Challenging Day in Pediatrics

At St. Mary’s today, we worked with a Polish pediatrician who was an amazing doctor. We saw so many babies with so many different ailments; it was such an eye opening experience. We started off in the ICU this morning, and there were only five babies in this room. Two of the five babies had suffered severe birth asphyxia and were being monitored for brain damage and abnormal functioning and development. There was a set of boy twins who were very small that were being monitored for growth and development, and one of them had developed slight jaundice that was being treated. The last baby, a little girl, was born early for no apparent reason, so was simply being kept to make sure all was well. We then headed up to the next rooms. We saw children with everything you can imagine! It was incredible because you would never find such a child in the United States, so the exposure was good for me. You never realize how good you truly have it until you witness somebody suffering from a situation not even realistic in your life. There were SO many babies with HIV and a paired sickness, it was astounding. There were children in for HIV and TB, HIV and pneumonia, HIV and measles, or a mixture such as HIV, TB AND pneumonia, or, HIV, pneumonia AND measles! We saw some children with all of the cases listed above. We also saw children with club feet, down syndrome, HIV (even up to type three! (This is the worst and final stage before type four, or AIDS, where your CD4 count is below 200)), pneumonia, TB, measles, burns, tract infections, HIV, TB and syphilis exposure (this can be mother-to-child transfused!), distention, child abuse, neglect, pink eye (the saddest story ever; I will expand below), everything you can imagine! My heart was heavy today because barely any of the children we saw were improving or able to be released, rather quite the opposite. Many of them were struggling to fight for their lives and weren’t doing too good in the battle. It was the most horrible thing to watch the mothers of these dying children, to see them feeding and holding their child for what might be the last time. It made me want to cry, so I cannot even fathom the pain they must feel. The child with HIV, TB and pneumonia was around four, and was barely clinging to his life. His mother was there trying to feed and comfort him, but he was struggling so much—probably in anguishing pain, and you could see the same look upon his mothers face. How hard must it be to nurture your child to death? I can’t even imagine, and it’s so common here, which just breaks my heart. There was a small baby girl with HIV and pneumonia that was barely sustaining life. And there were so many babies that had been abandoned by their mother’s right after birth that were left in the hospital with no place to go. Adoption is a sticky situation in South Africa; because the living standards are far below most, many cannot reasonably add another mouth to feed. Some children had even been in the hospital for over a year still waiting to find somebody to adopt them. It broke my heart, and my family saw it coming! They all told me before I left not to come back with any children, because they could imagine me bringing home five, and my heart wanted to so badly! I knew it was going to be something I’d face down here, and I knew from my nature that I would undoubtedly want to do all that I could, but this clearly wouldn’t happen and I would get over it. But now that I have actually met and witnessed these children with nowhere to go, I’m struggling to let go of the fact that maybe somehow I could make it work and bring them all home with me! I just want to sob for them. There was one boy in particular that reeeallly made me consider it (my heart was thinking momentarily, because this clearly isn’t a reasonable option for me). He was about four months old, and the most beautiful baby I have ever seen in my life. He was about four months old and so cute and cubby, and was still in the newborn ‘baskets’! It was the strangest thing to see this big baby next to all of the tiny newborns, and so I immediately asked why he was here; he looked so out of place. The doctor explained that he was an ICU baby at birth, and was abandoned by his mother shortly after. One of the nurses fell in love with him, and couldn’t move him out to the general pediatric ward, so she kept him in to take care of him. I immediately asked if he had any prospective adoptees, and luckily, that same nurse who fell in love with him was in the process of adopting him, or I might have crumbled and had to at least look into it. My heart clearly isn’t strong enough to handle the poor situations of some children down here.

There was a little boy about the age of four that we saw later in the day that was checked into the pediatric ward that made my heart break. His mother had gotten very upset over something, had smashed his head against the wall several times, and then hit him on the top of the head with something clearly very hard and damaging. He ran into the streets of his neighborhood with blood gushing from his head and crying for somebody to help him. A neighbor finally responded and brought him straight to the hospital. He ended up needing many stitches for the huge laceration she gave him from the middle of the top of his head, all the way down to his forehead. He was still in the hospital waiting for a social worker to come and take his case. What broke my heart is when the doctor informed us that in most cases, social workers put the children back into their homes because adoption is such a difficult thing in South Africa; they usually have no choice because the child has nowhere else to go. And, because of the loving and forgiving nature of children, the little boy told the doctor that he felt comfortable returning home; I wanted to cry. There was also one more case that really touched me and made it hard to continue on working. A social worker came upon a small boy, probably about five or six months old, abandoned and left in a toilet. Nobody knew how long he had been left there, which meant there was no telling how long he had gone without food or care. At such a young age, that is completely psychologically damaging, not to mention physically and emotionally. He had developed pink eye from all of the nasty bacteria and germs in the toilet, and because it had been left untreated for quite some time, it turned into a viral case on top of bacterial. It created a ‘cover’ over his eyes, and now in the hospital being treated, he is partially blind and still has a film lining his eyeballs. He was the sweetest baby you could have asked for. How psychologically disturbed must one be to have the heart to abandon a baby that is clearly fully dependent, not to mention something created by you? I simply cannot understand such a thing, and this poor child has to live with his mothers horribly stupid actions for the rest of his life. No child deserves that ): I have such a weak spot for children. If I could take every one of them in and make everything magically okay I would do so in a heartbeat. The saddest part was that every child in this hospital had a sad story attached! In the hospitals I have worked in in Seattle, yeah it’s sad that the children are sick, but you never find them sick in the ways you find them here in South Africa, or sick for the same reasons. Obviously there are some children that are neglected or abused or that have HIV etc, but they are far and few between compared to seeing every single patient in this predicament here. I couldn’t handle working in pediatrics as a practicing physician in South Africa; my heart just simply isn’t strong enough to let go of all of the avoidable suffering that I would be fully surrounded by each day.

I am really struggling with the concept of inequality and injustice as I observe the conditions of health care here and have nothing to compare it to but the United States. Why is it okay that the places in the world with the most need receive the least? I don’t understand how it can work in such a manner. These people don’t deserve to suffer anymore than anybody else in the world, but they get served the worst predicaments while we in the United States don’t have the slightest idea about hardship. And it seems that we all believe we have things so hard, me to blame as well, but we really aren’t seeing it. We are the most well off people in the whole entire world, and as much as we are taught that and ‘know’ it to be true, we really don’t ‘know’ anything until we see it with our own eyes.

While I was home sick yesterday, Miles got the opportunity to observe in the HIV clinic at St. Mary’s. He sat in with a doctor consulting patients on medication. In South Africa because of the limited medical supplies available, only those with a CD4 count of 250 or less (stage three HIV, just barely above AIDS) receive Anti-retroviral medication. So pretty much, to be completely blunt, you only get medication when you’re about to die. Miles got to meet a man who was coming in for medication with a CD4 count of FOUR. A normal healthy adult has a CD4 count of THOUSANDS. That is unconceivable to me. Once this man left the office, the presiding doctor told Miles that he didn’t even know this man was still alive, and expected him to die within the next few days because his body has absolutely no defense mechanism left.

Yesterday was thought to be a good day, because a ‘new’ HIV medication was supposed to become available in South African hospitals, and this was great news for patients who were becoming resistant to their current treatment and had no other available options for medication. A woman came into the clinic, very sick because her strain of HIV was becoming quickly resistant to her current drug regime, looking for this new medication that will essentially save her life. Although this medication was supposed to be available, no hospital in South Africa, including St. Mary’s actually had this medication, and had to turn every one of their expecting patients down. The doctors don’t expect to see it for another four months, which will probably be too late for many people, including this unfortunate dying woman. The only thing that comes to my mind is why? Why is the world so completely unfair?

I have no capacity to understand such things, and can do not a single thing to help. My heart is aching from having to sit back and watch this take place before me. I have never felt this type of sorrow before in my life. To ease the brick off of my heart, I think it is necessary to change the subject; there is no way to make sense of it all anyhow. It is a long weekend for South Africa coming up. Friday and Monday are non-working days, so we have a four day weekend to relax and explore Durban. Miles and I were originally going to spend the weekend at a place called St. Lucia, a wetland park about three hours north of Durban. It is supposed to be absolutely beautiful with tons of things to do and see; all of the past interns have visited and loved their time spent up here. But, I think we were informed about this place a little too late, because everything is booked! We haven’t been able to find a reservation available for this weekend. We are going to try one last time tomorrow morning, and if all fails, we will stay around Durban and delve deeper into the city. I think this I what’s most likely going to happen. If my prediction is correct, we are just going to go to the Indian Ocean beach to swim and enjoy the hot weather here; it is supposed to be almost winter time, yet it’s hotter than our warmest summers! We will also explore a famous tourist street called Florida Road. It is supposed to be packed with native Zulu and African art, fun restaurants, shops and clubs, and the beach only one street away. Both of our ‘brothers’ will also be able to show us fun things to do around town to occupy our time as well. I think we will have a great weekend even if St. Lucia doesn’t work out.