It’s been almost a week since returning from Haiti. Several times I’ve started to sit down and write about the experience but I’ve just been unable to put my emotions and feelings into words. You would think that after four trips that I will be emotionally and mentally prepared for the sights, sounds, smells and sensory experiences of Haiti. However, I wasn’t. Even leaving the airport in Port-au-Prince, I was choking with sensory overload.
Nothing prepares you for a country that suffers from the same crushing poverty 50 feet from the airport as well as 50 miles away.
This trip was challenging for me in that I was trying to balance the needs of a 12-year-old daughter and my 71-year-old mother. This is the daughter who doesn’t like me very much right now. So, admittedly, I was not sure how the trip would go for her. My fears were unfounded as she was truly amazing. She stepped up to the plate and did exactly what was needed. I only had to referee one argument between her and my mother when my mother put on her "stern teacher hat" and my daughter had no idea how to handle it. (She's used to the pushover Grammy!)
My work in the clinic is intellectually challenging and physically exhausting. I find myself scouring through databases trying to understand the unusual presentations of common fungal diseases or how to treat tropical diseases that I NEVER see in uptown Charlotte. With each patient encounter, I take the opportunity to pray for them. The mission of Bless Back Worldwide is to treat the whole person with grace and dignity. I want to make sure I do that with every patient encounter.
I made it through the whole week keeping myself together in the clinic. Monday and Tuesday we ministered to patients at the main campus, Then, Wednesday and Thursday we traveled offsite to a secondary campus (a place that the Haitian physician and nurse see patients at least twice a month) and to a relief clinic site (a place that Bless Back takes teams when available). I have to admit, when the ceiling of your clinic is a tree canopy, it does give you a different perspective.
Friday, we were back in the main clinic and we were anticipating a light day. Fridays are usually the lightest day of our clinic efforts as patients have sought medical treatment earlier in the week. This Friday, however, we were very wrong. All four providers were working nonstop trying to see patients. Maybe halfway through the morning, one of our triage volunteers, who happens to be a finance executive at Bank of America, popped her head in my exam bay and told me there was a baby out there I needed to see. I quickly shot her a look and reminded her that I don’t see babies. (I’m an Internist. I see adults. I manage enough children at home!). She smiled and retorted that the Holy Spirit told her I needed to see this baby. Well, you can’t argue with the Holy Spirit!
A few minutes later, a young girl walked in with a baby in her arms. The young girl looked no more than 17 years old. I glanced at the dossier (intake paper) and immediately knew something was wrong. According to the birthdate on the paper, the baby was 14 months old. However, she barely weighed 17 lbs. That did not make the growth chart. I took the baby in my arms and asked what was the problem. As I held the beautiful baby in my lap, she was listless. Her little head just laid over on my chest. The "mother" said the baby did not feel well. Through the Creole translator, I tried to discern what she meant. The mother said the baby was not eating well, was not really crying and would not smile for anyone. As I held her small hands, I noticed her nail beds were bright white. Furthermore, her conjunctiva (mucosal surfaces around the eyeball) was equally as pale. Profound anemia. The young girl also said that the baby appeared to be in pain, especially in her feet. I held her up, hoping she was put her feet down and bear weight on her feet. She would not. She whimpered in pain. I realized that her feet were incredibly swollen and the skin was tight up to her knees. She also had puffiness and swelling around her eyes and in her face, known as anasarca. This edema signified profound protein malnutrition or kidney failure. When I asked what she ate, the mother stated powdered milk and rice. There is no access to baby formula there.
Through the interpreter, I asked more questions about how far they had come to see the doctor. It was an hour and a half bus ride, at least. I also learned that young girl was not actually the mother of the baby. She identified herself as the "godmother." When asked how long she'd had the baby, she said a week. I was very impressed that the godmother had traveled such a long distance to seek medical care for the baby.
I could not find any other focal evidence of disease in the child, and I realized I had very little to offer other than iron drops and nutritional support. I explained these things to the young woman and encouraged her to get nutritional help for the baby. The young girl also wanted to be seen as a patient, so I asked one of our triage volunteers to come hold the baby while I cared for the young godmother.
The young girl had questions about her anatomy and normal body functions. There is very little health literacy in these areas, and I found myself simply explaining a woman’s menstrual cycle. I stepped out of my bay to ask a question of the nurse running our lab, and I caught another glimpse of the little baby on the lap of the volunteer. She was curled in a ball, leaning on the volunteer’s shoulder, completely motionless.
I walked over to the baby and just stroked her head. I cannot explain what happened next. But, as a rubbed her hair I realized that it felt different. I don’t know why I thought it felt different, but it did. Many of the children for whom we had cared all week had severe fungal infections on their scalps. Therefore, their hair was often damaged and patchy. This baby’s hair felt different and she did not have obvious tinea of the scalp. The child then turned sideways, and I noticed her eyelashes... they were incredibly long, out of proportion to the rest of her body. Somewhere, from the depths of my memories of pediatric rotations in medical school, I remembered that children and young adults with AIDS often have fine hair and long eyelashes. Although I did not want to, I asked the nurse in the lab to check this baby for HIV.
Twenty minutes later, the nurse running the lab walked over to me shaking his head. He showed me the test strip. Two lines. My heart sank.
I picked up from the baby from the volunteer and just held her. And, I wept. I needed to step out of the clinic and take a walk. I wandered aimlessly across the school campus with tears streaming down my face. I found a campus pastor and asked him to join me in the clinic. When I finally pulled myself together, we went back into the exam bay. The baby was still asleep in my arms. Through the translator, we explained the diagnosis to the young girl. After more talking, we learned that this girl had been caring for the child for over a year. This baby had been abandoned by the mother a year ago. This godmother had no idea where to find the mother. And, there was no contact with the birth father. I could only wonder if the birth mother knew the child was HIV-positive and did not have the means to care for her. She had left the baby with this godmother. And, this precious young woman was was doing the best she could. When I asked if she had family support, she said she also lived with her godmother as she too had been abandoned at birth. This young woman’s father did send her money every month, and she used that money to care for herself and the baby.
Tears streamed down her face as well as the weight of this diagnosis fell across all of us. We prayed over this child and her godmother. I prayed for God‘s providencial care and His healing. In addition to some nutritional support and the contact information of hospital in Port-au-Prince that treated children with HIV, the prayer was the best I could offer.
As this baby and her godmother walked out of the mission gate, I cried again. I wondered if she would get the care she needed. Port-au-Prince was a two-hour bus ride away. What more could I offer? What more could I do?
Indeed, this was not the first child that I felt I could not help. But this one has haunted me. If I could have brought that baby home with me to get the treatment she needed, I would have! I still would. (Joe may have a stroke to hear me say that —another adopted kid!)
But, that beautiful baby girl is loved and cherished by her godmother. My prayer is that she will someday know she is loved and cherished by the God of the Universe as well, His daughter and His heir.
For all who are led by the Spirit of God are sons of God. For you did not receive the spirit of slavery to fall back into fear, but you have received the spirit of sonship. When we cry, 'Abba! Father!' it is the Spirit himself bearing witness with our spirit that we are children of God, and if children, then heirs" (Romans 8:14-17 RSV).
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