There was a death yesterday of a sixteen-year-old boy.  When we heard about it, Cherlie and I both lowered our heads and cried.  They were tears of pain and frustration, at the country we live in and the limitations of our own capabilities.  We had seen the young boy in the clinic on Thursday, orphaned at birth and cared for since then by his aunt.  She brought him in to see us in consultation.  She sat rather casually in her chair as he writhed around on his in pain.  “He’s had abdominal cramps that started about ten days ago”, she said.  “Then, he got a fever and diarrhea and the pain has been worse since then.  He could hardly walk to come to the clinic this morning.”  “Walk to the clinic,” I thought.  “This boy doesn’t look like he can walk across the room.”  His abdomen was distended, tight as a drum and tender all over, especially in the right lower quadrant.  “Well, “I thought, “it’s either appendicitis or typhoid fever but it’s mostly certainly ruptured.”  “Why did you wait so long to come in,” I asked.  She shrugged her shoulders and said that they were hoping it would get better by itself.  Tragic mistake.

“You need to take him to the general hospital in Jérémie immediately”, I said to her.  “He needs to have emergency surgery and you need to go right away or he’ll die.”  I was hoping the dire prediction would make her jump into action.  But, she just sat there, shook her head and said there was no way she could take the boy to the hospital, no matter how sick he was.  She kept talking as I quickly wrote out a letter of reference for her to take to the hospital.  Letters usually ensure faster care, although nothing can be assumed at the government hospital.  But, it was his only possible chance for survival.

When I was finished, I asked Cherlie to talk with the aunt because I was concerned about her nonchalant attitude and wanted to be sure she understood the possible consequences of not taking the young boy to the hospital.  So, Cherlie talked with her in the frank way only she can and when they left, we knew the aunt wasn’t going anywhere except home.  The boy died later that night.

Our prayer is that some day we’ll have another jeep and a driver on salary and thousands of dollars in a Poor Fund so we can personally take a patient like this young boy to the hospital and be responsible for their initial care.  We can’t do it with everyone but we certainly can try with the urgent ones.  As things are now, we’re left with difficult decisions because we can’t leave 40 or 50 patients sitting in the clinic in order to drive an urgent patient to Jérémie to the hospital.  Someone else in the waiting area might be as much in need of our care.  So, we have to rely on the families to take responsibility for their loved one, and we often do give them money to help them out.  But, they have to make the ultimate decision on what to do.  Life here in Haiti is always a series of small choices that become more significant due to the poverty and lack of resources.  Money is only one of them.  Having others help at home and at the hospital are others.  Understanding how to get around in town is another.  Finding a place to stay and cook the patient’s food are others.  There are no safety nets here, no community resources, no social services, no one to go to outside of their own circle.   And that lack of resources sometimes makes us cry.

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