Working in a public health, management position, I have sometimes felt removed from the individual stories and struggles of the people I am here to serve. A few times I have prayed that God would bring some of these situations across my path, that he would break my heart. A dangerous prayer to pray, but sometimes I feel to removed or callous, so it wouldn’t be a bad thing.
This past week I met a 13 year old boy named David. I heard about him nearly a month ago. For the past two years he has had seizures, but he was never brought for medical attention; or if he was, his condition remained undiagnosed. It sounded like epilepsy and the small hospital in Foya said if this was the case, they could diagnose and initiate treatment then the clinic in his area could follow up and monitor the treatment.
Last week some of our staff traveled to his community – at least a 4 hour drive from Foya. The plan was to bring him to Foya for a day or two and then return him to the village. However, they found him emaciated. Last year he was thin, but not severely malnourished; it was a surprise and a much more critical situation than expected. They brought him to the hospital in Foya, but between his malnutrition and neurological problems – his case was too complicated to treat fully here.
On arrival, his hemoglobin level was very low at 2.2. After locating and purchasing blood – he received 2 units and was somewhat stabilized. I had heard there were inpatient feeding centers in the hospitals 45 min and 1.5 hrs away and suggested transferring him there (this was while I was still in Monrovia). When I arrived though, he was still in Foya. The Foya hospital had referred him to a town 5 hrs away by road! The next few days were a complicated series of encounters with the family and medical staff trying to arrange referral somewhere he could get appropriate treatment.
David’s mother is not in the picture. His auntie came with him to the hospital as his caretaker. His father attends school across the border in Sierra Leone. In most hospitals here, the nursing staff do not do any ADL’s (activities of daily living), this is the responsibility of the family. It is nice that family members are more involved, but it also creates many challenges. To refer and transfer David, he needed a caretaker, but being so far away, it was difficult to send a caretaker; his auntie has 5 children of her own and did not want to go.
David’s father responded to the news that his son was seriously ill by coming back from Sierra Leone and eventually to the hospital. We also checked out the feeding centers at the nearby hospitals. Several times we thought we had a good plan in place for referral, including the right hospital, caretakers and transport… but there was always a complicating factor. The feeding center nearby had no food supplies – none of the therapeutic milk needed to rehabilitate his nutritional status; the auntie wanted to go back home for a week before going anywhere else; the ambulances won’t take referrals across county lines; the ambulance will take him but needs to stop at every hospital in between; our car going by the hospital on its way to Monrovia was too full and liable to break down…and on.
It was a challenging situation. One night, before the father arrived, we went to bring some food and see the auntie. It was just supposed to be a quick visit as we were still waiting for the father and information on the other feeding centers. The auntie doesn’t speak much English, so a lab technician that spoke her language was also there. The medical staff starting telling the Auntie she needed to go to the hospital 5 hrs away with the boy. We had last told her that we were looking at a referral nearby. She did not like the idea of going so far, but the medical staff kept telling her she needed to go and raising their voices more and more – nearly cornering her. They told her this was her only option.
I felt so bad for her. I have heard about the local people’s distrust and dislike of the medical system here – as in many other countries. I totally understood as I watched this occur. I know the medical staff had the best interests of David in mind, I wanted the best for him and hated to see the state he was in due to the neglect of his family. But I could also see the auntie’s point of view. She had just finished telling me about the five children of her own. She would be leaving them to care for a child who was not her own and who may or may not survive. If I were her, I would be hesitating too!
Health care and social services are not perfect in the US, but we can be thankful for what we do have. That there are ambulances to respond to emergencies, and facilities that are adequately staffed. We can be thankful for health staff that are trained not just to treat patients medically, but to also care for their daily needs whether there is a family member present or not.
I have thought over again – what is the best in this situation. God cares for David and loves David, but what is best for David? And what is best for his family? What if they choose not to go and bring David home where he will surely die? What if we transport him and something happens on the way? Have we made the situation worse for the family and for David by trying to help? What happens if we send David and his father abandons him there?
I honestly don’t know how to answer these questions and to advise in the situation. I have been challenged to trust in God and seek his wisdom, to pray that the outcome ends up positive for all involved. The morning I wrote this, I helped put David and his father in the car for Gbarnga (5 hrs away) and I pray that I will see David again, fat and healthy.
After writing this, I have since seen David again. A few days after transport, we stopped in at the hospital on our way to Monrovia. He had been admitted to the feeding unit and was doing fairly well. He was eating, but then stopped so he is getting his nutrition through an NG tube now. His father was still there caring for him, and the nurses seemed to be as competent and as caring as could be expected here. They were evaluating him for underlying causes for the malnutrition – possibly extrapulmonary TB or epilepsy. Please pray for David – for his recovery and for the love and care of his family.
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