The Haitian baby girl is one year old and doesn't smile. She looks like a blan. I ask the lady holding her if she is her mom. No she is not and calls for the mom in the waiting area. The baby's mom comes in the exam room and is "timid". She says the baby is not developing and has a fever and cough. The baby looks at me without crying, smiling,moving or doing much of anything except looking perplexed. Mother looks healthy. Mother is calm and polite and looks like she cares for the baby somehow even though she had her friend bring her in the exam room. My exam on the baby reveals pale conjunctiva and a huge liver and spleen. Xray shows pneumonia in the right upper lobe. TB? We're in Haiti, so why not? Sickle? Baby is supposed to be black, so why not? I send the baby for admission to the hospital across the street but there are no beds for her so the timid mother shows back up with the baby like I asked her to. I give the baby a shot of Rocephin from my doctor's bag and try and treat her for what will kill her over night. It won't be TB that will do her in. It will be another homicidal quick acting germ...especially if she has sickle cell disease.
Mom returns the next day with this darling baby girl with a cap on her head. The baby actually tried to come to me as I walked into the clinic. I only hurt her with the shot, but all baby's seem smart. They seem to know who wants to hurt them and who doesn't. Mom had no money to get the labs or the medication I prescribed. Baby's fever is down some, so I go with more Rocephin for the weekend and hope to see her on Monday. I never know which baby's will return.
I feel guilty as usual treating these Haitian babies like they are starter babies for a third year medical student on his pediatric rotation at some huge inner city county hospital somewhere. These babies always haunt me as do my medical decision making skills.
This isn't happy pediatrics. It is Haitian pediatrics.