A tale of two families

The last two days have been busy in the clinics at both CONASPEH and Carrefour. Today amidst patient after patient, I saw a mother and daughter. They looked well fed, unlike many of the people who sat before me. The girl was well dressed, getting ready for school and had some questions about her changing body. Mom was educated, employed and nursing a sinus infection. It was almost like a clinic visit in the suburbs. The encounter contrasted starkly with another mother/daughter encounter I had a week ago. Dealing with their relatively normal and benign problems, I was reminded of prolems that are harder to solve.

Last Wednesday, one of my clinic encounters filled the tiny space where I do evaluations in the Carrefour clinic when a mother and her 4 daughters filed in, all with appointment paperwork. Beautiful faces ages 7 months, 5, 7 and 11 years looked back at me under the wings of a strong and sinewy mother who had each girl step forward and explain their ailments. The faces of children here, especially those who have had to endure a less-than-carefree childhood, often look back at me with a mix of suspicion, tolerance, and experience beyond their years. I saw such with the young ladies in front of me. All had stomach pain. Despite hunting for some easily curable malady, I couldn't find any reason to suspect infections or digestive issues. The hard fact was that these girls were hungry. One small meal a day leaves hunger pains that ache in growing bodies.

During my evaluation of the mother, we discovered she had a blood sugar of 400. She knew she was a diabetic, but hasn't been able to afford her diabetic medications, which previously included both oral meds and insulin. On top of it all, now she had high blood pressure. Her collarbones jutted through her skin and she flashed me a look of "but what can I do?" painted over her face. She had 4 children who had tummy pains because she couldn't find enough money to put bread in their mouths. Medication had to take a backseat among such priorities. I couldn’t help wondering where these children will be, who rely on the love of their mother and their one meal a day, when their mom suffers complications from her illness.

The oldest child emerged from the corner, last to be evaluated. She reported belly pains much like her sisters as well as a "vaginal infection." Such reports are common complaints among young girls in the throws of puberty. They usually offer a nice way for me to talk about the natural processes of the body. I opened first with my standard history gathering questions that I've learned to deliver unbiased. In medicine you quickly learn to not judge by the cover or the age when asking questions concerning drugs, alcohol, sexual activity and education. My rote question to the 11-year-old came out like a reflex. The "yes" answer equally as matter-of-face came back at me like a bullet. It took my best doctor skills to respond like I would to any "adult" with concerns related to sexual activity. Turns out she lived for a while with her father who apparently wasn't super protective when it came to his friends and their interest in little girls.

Today when I asked my patient the same question, her well-groomed mother looked at me like I was crazy. “She’s only a child!” she retorted in disbelief. Yes, a child. However not all children are allowed to just be.

Last week wasn't the time for shock. For nausea. For righteous anger. It was time to discuss how what I thought about my 11-year-old patient’s symptoms had now changed a bit given her history; we had to investigate further.

This is not a problem unique to Haiti. In fact, early sexual experimentation, teenage pregnancy and sexual abuse of children are problems that span all continents and cultures. I delivered a baby to a mother who was 12 years old during residency, and it wasn't the first time our hospital saw mothers barely used to buying Tampax, much less diapers. But evaluating my young patient’s problem within the complex web of her other issues left me angry, especially as the mother sat helplessly by. I bristled with the injustice that this 11-year-old girl has to face hunger pains, a mother with serious chronic illness, no education, sparse opportunity, and memories of sexual abuse under the "protection" of her father. Likely this girl will eventually be left to take care of her sisters if her mother falls ill. Her childhood is long over.

Our world has its share of wounds, of suffering, of injustice and crimes against humanity. We read about them, maybe get infuriated for a moment before we busy ourselves with the routine of our lives. Maybe we get inspired for a moment, write some letters, march in protest, volunteer or work for a better pocket of the world. But we have the luxury of choosing to get involved or not. And when it gets to be too much, we can turn away.

I think of this often, when looking into the faces of the people who live in the midst of one or many headlining problems of our world. Hunger. Abuse. Child Labor. Poverty. Sex and slave trade. Lack of education, healthcare, clean water, sanitation, opportunity.

When I broke the news to the mother that her children looked relatively healthy and that I suspected their tummy aches were due to lack of food, the mother nodded in agreement. This was no surprise, no news flash. When I discussed what exams needed to be done and meds given to her eldest, she nodded with understanding. This was life as she new it, full of struggle and survival. Yet she smiled, thanked me for my time, kissed her youngest, tussled the hair of her other children and escorted them out the door to figure out how to make the best of another day of their life.

If you looked at that family, without gathering any information about their daily existence, you’d simply see a family relying on each other, loving each other. You’d see a family comprised of a protective mom and sisters who seem to look after each other well. You might even look at the 11-year-old and assumed she passed her time thinking about school lessons, her girlfriends and soccer. Often when looking one face at a time at the people here who are attempting to survive" the problems of our world,” we see less dramatics that one would expect. Then the stories come and carve an edge to the picture. The tales of trials endured make stoic warriors out of thin mothers and 11-year-olds with old eyes.

I remind myself to not allow their courage, their will to survive, their adaptability and patience lessen our my own anger at the causes of their suffering. I pray to not fall numb to the stories, or close my eyes to the injustices of our world when somedays it feels too much. And I have a new appreciation for the stories of children spared such trials. The benign and almost boring nature of my clinic visit today with mother and daughter was something worth celebrating.