Two choices...in theory...

Quite a few people in Holland have asked me if I really need to work as much as I do. “Can’t you just limit the number of children you see in the clinic?” My answer: “Yes, I can”.

You see, I have two choices at 8:30 am every clinic day.
1) Let in all of the children waiting outside the gate; sometimes up to 65 children, many of who have been waiting since 5 or 6 am.
2) Let in a set amount of children (which I sometimes set at 50) and send the others away.

Problem solved- choose option 2. But it’s not that easy.

In a country such as Holland with a very low child mortality rate of 5 per 1000 and good emergency services this is possible; simply tell the parents to come back in one or two days. (As if people in Holland are waiting in line with their kids at 5am to see the doctor, but you get my point.)

In Sierra Leone the reality is that every child you send away could potentially be dead 24-48 hours later. An all too common childhood illness in Sierra Leone is malaria- the leading cause of under-five mortality (20%). Every child that walks through the gate could potentially have malaria. My fear is that if 15 children are sent away, some of these children may have malaria and some of these children may die or suffer severe consequences because of it. The healthcare system is so poor in Sierra Leone that I am not convinced these children will receive proper treatment in time if I turn them away. Even if we ignore the malaria factor these children are still at greater risk of death. Think about the neonates with sepsis, children that have been sick for some time because they couldn’t afford to go to the doctor, malnourished children, dehydrated children etc. Of course some of the children I see only have a cough, a viral infection, an ear infection, etc.; common illnesses that don’t need immediate attention.

This leaves me with the following question: “Do I want to take the risk, in a country with a child mortality rate of 283 per 1000- where 1 out of 5 children don’t reach the age of 5- and deny a child access to good quality medical care????”

I'm afraid there is no simple answer.