Thursday, May 03, 2012

Please Do Something!


Yesterday morning in the pediatric clinic a mother came into my office and sat down with her baby wrapped in a blanket. She had not checked the baby in at the front desk and offered no dossier for me to look at. The dossier is the medical chart that is supposed to transmit information from one visit to another. 

This was a "red flag" to me right away. And there were three Haitian pediatricians seeing patients in their offices. Why did mom pick me?

Mother quickly uncovered the baby before I could tell her the important need to "make a dossier".  She showed me her six week old baby girl Sarah. The baby's skin was hanging off her and she had the shrivelled little old person look due to severe malnutrition called marasmus. And she was also eaten up with scabies.

I weighed Sarah. Five pounds.

Mother said that she lives in a shack on the Soleil wharf just a few blocks from the clinic.  She and Sarah and Sarah's other seven siblings live together in a tiny place. 

Two of Sarah's siblings have died. The father of Sarah's brothers and sisters is also dead. And mother told me she had not seen Sarah's father since she was pregnant with Sarah. She referred to Sarah's father by his nick name in the slum.

Mom hung her head down and talked quietly explaining how she has no money to buy food for her kids and her breast is dry for Sarah.  This story is ubiquitous in the clinic and throughout Soleil and is partly true. I hear this story every day. 

However, this mother seemed well fed and quite intelligent. She looked poor, but she was definitely a little different than the normal Soleil wharf person. I noticed that her eyes seemed to dart around a lot as she was telling me her problems. She even looked out the door a couple of times. 

I agreed she has many problems. However, her main problem is Sarah.

It didn't take much time to find out that Sarah has a very loud and hungry scream. So the nutrition nurse mixed up some Similac and put it into a tiny five ml plastic cup and her mother competently dribbled drops of milk into Sarah's mouth. Her distress and cry ceased almost immediately and the look of desperation disapperared into a content face. You could see her distress and her hunger pain abating. Sarah stared directly into her mother's eyes like she was saying "thank you".

So I thought here is another baby starving just 90 minutes form Miami in the hell of Cite Soleil. And the Sisters who run the clinic have a malnutrition program but don’t admit babies until they are six months of age. So Sarah is too young to be enrolled since she is only six weeks old. 

I examined Sarah and treated her with some very diluted down medication for her scabies. I sent her mom home with some Similac and told her mom to bring Sarah back in the morning. Her mom promised me that she would.

But I had bad feelings about the mother.

Last night I called a close friend of Maria’s and mine. I will call our friend Kim. 

Kim and her husband have an orphange and nutrition center in Port-au-Prince and I explained to her about Sarah. Kim has heard countless similar stories and she said that she would come to Soleil in the morning and evaluate the baby. And if all worked as planned she would take Sarah and her mother back to the orphanage and supply her with food. 

So this morning when I walked into clinic, Sarah and her mother were seated on the bench outside my office. But Sarah was screaming her desperate hungry cry. I asked mom if she had given Sarah the powdered milk this morning and said she had not because she had no bottle. 

This angered me to hear this. What was mother thinking? Her baby needed nutrition.

And Sarah proved she did not need a bottle yesterday in the clinic. She had been fed from a little plastic cup. So the nutrition nurse and I mixed up some more Similac which Sarah devoured quickly from the tiny cup and went to sleep. 

What could mom be thinking? Why wasn't she feeding her starving baby girl?

Kim showed up. So we sat next to mom and Sarah and Kim explained what she could do for Sarah. Mother said no, that she did not want her baby in an orphanage. And when Kim said that she would take mother and Sarah to the orphange today and give her one weeks worth of powdered milk AND transportation money back to Soleil, mother refused that offer also.

I stared at the mother. What is with this Soleil mother? She has a beautiful baby that she is not able to feed or is choosing not to feed.

In the US I would have called DCFS yesterday and admitted Sarah to a hospital for potential neglect.  And even though there is an equivlanet agency here in Haiti, it is way too overworked and understaffed and there is no way it would respond to Sarah in Soleil.

So I pleaded with the mother to go with Kim. She refused again. She said she had to get home to get her other kids to school and the "streets are dangerous". But she made no move to leave. 

I thought what if I had offered the mother some money so Kim could take her and return her to a good nutritional state and then return her to the mother. I would be bribing the mother to try and save Sarah's life. I concluded this this would be a very bad idea, because it would appear that we were “buying a Haitian baby”, when in fact we were not. But that is how it would appear.

So Kim gave her her phone number to call if she was ever interested feeding Sarah with a constant flow of milk. Mom said she would consider this although I had my doubts.

So Kim left. And I went and sat in my office and closed the door so I would not have to look at the mom and baby Sarah as they sat on a bench just a few feet from me.

I was angry with the mother.

I thought she is using Sarah as a bartering tool to get some money....or to get anything. She is playing the system. Yes that is it.  She is barely keeping Sarah alive to see what she can get from anyone. 

Or maybe Sarah’s long lost father told the mother not to give the child away or he will kill the mother? Is the mother afraid of the father even though she says she does not ever see him? Has she been threatened by him?

I opened the door and called mom into my office again with Sarah. I examined Sarah again. I explained that Sarah is dying simply due to lack of food. I told mom to reconsider Kim's offer. She said all her kids are hungry and asked me for money to feed them.  I told her no...I didn't want Sarah to be her bartering chip. 

I then met with a Haitian Catholic Sister who works with the malnourished kids and explained to her Sarah’s situation. The Sister just looked at me and said the mom wants money. But Sister talked very matter of factly with mother and explained that she needed to call Kim tomorrow. Mother told Sister that she would. 

Two hours later mother was still walking around the clinic in front of hundreds of other slum mothers carrying pathetic Sarah in the dirty blanket. Mother acted like she had no problem in the world. And the other mothers just stared at her. And she hadn't left to make sure her kids made it through the dangerous streets of Soleil. 

Sarah, if I could do something better for you, I would. I just don’t know how. Poverty does bad things to people's bodies, minds, and souls that people like me don't understand. 

Hopefully, your mom will reconsider, and bring you back tomorrow so we can call Kim and you can eat. 

John A. Carroll, MD

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