No money, No doctor...

Last week I saw a little boy who was moderately sick. He had lost weight, had many palpable lymph nodes and a chest infection. I decided to treat as outpatient with a strong antibiotic and see the child again on Wednesday; unless he got worse that is, then the mother was to take him to the Children's hospital. I guess my thought was he likely had TB but I needed to try out a course of antibiotics first.

Yesterday he returned. And looked worse. He had lost more weight and also had diarrhea and vomiting. Obviously the mother had not taken my advice to go to a hospital for admission if he was worse. He definitely needed to be admitted now. I called the NGO hospital- they didn't have a bed and said to check back with them. I started the child on ORS and kept checking back with the NGO hospital. After 3 hours of observation and still no bed available at the NGO hospital I decided I couldn't wait any longer. I had to send them to the government-run Children's Hospital in town. The mother only had Le 10,000 with her and it would cost Le 15,000 to see the doctor. She had the father's phone number with her so we called him. He agreed to meet the mother and child at the Children's hospital. I said he needed to bring money, he asked how much, I told him, he said ok. So I sent the mother and child off, assuming they would meet the dad, see the doctor and be admitted, and hopefully recover. I was seriously thinking HIV/TB at this point.

Just a brief explanation of the money situation- treatment at the government hospital is not free. So, what happens??? Sometimes we do give money. Because I have heard if there is no money the child will not get seen by the doctor. Or if they see the doctor but don't have money for medication, they will not be treated. And it's not cheap either. It's outrageous to think some patients I have referred have spent Le 150,000 for their child's treatment. That's half a months salary for my staff and most of these moms I see are unemployed! Anyway, it is always a dilemma when referring a child to know how much money to give. It's hard to give money to all of them- because the parents do need to take responsibility. And I don't want everyone showing up at our gate with really sick kids because they think we'll give them money to be admitted elsewhere. Plus sometimes when we give money the mom's go home with it, rather than to the hospital. Many reasons for daily money frustrations. But often they really don't come to the clinic with much money- and to send them home first means more of a delay. So, if they have the money or can call someone to meet them, that's often what we do. Or we give them enough to see the doctor and start some of the treatment and tell them they will need to collect the rest at home after the child is stabilized. Not easy decisions.

Today the mother called. The news was not what I wanted to hear. The child died yesterday. The child never saw a doctor. First she said the doctor wasn't there. I told her there are many doctors there. Then she said they wouldn't see the child because they couldn't pay the registration fee. So mother and child stood there waiting. And the child died there at the children's hospital without being attended to because they didn't have the money upfront. I guess the dad was struggling to get the money together (why didn't he tell me he didn't have it on the phone?!) and got there too late.

Needless to say I was upset to hear this terrible news. Frustrated with the screwed up system. Feeling guilty for not having given them money. Wondering how people can sit behind a registration desk and watch little children die. Questioning why the father couldn't come up with the money when he likely did get money together for the child's funeral today. Thinking about all the things I could have done differently (and if they would or wouldn't have made much of a difference). Figuring out where my responsibility beings and ends (and where that of the parents lies). I guess in the end, what has happened has happened. I already knew the system was messed up and now I've seen it happen once again. I guess in the future I will at least make sure the mother has Le 15,000 when referred off. And pray that somehow, sometime soon, something changes at the government hospital...