I made it four days through my five-day journey, and I was feeling pretty good about my experience. After three trips, I knew what to expect concerning the staunch poverty and depravity that I would experience. I had been mentally prepared and emotionally strong. That is until Thursday.
As you know, I am a general Internist. I do not see young children in my medical practice at home. I figure, I have enough children to manage at home! Thus, part of the challenge of being here is that I see whatever patients come my way, including children. On my previous trips, we've had providers who were pediatricians or family medicine-oriented. I had always been able to "shuttle" the sick kids their way in exchange for seeing my favorite frail elderly.
For most of the week, I had still avoided the pediatric cases. Not so lucky on Thursday. The first child that gripped my heart was a two-year-old little girl who came in snuggled up to her mother. The mom described a cough that prevented the child from breathing. I'm not a pediatrician, but I knew from my own experience this sounded very much like croup. Croup, also known as laryngotracheobronchitis, is an infection, usually triggered by a virus, that causes swelling of the trachea, or windpipe. The tell-tale sign is a "barking cough" and respiratory stridor.
Indeed, within a few minutes of being in my examination bay, the child had a coughing fit that degenerated into the barking and wheezing that is classic for croup. The child was gagging and gasping for breath. I watched this mom jump up and desperately pat the child on the back, waiting for her to catch her breath. The memories flooded back to me of my own daughter who had been hospitalized twice with croup when she was about two years old. I remember hearing that same cough and running into her bedroom to find her leaning over her crib, completely blue in the face because she could not catch her breath. We had scooped her up and run across the street to the emergency room. Within a few minutes, she had been given racemic epinephrine and high-dose steroids. We were admitted overnight for observation in a step-down ICU unit, with respiratory therapy checking on her hourly.
I had none of those resources to offer this mom and his child. We spent the next 30 minutes in the clinic rummaging through supplies, trying to find injectable steroids. Although not on the formulary, by the grace of God, we found a vial of such medicine. Our skillful nurse administered the injection while the child just wailed. I know the steroids will, eventually, shrink in the airway and provide this child and her mom some relief. But, I felt desperate and woefully inadequate to help this beautiful child and her loving mother. I was stricken with the difference in resources available to me when my child had this illness and the resources I had to offer this mom when her child had the same thing.
About an hour later, luck of the draw landed me with another infant. I was shocked when I saw the intake papers documenting the patient's birthday. She was almost a year old. Yet, she weighed 6.2 kg. That's less than 14 pounds. The clinic we support there actually has an electronic medical record, so I was able to pull up a growth chart. (This clinic may be the only one in Haiti with an EMR!) Neither height nor her weight registered on the chart. The mother kept saying the child had no appetite. Yet, the entire time she was in my bay, she was groping at her mother's breast trying to nurse. I asked the mother if the child ate table food. At 11 months, it would be developmentally appropriate for the child to eat from the table. The mother made a funny face and, through the interpreter, replied that the child did not eat from the table because they had no food and no table on from which to eat it.
As I examined her, I was shocked with the stark white appearance of her nail beds. In training, you learn this is a sign of severe anemia, but I've never seen it in the United States. Looking at the mother and the child, I realized that the baby was suffering from severe malnutrition. Although the mother was doing her best, she likely was not producing enough mild to sustain the child because she was not eating either. When I asked the mother if she was drinking water (to produce milk) she said she did not have access to that either. This town has not had power since Hurricane Matthew came through in early October. Somehow, her water supply (likely a well) was tied to power and she did not have it.
Again, all I could offer was some liquid iron drops and a prayer of blessing. The mission with whom we partner does offer nutrition packets and we tried to connect this mother and child with that service; however, I'm not sure that any amount of nutrition will make up for the loss this child has experienced in her first year of life. I felt completely inadequate again.
As we went to eat our own lunch (of rice and beans) my heart was just sad. I felt guilty eating! I returned to patient care praying that I would not see more sick kids. Luckily, I had all adults. Toward the end of the clinic day, the translator with whom I had worked all week asked if I could see him as a patient. I, of course, said yes, and he went through the process to get registered in our electronic medical record as a patient of the clinic. He was a new translator for the mission. Over the years, the mission there had gathered a group of translators to work with our Bless Back teams and other American teams when they come through. Many of the translators do get their medical care from the clinic so his request to be seen was not unusual. I had seen other translators as patients before.
For the entire week, he had been by my side as my Creole voice. Between patients, I had asked multiple questions and tried to learn his story. I knew his mother had passed away, and that he lives with his father as his caretaker. His siblings had left the area. He had somehow learned English by driving to Port-au-Prince, a two-hour bus ride away, on the weekends to learn English at the University. I have no idea how he paid to get that education. Although this was his first translating experience with our medical team, he had done a great job.
When he came back in as a patient, he asked for some help with sleeping due to a cough. As I mentioned in an earlier blog, the air quality there is abysmal. Smoke and smog triggered coughs, even in our own team members. A little Benadryl would significantly help, so I eagerly wrote that prescription. He then asked for something to help with dry eyes. That same air quality issues causes dry eyes, so some lubricant eye drops seemed like a reasonable request. I wrote that prescription as well. Then, he asked me for vitamins to help with his strength. I must have had a puzzled look on my face as I wondered why an apparently healthy 24-year old would request vitamins. He said it would help his strength. He sheepishly said that he wanted to eat regularly, but he didn't have the opportunity. Like a punch in the gut, I realized that he was hungry. And, just like the infant and mother earlier in the day, he had no food.
All week, he had heard me ask multiple questions about eating regular meals, hydration, clean water. And, he had heard me lament my sadness when I saw all of these under-nourished and malnourished patients. I thought back over the first few clinic days, when had had asked me for a cereal bar that is often given to hungry patients waiting in the lines outside. I thought back over our trip to the remote clinic the day before, when he didn't bring a water bottle or snack. I thought back over the heaping helpings I had seen him eat during our lunch lines at the clinic. (The translators are fed as part of their payment for services with the mission.) My own translator, who had been my voice for the week, was hungry, and I did not even know it. I was past sad. I was heartsick.
After dinner, back at the mission, I was talking to one of my team members about the sadness I had felt. He asked me if I thought we were making a difference. He knew that I prayed with every one of my patients on previous trips. And, I prayed for every one of my patients on this trip as well, including my translator. My prescriptions for iron, steroids, eye drops and vitamins cannot compare with the healing that could be provided from the Great Physician. My sadness turned to joy as I realized that my purpose here is not those prescriptions, but it is to point my Haitian brothers and sisters to the only One who can truly satisfy their needs:
Then Jesus declared, “I am the bread of life. Whoever comes to me will never go hungry, and whoever believes in me will never be thirsty." (John 6:35)
On the last and greatest day of the festival, Jesus stood and said in a loud voice, “Let anyone who is thirsty come to me and drink. Whoever believes in me, as Scripture has said, rivers of living water will flow from within them.” (John 8:38-39)
My prayer for these people is that will find this source of life. May their hunger will be satisfied forever.
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