The Monster Chicken in the Room
How language kills while billionaires hunt
In 2021, Bill and Melinda Gates announced their divorce. For most, this news read as unremarkable — offensive, almost, that this development might be attention-worthy. In development circles, rumours grew. The Bill & Melinda Gates Foundation had been one of the world’s largest funders of health and gender work. Would her divorce settlement fund ‘big bets’ to advance gender equality? I wondered: What if the boldest bet started with a single word?"
Half a world away, in an Indonesian village, my friend Fatima* whispered a different kind of gamble: “Kakak (meaning older brother), if I pass the blood test, I’ll marry him next week.”
“When?” I asked, as I stifled my shock.
“Maybe next week. My grandmother already agreed to it. As long as I pass the test, I will drop out of high school and get married.”
Even after six years of disaster relief work in Indonesia, I was still unnerved by the nonchalance here. She reassured me that he wouldn’t go through with the bride kidnapping (a not-distant-enough tradition on the island). Plus, she didn’t need to finish high school since “he wouldn’t allow me to work or go to university anyway”.
I buried my comments and poked at the blood test. Why would a soon-to-be bride need a blood test? This line of questioning would soon unravel a potential idea.
As it turns out, some women — girls, more often — were required to do blood tests as part of their marriage agreement. Almost 50% of Indonesian women in general, and over 80% of pregnant women aged 18-24, suffer from anemia. This condition risks delayed fetal development and delivery complications during pregnancy. Underlying this statistic, of course, is the presumption that a wife must be of child-bearing material.
Global health’s solution was textbook — distribute iron supplements through clinics. Proven. Cheap. Unthreatening to the sticky business of behavior and nutrition change.
Further digging served up a rude awakening. In pockets of Indonesia, 90% of women eligible for the iron supplement program collected their tablets. Yet only 30% of them were known to consume them. Starting with Fatima’s friends, I asked, “If the tablets are free and you already have them, why not just eat them?”
The problem begins with language. In Indonesia, the term for anemia is kurang darah, or “lack of blood”. Not a lack of iron, vitamins, or any of the other anemia variants. Blood. This etymological oddity translates into the belief that taking supplements will lead to more blood, instead of iron, in the system.
Blood, of course, goes beyond biology. In communities where women bathe communally and menstruating girls skip prayers, blood can be public, primal, and shameful. As one of Fatima’s friends said, “I can’t risk others hearing about the sight and smell of my blood”.
I kept prying. “Why collect the tablets at all?” One of the women shrugged, pointing out that the tablets were free. “Do your friends share this belief?” Responses were split. “Do the doctors know about this?” They murmured sheepishly, before coughing up a ‘maybe’.
And then my favorite: “So what do you do with the tablets?” One lady scooped a chicken into her arms, cooing as she said, “We feed it to the chickens! Hopefully that will give us more eggs.” Somehow, the image of iron-pumped chickens slurping up healthcare funding while women stressed over their marriage eligibility amused her more than it did for me.
This isn’t Indonesia’s flaw. It’s baked into the word “anemia” itself – in Greek, an-haima means “without blood”. Over 20 languages — Arabic (فقر الدم), Hindi (रक्ताल्पता), Mandarin (贫血) — take on this misnomer as well. Ironically, it’s the languages that retain the original Greek term that get to hide behind perceived jargon.
Doctors measure iron. Women hear blood.
Gates’ fortune could fund linguists to rethink kurang darah. It could rebrand iron supplements as explicitly that — iron, not blood, add-ons. These solutions aren’t elegant and will need a heavy dose of contextualizing. But they point to a broader issue — there are swaths of programs that break down because of a linguistic quirk, unbeknownst to funders.
Diction as a means of revolution is not new. Many have tried; some have succeeded: pronouns have become protest, while “climate crisis” wobbles along, seeking to replace “climate change”. Still, should we not try?
The tragedy here isn’t (simply) the discontinued education or health concerns. It’s that language is the silent killer that few funders diagnose. Philanthropists chase moonshots, while on the ground, women feed pills to poultry. Until we fix the words, Fatima’s monster chickens will keep clucking, gorging on the carcasses of solutions that never stood a chance.
* Names have been anonymized.
View our sources for this piece here.