This week started off a bit chaotic, with the uncertainty of “first day on the job” compounded on that of “first day in a new country.” In the year and a half since I last worked abroad, I had forgotten how important it is to master the art of waiting. Though at times awkward and uncertain, waiting is a meaningful way to take in surroundings, get a sense of the flow of things, observe, and ponder. On Thursday, I began my Family Medicine rotation with two residents who go to La Barquita, an underserved neighborhood of the city, to do daily consults in a small clinic. The impoverishment of this area was immediately clear to me. The roads and houses were not well-maintained, stray animals ran amok, litter was everywhere, and lots of young people were just sort of hanging out. According to the medical residents, the high rate of malaria and dengue in the community is due to the area’s location by a river with standing water.
Our second patient was a six-year-old boy accompanied by an older woman, with complaint of lots of vomiting since waking up that morning. The patient had an ataxic gait. Curled up on the woman’s lap, he did not make eye contact or speak to us the entire time. The residents asked about his medical history, but the woman didn’t know. They then continued on to other questions that the woman refused to answer in front of the child. While the resident examined him in a bed in the corner out of earshot, the woman explained his story to us. Apparently, his parents are “delinquents” that hung around the neighborhood for a while, but then began to neglect him. When she started noticing that he was skinny and dehydrated, she began feeding and looking out for him.Then one day his parents were gone.
I just sat there silently for a moment and reflected on the situation. Without social safety nets for kids like him, the child was entirely reliant on the kindness of this woman. I wondered what might happen to him if at any moment the woman could no longer afford to care for him. I could not imagine a more vulnerable situation for this child to be in. The fact that there wasn’t much we could do without an existing social assistance program in place to watch over and check up on him was crushing. There was no way of making sure he was being taken care of by the woman who brought him in. Besides this woman, the child had no one. In addition to being behind on routine check-ups and immunizations, he also clearly had some social and developmental delays for his age.
Life is hard enough without starting out in a situation like this in which so many bad things have happened to him before age six, and how much more vulnerable he is to future problems as a result. The situation was precarious, and I didn’t like not being able to do anything. His future was so uncertain, and there was no plan or system in place to protect him. Because the residents rotate out of the clinic every month, and I would only be there for two weeks, I knew there wouldn’t even be a chance for follow-up. The resident directed the woman to get him antibiotics for pharyngitis, and expressed that she wished there was a social program to compensate her for the expenses.
“You are a saint. Take care.” I said to the woman as I walked her out. I didn’t know what else to say.