"health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right"
Saturday, July 15, 2006
Left to Die
Each day we show up on an island with our mobile clinic, we are presented with a wide variety of medical problems from malaria, typhoid, and measles to tuberculosis, HIV, and end-stage syphilis. Many present with very advanced disease that has been present for years and have never been seen in a clinic or hospital. For example, our first day of clinic, we encountered a 1 year old child with severe failure to thrive. Her frail body, consisting only of bones with loose skin hanging off, looked as if it could barely support her out-of-proportion head due to malnutrition. It was clear that death was imminent within the next few months without intervention. In this case as in many others we are left questioning: Why would these people wait so long to seek medical care? How could this mother wake up each day and look at her child who is obviously wasting away towards certain death and carry on with her daily activities.
We also frequently encounter patients with problems beyond the scope of what we can handle with our basic medications and equipment. Logically, we had been directing those with advanced HIV, suspected TB, tumors and the like to the local hospital to receive more advanced medical care. However we couldn't help but wonder: How many of these patients would actually find their way to further medical care?
All of our questions were brutally answered when a young child was brought unconscious in a woman's arms to our immunization and deworming project on Rusinga Island. The child had been healthy one day prior and now was febrile with eyes rolled back and stiff neck, unable to respond to any stimuli. After performing a physical exam, we immediately suspected bacterial meningitis, a disease that can be rapidly progressive and fatal, where every hour can mean the difference between life, death, and permanent disability.
Sensing this urgency, we attempted to arrange for emergency transport to the nearest hospital. We soon found that not only are there no ambulances in the region, but there were not even any motorized vehicles available. Upon asking the local people how people reach the hospital, the answer became quite clear--- the majority don't and are left to die. Unwilling to accept this, we split up to run through the village and found a single car doing a promotion for herbal medicine in the town. We explained the urgent situation and were astonished to hear "your offer has not been accepted". It took a considerable amount of money and persuasion before we were able to comandeer the car and take the child and his guardian aboard. The ride from Rusinga to Mbita Hospital was nothing short of surreal. Maneuvering around donkey-carts and herds of cattle, we bounced along the rutted and pitted out roads praying every second that the child would reach the hospital alive.
When we reached the "hospital", we were shocked to find it was little more than two cement warehouse-type wards run by a nun and a single doctor. The line of the ill wrapped out the door as we barged in and layed the child down. The doctor agreed with our assessment of meningitis and plan for IV ceftriaxone. Unfortunately, "this is a very expensive medication and the family will not be able to pay" he stated matter-of-factly. Without money for medication, those lucky enough to find transportation to the hospital will be again left to die if they cannot pay for the medication up front. In this case, the guardian of the child was actually his grandmother, as he was orphaned by HIV/AIDS. The family had little to no money to live on a day to day basis, let alone provide an expensive medication. Unable to watch the child die in from of us, our group agreed to collectively provide the funds necessary.
To obtain the medication, we were told to purchase it at the hospital pharmacy and then bring it to the ward to be administered. It was little surprise at this point that the pharmacy was out of ceftriaxone. We were forced to run into town and find a local pharmacy who had stock of the medication, then return to see the medication delivered.
Through this experience our questions have been answered. We now have come to the brutal realization that there is no lack of initiative amongst people seeking medical care, and that likely none of the patients we had referred to the local hospital actually had received medical care. The barriers of lack of primary health resources, transportation, and cost of medication restrict nearly all of these people from the basic human right of health care. Though the child with meningitis did recover after IV antibiotics, it is very scary to think of what would have happened if not for outside help and financing. The harsh reality is that in this impoverished area, most people are left to die of preventable and treatable diseases.