This afternoon we took another pediatric patient to the general hospital in Jérémie. We had seen him, a three-year old boy, last Thursday with fever and malaria. Since his father died and his mother lives in Port-au-Prince, he lives with his grandmother in a community near the clinic. We told the grandmother that if he wasn’t doing well over the weekend to take him down to Jérémie to the hospital. As it turned out, his fever came down but he developed diarrhea and wouldn’t eat. She gave him some juice, but other women in the community unfortunately advised her against giving him water, saying that it would somehow make him weaker. She was sitting there on the bench outside the clinic when we arrived this morning. It was obvious that the child was severely dehydrated, his little eyes sunken and his cries weak. We suggested that she take him down to the hospital right away, but she shook her head and said that was impossible. She didn’t know where to go, had no one to help her and had no money. So, we had her give him oral rehydration fluid all day there in the clinic, hoping that we could stabilize him enough to send him home. But, as we neared the end of the patient consultations, he had not improved and we knew that if we sent her home with him he would probably die during the night. So, the back of our pick-up truck became an ambulance once again, as we took the child and his grandma down the mountain to the hospital.
When we got there, I told the nurse on the pediatric ward the child’s history. She took some notes and sent someone off to get the doctor on call. She left the child lying on the examination table, and went off to take care of her other duties. My thoughts flashed back to the Emergency Departments where I used to work in Wisconsin. “Isn’t severe dehydration an emergency?” I thought. “Where is all the activity – drawing blood, starting an IV, nurse at his side, doctor in the room immediately?” Then, I realized with all too much clarity, that this, indeed, wasn’t Wisconsin, and in the nurse’s mind, this “emergency” could wait a few more minutes. Cherlie and I, however, were getting increasingly uncomfortable, so I finally suggested that I go to the pharmacy to buy a bottle of IV solution for the child (patient’s families generally have to buy all medications, needles, IV solutions and supplies for the patients before they are given any care). I figured this was a good way to get the ball rolling without being offensive. So, I bought the IV solution, but the pharmacy didn’t have the right size IV needle. The nurse said she would “lend” one from their supply, and began gathering gauze, alcohol, tape, tourniquet, etc. to prepare to start the IV. Finally, after another 30 minutes, the IV was in the young boy’s arm and the IV solution was running. I breathed a silent prayer of gratitude. Shortly thereafter, the on-call doctor came in and I again related the child’s history. He turned to write his admitting note and orders and it was obvious my presence there was no longer needed. So, we left some money with the grandmother, said we’d check on the child tomorrow and went on home.
As I sit here thinking about and praying for the little boy, I also think and pray about our clinic and the potential we have to impact lives such as this. Had the grandmother and her neighbors been more knowledgeable about childhood diarrhea and the importance of the use of oral rehydration solution, the child’s dehydration might have been treated sooner and been less severe. That’s why community education and health teaching is so important. And, if we had a clinic building and living quarters built there in Gatineau, we would be able to offer medical care daily, so the grandmother could have brought him back for re-evaluation sooner. And, if we had our clinic functioning and fully staffed for emergencies, we would be able to give him IV fluids during the day and keep him overnight, if necessary, rather than taking him to the local hospital, where emergencies aren’t urgencies and very little care is given without money available first.
As you think about this little boy, please pray with us that the “if only’s” will someday become reality.