Thursday, June 02, 2005

The Week and the River

This week will go down in history here as “the week they drained the river”. The emerald green river, a hallmark of Pina Blanca , which allowed this little town a small amount of uniqueness and beauty, was drained. Nearly the entire town came out in disbelief. They watched the water dry up and along with it a certain amount of dignity and pride. There were rumors of why and for how long. Some said months some said forever. I overheard in the café that the mafia had taken over the Tilapia market of Lake Yahoa and the growing amount of pollution in the lake was being attributed to the river. Who knows the truth but the muddy basin left behind was horribly ugly and filled with a tremendous amount of rubbish that had accumulated over years. Many farmers depended on the river to help with cattle raising and a large portion of the town used it as a washer and dryer for clothes because there are gigantic cliff rocks that the clothes can be laid on to dry. For many it was a bath tub, others a recreation site for swimming and boating (sorry no sailing) for others still it was food supply by means of fishing. It would be only weeks before it became garbage dump and a mosquito breeding heaven. A great many towns people complained and with in a few short days the river was ordered to be filled again. Jenny and I were so happy. There is a significant amount of public health education required around the use of the river but until other structures are put in place it does have a purpose. It was good to see the authorities have a vested interest in what is important to the town.

We brought in 2 new children this week to keep a bit, both severely malnourished and quite ill. Both of them had Kwashiorkor a form of protein malnourishment which causes the child to swell up like the Michelin man. The children eat a lot of starch which fills the belly but has no other nutritious components. Their faces were so puffy the skin was taught and their hair was falling out. Both had severe pneumonia and bad dermatitis. Neither one had the energy to smile. The boy was 3 yrs old, brought by his grandfather and older brother. It was painful for the man to admit he couldn’t take care of the little one. He was afraid to leave him as he did not know us. The oldest child was also quite thin but not nearly so malnourished. His demeanor was one of humble pride much like the grandfather, with an element of quiet strength and a sense of protector. He was clearly the primary care taker of the 3 yr old. When we offered them food he turned it down and said “No, save it for Anthony”. When it was time for the grandfather to leave with the older child Anthony’s eyes welled up as he held out his tiny little hand, fingers spread. Anthony tried to walk after them but his little legs could not keep up. His older brother turned and saw Anthony following, he went running back and hugged Anthony one last time. As I picked Anthony up he began to sob, quietly at first then he couldn’t hold back. I held him and sung to him for a long time but his tears still flowed.

The other child was 10 mos old and had been at the government hospital for a week. She came in with measles and received an IV in the scalp because she was so swollen they couldn’t find a vessel in her arm. Unfortunately the IV infiltrated which resulted in a giant burn covering ¾ of her scalp. She wasn’t getting better and the family had no money so the hospital sent her home with vitamins to die. By the time her mother got her to us her head was badly infected her lungs were filled with fluid and she had a horrible case of Scarlet fever. After a few days of intense IM antibiotic therapy, appropriate wound care and being gentle with refeeding she is doing quite well. Neither are out of the woods but both have definite improvement, in fact, Anthony smiled at me today….

Trouble and Irony

In my hand a small piece of an earthworm squirmed as I tried to drop it in the mouth of baby bird that had fallen out of the nest in front of my room. I felt nauseated but the plight of the bird seemed stronger than that of the worm and so I persisted. Jen chuckled and taunted in the background as she is not sure what to make of me sometimes. The chance of survival for this ugly little thing was slim but in both of our eyes allowing it to suffer hours of starvation was harder than feeding it worms. Suddenly our chuckles were interrupted by terrible screaming. There were two voices outside, one young and fearful the other deep and enraged. We ran to the door in time to hear loud cracks. A bit fearful we pushed open the door and became for a moment frozen as a man stood with piece of hose snipped at both ends arm raised biceps bulging and sweat pouring from his back as he brought down with all the force his shoulder and arm could muster a blow to the child’s back. The child was begging for mercy with tears on her cheeks. What do you do in a moment like that? With only an instant of hesitation to note the fear I had inside, I lept out into the walk way with a voice I did not know I had. The man turned on me and I was no longer afraid I was furious. His eyes wavered between rage and shock. The only thing between me and the whip were my words and the knowledge he had that I was a doctor. Even in Honduras it is against the law to abuse children. I’d be lying if I told you I said something profound, I did not. I spoke the truth about beating children words I once spoke because I was taught them words I now spoke because I understood them. The shock took away his power. His necessity to justify his actions deflated his rage. Jen came behind me pulling me back with enough force to bruise my arm…….. it was done. He walked away yelling back at me to mind my own business this is Honduras not America, blah blah blah. Jen called me foolish, and maybe that’s true, but I could not let a man hide behind the concept of cultural moray to protect himself from his own in ability to deal with self generated anger while he committed an atrocity. My sadness comes from my sense of powerlessness to protect this child from future beatings.

Children look to their parents for protection, food, shelter and guidance. The psychological damage that is generated by having the only people in the world you trust turn on you and hurt you is enormous. Violence of any kind teaches a child they can not trust anyone, it teaches them that the way to control people is through fear, it takes away self esteem because children are concrete thinkers, life is black or white, I’m bad or good, I’m lovable or I am not lovable, if I’m being beaten I must be all bad, I must not be lovable…….if I was lovable I wouldn’t be beaten. In America many people hide behind the saying “well I was beaten and I turned out okay”,..…I beg the right to ask the question…when they look in the mirror at night are they really okay, or have they strived for an entire lifetime to overcome the injuries of childhood. I can not argue against the fact that physical and mental violence can be effective control mechanisms, but I do say there are other ways Educating parents on effective parenting techniques is the one thing that can be done not just here but in America in our inner cities in our suburbs. Remember, the woman I spoke of last year whose children were shot and one of them was locked under a hut for 4 years while the father tried to starve him. She too beat her children, it was a problem. We spent a lot of time talking with her and teaching her other ways. They paid for her to attend adult education classes. She learned to read, she gained hope for a better life, she obtained tools to deal with her feelings, she doesn’t beat her children any more…...

That night the bird died.

After a week of inner silence I have come to a realization. When I was a child the first thing that caused me to want to be a physician was my frustration with my inability to save the baby peeps my parents purchased for our farm. Several died without an obvious cause. I buried each one with a little cross of sticks and prayed for God to take care of them and if he could maybe someday would he help me to know how to fix them. Here I am finishing my training, I have finally reached what I thought was the top of mountain and I can’t save the damn birds. I cried…..

I recognize that I have not reached the top of the mountain only a small perch along the way. I accept that I may still not save the bird or the child but if I continue to try there will be some that will benefit like the woman from the plantel if all of us try there will be many who will benefit……….
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