adequate medical care and apply it to every other aspect of life.

Where do you send your kids to school? Are you in the right neighborhood? Can you afford the good school? Can you help your kid with their work? What advice can you give them about college? Do you have friends and family members that can give a hand? If their teacher mistreats them, if the school discriminates against them, can you stand up for their rights? Does the school staff know this and thus avoid mistreatment, or do they expect you to be vulnerable and powerless?

How do you apply for a government program? Can you even get to the office? Will they give you the time of day while you’re there? Will they deny the validity of your application? If so, will you know how to fight it? Can you even read the forms?

Do you have access to a bank? Can you open an account? If they tell you to sign something, can you read what you’re signing? If someone defrauds you, how will you even know?

Who do you talk to when you need a job, who are your connections? When you get in trouble with the police, do you have resources to advocate for you? If you have a relationship issue, do you have people who can help? If your neighborhood is polluted, or is going to be torn down, do you know your rights and do you have the capacity to fight for them?

That’s social capital. And in many realms of life, my friends in the slum lack it.