I have had the good fortune to have visited five of the 54 countries in Africa. Each has left me with a strong image.

When I think of Cairo, Egypt, I think of a man leading a donkey cart with his wife seated inside. After he moved beside the cart to help his wife down, I realized from her contour she had come for a prenatal checkup to the women’s health clinic we were visiting. According to our informant, an English-speaking female gynecologist, over 90% of the women she attended had survived female genital mutilation. I considered the difficulty of this woman, brought by cart, would have when giving birth.

At dusk, Gail and I wandered around Cape Town, South Africa, then walked leisurely to our hotel. A man came from the shadows while passing a park and grabbed my arm with a vise-like grip. He asked for money to get home to his “settlement.” When I asked for more information, he produced a neatly typed letter explaining where he lived and how much it would cost to get a ride home. Although usually generous, this smelled of a racket and we walked away after I peeled off his fingers. Many times, especially while reading Trevor Noah’s “Born a Crime,” I have wondered if this poor man really was honest in his need.

Eswatini (formerly “Swaziland”) was my introduction to Sub-Saharan Africa. I accepted an invitation to go there with trepidation, because of the way SSA is portrayed in the media. However, I felt very comfortable while there. I have many competing images from Eswatini: the healthy twins I helped birth while the mother was lying on a gurney outside; the football-sized tumor I removed from a woman’s pelvis after getting permission from her landlord to do the surgery since women couldn’t give their own consent. Perhaps the strongest image, however, is the skinny cattle on the red, barren land. Because only the royal family, the government and a few elites can own land, cattle are the Swazi people’s wealth.

I became curious while walking past a small building at the Baptist Medical Centre in Nalerigu, northern Ghana. It turned out to be a clinic where malnourished infants and small children were fed. A parent (usually the mother) stayed with each child; sometimes older children would accompany them. Fans turned overhead and mosquito nets hung on empty cribs. Breastfeeding was encouraged, and the older kids were fed nutritious food. In addition to their meals, parents received instruction about food preparation and nutrition.

A friend convinced me to overcome my revulsion of the Rwandan genocide and go to Kigali for an international conference about family planning. Gail and I discovered a peaceful, clean city where people cooperate despite different ethnicities. The image that sticks in my mind is not what we saw there, but a picture from the article “Remember Rwanda?” “Cutting the last tree on a lot” shows a barren background with three people watching, and is emblematic of over-usage of natural resources. One theory of the root cause of the genocide is poverty combined with more people than the land could bear.

These five countries are arranged above in order by current average per capita annual income. They go from $3,569 in Egypt down to an incredibly low $798 in Rwanda, according to the World Bank.

Some individuals worry that white people’s concern about rapid population growth in Africa is motivated by racism. Some point out that the footprint of a person in Africa is much smaller than our own, so Africans should be able to have larger families. However, the average number of children an African woman births is more than four, which means the population will double in just 28 years if growth continues at the present rate.

Already there are food shortages in many places in Africa. In order to prevent famine and even possible future genocide, I feel that some African countries need to slow population growth. We can help with education and making contraception available to all.

Next month, I’ll write about an African success!

Richard Grossman, M.D., is a retired obstetrics-gynecology physician who lives in the Bayfield area. He has written this column for The Durango Herald for 26 years.