Health Care

once when i was young, i was playing in my grandparents backyard with my cousin and my little brother. we were trying to climb a rock wall when one of the bigger rocks came loose, rolling down onto adam's foot and crushing it. it was a long time ago and my memory of that day is fuzzy, but the one image still in my mind is of his screaming, people streaming out of the house above us, and someone swooping him into their arms and running up the stairs with him. when he came back from the hospital, with his leg in a cast, he was all smiles. he was spoiled rotten, showered with toys, candy and attention, we all signed his cast, and the only inconvenience was his spending the summer on the beach with his casted leg in a plastic bag. we have pictures of him smiling a huge toothy smile, wearing his dirty cast as he played in the sand. and that's the way it should be. when a child hurts itself, as children always do, someone should swoop down, pick them up and rush them to the hospital. that hospital should be nearby, like they are in my world. it might feel like it's 5 hours away when you're driving there in pain, but it's really only a short distance and you always get there in time. there should be doctors there. those doctors should have the equipment that they need, and they should be properly trained. if you need medicine, it should be available, like it always has been for me. these are basic human rights. everyone deserves timely, equal access to health care. it is not a privilege, it is a right. we have a patient right now who didn't have timely access to health care and it has now changed the course of her entire life. she's 10 years old, small for her age, adorable, and she fell from the tree she was climbing. when she landed she broke her leg. she broke it badly. both her tibia and her fibula snapped in two, and both protruded from the skin. a horrible injury, but had it been treated in the developed world, she would have been fine. surgery, stitches, casts, rehab... who knows what it would have taken, but she would have been fine eventually. instead, she broke it here, in "this f***ing place" as carmenza has started to refer to it as. she is a nomad and lives out in the wilderness. it took her family 12 days to reach us. in those 12 days she had no anaesthesia. no aspirin, no tylenol, nothing. by the time she reached our hospital her foot was dead. black, smelly, dead. it hung from her leg by a piece of rotting tissue. carmenza cut it free with a pair of scissors. we can't transport her to el geneina, so carmenza cleaned the wound, removed the dead tissue, wrapped her stump and admitted her. today we went to the hospital when one of the nurses radioed to say that "parasites" were coming out of her bandages. we knocked her out and carmenza unwrapped the wound. one fly had managed to get into the dressing and had laid eggs. maggots crawled on the wound, disgusting but useful. they only eat dead tissue, not live tissue, so they actually help clean wounds. still gross, don't get me wrong. carmenza cleans it, and as the little girl slowly starts to regain consciousness she is yelling something over and over. i think that if we could understand her we would probably find her drugged ramblings funny. then the nurse translates that she is calling for her father because she is dying. oh. not funny. when the wound is clean it is rebandaged. until the family can find a private car to take them to el geneina, there is nothing anyone can do for them (msf will pay for the trip, but we can't take them and put ourselves at risk on the road). when she gets to el geneina they will take off more of her leg. if things go as they usually do, the infection will return and they will take more off, and then again, and then again.
as i write this i know that most of you won't be able to understand the full implications of this story. you have never visited homes in the philippines and found the emaciated handicapped child the family hides in their home, never actually killing it but slowly starving it in the hope that it will die and they won't be held responsible. you weren't with me in afghanistan, watching the man with the paralyzed legs drag himself through the mud and sewage with his hands. you haven't witnessed the utter degradation that is the life of the handicapped in the developing world.
this isn't the world that we, the elite few, are used to. this child's life is forever altered. there is no rehab center here. there are no advocates for the disabled here. there are no physical therapists here. there are no prosthetics here. there are no crutches here. there are no wheelchairs here- even if there were, there is no wheelchair access because there are no roads or sidewalks to wheel on. she is a girl, thus already a burden to her family. now she is a nomad girl who can't even walk.
i have never seen carmenza so affected by a patient. she is devastated and threatening to take up smoking. she knows what this girls future holds and there is no way to save her from it.
how do you find a way to be grateful for all that you have ever had, without being bitter that not everyone else has it as well?