Weeks frustrations...

It’s Friday again and although I enjoy work, I’m glad it’s weekend! This week has been especially busy and at times challenging and frustrating. I saw about 140 patients this week, which in itself can be quite tiring. However, the most challenging and at the same time frustrating thing this week has been my discussions with people regarding various aspects of life in Sierra Leone.

Today I was at the Feeding Center again and ended up in a discussion with one of the nurses. I was basically faced with the question of whether or not I am helping the families by paying various expenses (admission, doctor’s fee, chest x-ray, etc) for the malnourished children. Is it better for me to pay the fees and by doing so know that the child will receive the treatment he/she deserves? But also realizing that by doing so they will become dependant on me for money? Or should I ‘make’ the caretaker take some responsibility and expect them to come up with the money? That way they will learn that they are the ones that need to take care of their children.

According to the nurse the caretakers won’t let the children die- they will find the money somewhere. The extended family is the support system- if your child is sick, you should be able to get the money together. She said “Do you think that if you weren’t here these children would be left to die?” Her answer was “No, of course not”. Well, to be honest, I am not so sure.

I do realize that if we do everything free of charge people become dependant. That is why we have a small fee at the clinic, so that the parents will take responsibility for their child’s health. Easier said than done, because I know that children are often not the priority in the family. Remember, the child mortality rate in Sierra Leone is the highest in the world. 286 out of 1000 children do not reach the age of 5! It seems like the death of a child has become ‘normal’ here, it almost seems like it is an accepted fact. Because of that I am not convinced that parents will necessarily go out on a limb for their child.

I also realize that some of the patients I refer to the Feeding Center can pay for their admission etc. But I think there is a fair amount of them that really don’t have the money. Remember, we’re talking about malnourished children. Often the reason the child is malnourished boils down to a poor social/family structure, where there is a shortage of means, lack of education, neglect etc. Not exactly the type of family you would expect to have ‘extra’ cash laying around. However, according to the nurse, only about 1 in 100 cannot pay the fee. Well, then why does it take some of the patients I refer over a week to see the doctor? I guess either they don’t have the money, or they really are waiting for me to come and pay the fee for them!.

Anyway, enough to think about as you can see. It’s hard to know what to do. Ultimately I am here for the child. Yes, I think people need to take responsibility. And if I was seeing adults it would be a lot easier for me to tell them they need to take responsibility and come up with the money for their medical care. But I am dealing with children- a vulnerable group, dependant on their parents, no voice of their own. I suppose I can tell the parents to take responsibility and come up with the money for their child. But, if they don’t do it- it’s the child that suffers. Do I want to take that chance?