The great and erudite William Osler once said; “Mankind has 3 great enemies – war, famine and fever. Of these, the worst, by far the worst of them is fever.”… I disagree
In the few years that I have been privileged to practice medicine, I have come across a lot of illnesses- acute, fulminant, chronic, infectious, non-infectious, autoimmune, malignant, benign, name it.
As people have let me into their private lives and bared their bodies, minds and souls to me, I have had the privilege of an insider’s perspective and in going through these details with a fine tooth comb, I uncover both physical and psychological ailments. Most times, I can offer a cure or treatment at least, to their infirmities, but there is one condition that I have come across, all too often, which, brutal and fierce in its presentation, has unfortunately, no cure. At least, not in this dispensation.
Of all the illnesses I have encountered, none is as debilitating as poverty. It is a canker that affects the mind as well as the body with equally devastating effects. It, like all other diseases, has various types, subtypes and degrees of severity. Sadly, not one of them can be said to be preferable to the other.
A lot of people think of poverty as merely the absence of financial means. It runs much deeper than that. It is a state of being. A psycho-physiological adaptation to a state of lack. When the knife of poverty cuts keenly and food, shelter and raiment become luxury, when surviving today becomes a daily battle, when each next breath is drawn without the certainty of the one that comes thereafter, it is easy to focus on the physical carnage it leaves. A portrait of poverty to most, would look like hollow cheeks and haunted eyes, sallow, jaundiced skin, dusky hair, countable ribs, knobby knees, brittle rags, and drooling faces. We often don’t see that it is the inability to perceive the world beyond the perpetual grumble of hungry tummies, the absence of belief that for any split second, one’s destiny might actually be influenced by one’s own decisions. It is the apathy that accompanies the resignation to a fate in the hands of the gods, held in trust by men of greater station. It is the sinking feeling of utter helplessness in the face of nature’s and society’s continuous assault on the man, the blunt refusal to waste calories on any attempt to fight for life beyond survival.
I have seen poverty up close and personal, wallowed in her shallow pools and played with her children- disease, illiteracy, death. I have come to see why it is easy to blame the poor for their status and to get angry at their apparent unwillingness to rise above what is clearly an unpalatable situation. I have gone through a cocktail of emotions as this romance has blossomed- pity, then empathy, then compassion and sympathy, then fury, then love and frustration and despair and a numb feeling of being threadbare. It is a rollercoaster ride of epic proportions.
I’m on call tonight and I have had another brush with the ominous disease. The setting is the first wing of the Pediatric Ward. My patient at hand is an 11 month old (if the grandmother is to be believed, since there are no birth records) infant with disseminated tuberculosis. He has a chest tube sticking out of his left side, connected to a crude improvisation of an underwater seal. He looks like a small child of 3 months, even though he has a mouthful of teeth, visible when he cries in that plaintive, unsteady voice. His belly is round, ballooning out from underneath a ribcage with wasted muscles and visible bones, almost creaking with each indrawn breath. His hair, if you can see it, is thin and wispy and an unhealthy dusty colour. Needless to say, his limbs look like the corresponding parts of a matchstick figure. Pervading around him is the unpleasant smell of stale feces. The grandmother does not want to remove his diapers, because she does not have any other one to replace it with and she cannot leave the child naked or he will desecrate himself once again, without any barrier. I don’t know how long he has had the soiled diapers on, or how many times he has soiled them over. Damn disposable diapers!
He had been due to receive a dose of antibiotics 2 hours before, but since hospital policy directed that patients provide their own disposables (they’d only be charged for the bed, utility, procedures and medical care and drugs if the hospital provided them), they did not then, as they did not now, have syringes or an IV canula, seeing that the access line in place was no longer patent. He had just been tepid-sponged 30 minutes before I met him, because his temperature had risen again. A familiar pattern, looking at his temperature chart. I was crestfallen to say the least.
How could I start this call with such a patient? Who did I offend to deserve this?
I ask for cotton and alcohol wipes, latex gloves, a canula, syringes to draw and administer his drugs. None of them is available. I ask her to please change the diapers, because it is getting really uncomfortable for all of us. I ask her to borrow from any of her neighbors, so that we can start, since he is already behind on his drugs. She mutters that she does not know who to borrow from. She is indebted to every one of them, for one item or another and has not replaced any of what she has borrowed so far. The child’s father went to source for funds and has not been seen all day. The mother is in isolation- She also has tuberculosis. She says this in a bitter, angry manner, as if by reminding her of what I’ll need to take care of the child, I have somehow contributed to putting her into this predicament, along with the child.
I swallow. It tastes bitter. I don’t know if bile is rising to my throat or if I am coming down with another bout of Malaria. I go from bed to bed, soliciting on her behalf, for some diapers. I cannot be more involved than marginally- financially speaking, that is, seeing as we were last paid 2 months ago. I have me some financial troubles of my own. I am in my own corner of the spectrum of poverty whether I like to admit it or not.
The other items I cannot borrow from the ward, I go to the emergency pharmacy and purchase for her. I return to freshly changed diapers and breathe in. The difference is outstanding. I secure another IV access, remove the old one and administer his drugs. I reseal the syringe and keep it in his bedside cupboard, he has another drug due in a couple of hours. Never mind the syringes are supposed to be sterile, single-use. Good job doctor!
She looks on, his grandmother, helpless as proceedings go on around her. She is blind in her left eye. The cornea is frosted over – probably trachoma. I find myself wondering, what if she has glaucoma and the other eye is at risk? How will she know? How will she take care of that? For now, she is a prime asset- available to step in and take care of the boy in this time of need. What if she is a few years away from being a liability to the family?
As the child starts to cry, she starts telling him off, venting her frustration on him. I don’t know if the child can hear her, because he only cries louder. I step in and tell her to stop doing that.
“It is not his fault that he is sick…”
It is not our fault. None of this is. But we will not dwell down here, pointing fingers and trading blames. We will do what best we can, shake off the dust and grime and push forward against the forces that be, filing away at the shackles of poverty that imprison our pockets and bodies. We simply cannot sit still. Otherwise this canker that now feeds freely on our flesh, may move on to infest our minds… And hold us truly captive.