Cloudy reflections

This morning I woke delighted in an overcast morning that promised to delay the onslaught of my home-made sweat bath for a few hours. The last few days have been kind with grey skies blocking out the direct overhead rays, allowing breezes to blow cool. Although still in the high 80’s, I can’t help but be thankful for the “fall-like” change in the weather.

Yesterday I accompanied Patrick to Leogane, and volunteered some time in the orphanage he works with while he taught his classes in the CONASPEH seminary there. Patrick goes to the orphanage on Wednesday afternoons to play with the children, to teach them a language, to interact with several of the severely handicapped kids there and teach staff that they need love and attention as much or more as the other kids. His time there is valuable.

The orphanage is relatively new, started by a well-meaning man and wife who raised money from friends in the community and opened their doors to 50 orphaned children ages 2 to 12. They have a school and a community clinic with a Haitian doctor who works Monday through Friday. They’ve been forth-coming with Patrick, admitting that their funds are running low and finding money for food for the children has been difficult as of late. They have big dreams of expanding services, increasing the number of children served, but such dreams have a long way to go.

I agreed to see the kids after meeting them on a visit last week, recognizing the distended bellies and flat affects of kids suffering malnutrition and likely worm-infected bellies. Upon arrival today I was ushered straight into the clinic and all 50 children of the orphanage took their turn standing before me. Most were shy, slow to smile. There was not a single tear, no screaming, no crying. For doctors and nurses reading this, you'll know just how odd that is: fifty children and not ONE cried with a physician's exam.

I inspected scalps, looked into ears, scanned teeth. I listened to hearts, lungs and tummies, scanned the skin looking for rashes, fat distribution, infections. I took weights and wrote notes.

In most of the children, skin stretched tight around bony rib cages, shoulder blades and nobby knees. I could circle my fingers around scrawny upper arms despite tummies protruding like beer bellies on old men. Bite marks of scabies and flees marked many hands, feet and waist-lines, fungal infections crept through scalps. Pale gums and nail beds hinted of anemia. Heart murmurs suggested possible heart conditions, anemia or infectious conditions. Rotting teeth betrayed poor hygiene.

I began to wonder why I was asked to come. Recommendations for true change in health sounded too basic: nutrition, hygiene, clean water and sanitation. I could dose all kids with worm medicine. I could hand over safe medication to treat fevers. I could write prescriptions for antifungals, for antibiotics for the few kids who had bacterial infections complicating their health, for shampoos to kill the scabies and lice. I could remind the leaders of the orphanage of the importance of boiling sheets, brushing teeth, offering the children vitamins each day and providing protein in their meals. I was told lab work wasn’t an option at this time, referrals not within the capabilities of the overworked staff. And I wasn’t sure how many of the prescriptions I wrote would feasibly be filled. As one child's face followed another, I began to wonder what individual exams would accomplish. If I found an anomaly, a potentially seriously ill kid, would anything change? These are the moments in medicine where my heart sinks, my anger flares at injustices in the system, my maternal instincts screaming for a way to protect the children from the world they are living in.

I can't help but question why this orphanage is holding 50 children that they can’t feed, can’t provide health care for, can’t ensure basic care? In the private sector, I'm just as frustrated by a couple who continue to have children when they can’t afford to take care of themselves or the family they have, but I find myself judging more harshly institutions—no matter how big or small—who advertise a service but take on more than they can handle. Especially when children are involved.

But what is worse? A child starving on a street corner without even a flea-bitten bed to sleep in? A kid living with his family who can’t offer a bite of rice a day? Or a shelter for children that offers a little education, at least one starchy meal a day and a few staff to help give hugs and hygiene, even though beds are shared and there is no space to run and play?

It is not my place to judge, especially here, so I battle such tendencies when I find outreach sorely inadequate or when I find myself disagreeing with methods. After 2 weeks of seeing several ill-supported “orphanages” for children, I’m not at all convinced this is the best way to care for kids. I’m tempted to back away completely, not aiding and abbeding an organization that has overstretched itself beyond the ability to provide basic care for children. Where is the social services agent to come condemn the building?

Or should I instead be glad that people are willing to do the best they can in the midst of a horrible situation? Am I projecting my own frustrations at having to do the best I can in a hard situation? Where are the lines of justice drawn? When are good intentions enough? When will the leaders of this country, the people of the world get sick and tired of kids suffering the consequences of systemic disease, political games, oppression and corruption?

I'm glad for the overcast day. Cloudy days always help me feel reflective. I don’t have the answers, and sometimes the questions overwhelm. I do know that I need to step a way for a minute, let the observations and thoughts of the week simmer. I need to pray. I look forward to re-immersing myself in my community clinics where children are brought in by their mothers, where education can be given one family at a time. I look forward to tomorrow's school day and seeing the kindergarten children being walked to school by their moms and dads. Families. Healthy children. Laughter. Hope.

I welcome your thoughts, your experiences, suggestions and prayers.