Life does go on - so many children demonstrated this today. All of these horrible things happen to them and they move on. It is amazing how much you can learn from a child, just by observing them. Today was not as bad as yesterday. Today I was actually emotionally prepared for what I was going to see. Today I saw such hope and love for life, it was really moving.
The day started off with a lecture at 8 A.M. on two different topics. One was on the increased percentage of children that are born with this defect (cannot remember the name) where the stomach muscles do not come together. As a result, their kidney, colon, intestines etc. are outside of the body. Sometimes they are covered by an external membrane and other times, they are not (the membrane determines what the condition is called). For patients who have a small enough mass, the intestines and other organs can be pushed back into the body but a lot of the time, the mass is huge while the infant is small. There is no room for the organs to go. What happens is, if a membrane covers the organs, doctors use a substance that will dry out the membrane. In drying out the membrane, the mass shrinks and slowly, over about 1-2 years, the mass will continue to shrink, organs will continue to slowly be pushed back inside of the abdomen and eventually, the child is normal. Unfortunately, since it is a membrane that is not as tough as skin, there is still a high mortality rate due to infections. If the child does not have a membrane around their organs that are external to their abdomen, a so-called manufactured membrane is placed over it and performs the same job to slowly push everything back inside. I had never heard of either of these conditions but they are increasing in frequency. There is no idea why it occurs but there appears to be a trend with extremely young and extremely old mothers. What was even more amazing was that during rounds, I saw a baby in an incubator that had this condition.
We went to the clinic where the day before had acted as a burn clinic. Today it acted as a general clinic and it was pretty crazy. There were so many patients to be seen and all of them had different things. It appears that a common theme among the patients was gastrointestinal problems, specifically with constipation. One boy, whose name I cannot remember because I could not pronounce it, was the highlight of the day. He was 11, going onto 18 - such a mature boy. He walked in with his backpack on, a wrestling shirt on and his foster mother in tow. Out of all of the children, he was the most well behaved and attentive child. Apparently, what occurred is that in the rural regions, when a child is constipated, the mother takes it upon herself to relieve the blockage or whatever is causing the constipation. This boy's mother took an object, put it up his anus to try to rid the boy of constipation. Unfortunately, the object was caustic and completely destroyed the colon. At a very young age, he had to have a colonoscopy because it was practically dead tissue. I do not know what happened to the mother, she could have died or he could have been taken away from her. The foster mother was there and explained that ever since this incident when he was a boy, he has been unable to control his bowel movements. At least once a day, he soils himself, a lot of times it is during school. Due to the lack of a colon, he just cannot control it. He can feel that he needs to use the bathroom but at times, it is too late. The ridicule this kid must have to endure from other children cannot even be imagined. What is worse is that this condition is irreversible. Doctors can do a procedure that will give him a "bag". Essentially, they set him up with a bag where all of his urine and stool will go so that he no longer soils himself. This bag is tiny and would not be able to be seen by the other children yet the foster mother will not consent. I can completely understand her reasoning. Boys are active; what would happen if he fell and the bag popped? What would happen if one of his classmates found out about it? He would endure even more ridicule. This foster mother really was an amazing woman and realized that either way, this child is not going to have a childhood. But with a bag, he will have even less of a childhood because it will be one more thing he has to worry about. She wants to wait until he is old enough to make the decision himself. All that we could do was to take an x-ray of his abdomen to make sure there was no blockage or inflammation and then increase the dosage of his medication. The theory is that if the stools become more firm, less will be passed and there will be a lower frequency of him soiling himself at school. After having to live this life, I would have thought that the boy would be angry at the world and depressed. He was the happiest kid, had such a smile on his face. I asked him what he wanted to be when he grew up and he said a police officer, so that he can make the world safer. Throughout the day, I saw him, walking (which is more of a bob because he walks with such a spring in his step) and whenever he saw me, he got this broad smile on his face, said hello and waved frantically so that I would notice that he was there. It did not matter that people in the room were talking to about him soiling himself (a conversation he can understand) and he did not get embarassed. Instead, he laughed at my attempts to talk Xhosa with him and enjoyed talking to Jeff about wrestling. He thought it was hilarious that Jeff's name was close to one of his favorite wrestlers. There are so many horrible sights to see in that hospital but I can tell that boys like this one are what helps get the workers through the day. They may not be able to help him, but he had such a love for life, was so vibrant and cheerful. When his foster mother got hot and took of her coat, he immediately folded it up and placed it in his backpack, so that she would not have to carry it. I continue to be amazed by him and by this country. They have such a large compacity for forgiveness, resilience and such a love for life. There is so much hope here that it is infectious. Tomorrow I will be in the burn ward and the trauma ward but I hope that in remembering that little boy and others just like him that I saw today, that I will be able to get through the day.
The day started off with a lecture at 8 A.M. on two different topics. One was on the increased percentage of children that are born with this defect (cannot remember the name) where the stomach muscles do not come together. As a result, their kidney, colon, intestines etc. are outside of the body. Sometimes they are covered by an external membrane and other times, they are not (the membrane determines what the condition is called). For patients who have a small enough mass, the intestines and other organs can be pushed back into the body but a lot of the time, the mass is huge while the infant is small. There is no room for the organs to go. What happens is, if a membrane covers the organs, doctors use a substance that will dry out the membrane. In drying out the membrane, the mass shrinks and slowly, over about 1-2 years, the mass will continue to shrink, organs will continue to slowly be pushed back inside of the abdomen and eventually, the child is normal. Unfortunately, since it is a membrane that is not as tough as skin, there is still a high mortality rate due to infections. If the child does not have a membrane around their organs that are external to their abdomen, a so-called manufactured membrane is placed over it and performs the same job to slowly push everything back inside. I had never heard of either of these conditions but they are increasing in frequency. There is no idea why it occurs but there appears to be a trend with extremely young and extremely old mothers. What was even more amazing was that during rounds, I saw a baby in an incubator that had this condition.
We went to the clinic where the day before had acted as a burn clinic. Today it acted as a general clinic and it was pretty crazy. There were so many patients to be seen and all of them had different things. It appears that a common theme among the patients was gastrointestinal problems, specifically with constipation. One boy, whose name I cannot remember because I could not pronounce it, was the highlight of the day. He was 11, going onto 18 - such a mature boy. He walked in with his backpack on, a wrestling shirt on and his foster mother in tow. Out of all of the children, he was the most well behaved and attentive child. Apparently, what occurred is that in the rural regions, when a child is constipated, the mother takes it upon herself to relieve the blockage or whatever is causing the constipation. This boy's mother took an object, put it up his anus to try to rid the boy of constipation. Unfortunately, the object was caustic and completely destroyed the colon. At a very young age, he had to have a colonoscopy because it was practically dead tissue. I do not know what happened to the mother, she could have died or he could have been taken away from her. The foster mother was there and explained that ever since this incident when he was a boy, he has been unable to control his bowel movements. At least once a day, he soils himself, a lot of times it is during school. Due to the lack of a colon, he just cannot control it. He can feel that he needs to use the bathroom but at times, it is too late. The ridicule this kid must have to endure from other children cannot even be imagined. What is worse is that this condition is irreversible. Doctors can do a procedure that will give him a "bag". Essentially, they set him up with a bag where all of his urine and stool will go so that he no longer soils himself. This bag is tiny and would not be able to be seen by the other children yet the foster mother will not consent. I can completely understand her reasoning. Boys are active; what would happen if he fell and the bag popped? What would happen if one of his classmates found out about it? He would endure even more ridicule. This foster mother really was an amazing woman and realized that either way, this child is not going to have a childhood. But with a bag, he will have even less of a childhood because it will be one more thing he has to worry about. She wants to wait until he is old enough to make the decision himself. All that we could do was to take an x-ray of his abdomen to make sure there was no blockage or inflammation and then increase the dosage of his medication. The theory is that if the stools become more firm, less will be passed and there will be a lower frequency of him soiling himself at school. After having to live this life, I would have thought that the boy would be angry at the world and depressed. He was the happiest kid, had such a smile on his face. I asked him what he wanted to be when he grew up and he said a police officer, so that he can make the world safer. Throughout the day, I saw him, walking (which is more of a bob because he walks with such a spring in his step) and whenever he saw me, he got this broad smile on his face, said hello and waved frantically so that I would notice that he was there. It did not matter that people in the room were talking to about him soiling himself (a conversation he can understand) and he did not get embarassed. Instead, he laughed at my attempts to talk Xhosa with him and enjoyed talking to Jeff about wrestling. He thought it was hilarious that Jeff's name was close to one of his favorite wrestlers. There are so many horrible sights to see in that hospital but I can tell that boys like this one are what helps get the workers through the day. They may not be able to help him, but he had such a love for life, was so vibrant and cheerful. When his foster mother got hot and took of her coat, he immediately folded it up and placed it in his backpack, so that she would not have to carry it. I continue to be amazed by him and by this country. They have such a large compacity for forgiveness, resilience and such a love for life. There is so much hope here that it is infectious. Tomorrow I will be in the burn ward and the trauma ward but I hope that in remembering that little boy and others just like him that I saw today, that I will be able to get through the day.
The picture is of some children that we made friends with in Khayelitsha, one of the townships. I uploaded pictures of Boulder Beach (the beach with the penguins) on my photobucket website. I do have to say there are some cute pictures of penguins.
3 comments:
Yes, life does go on, and tomorrow you do need to remember your sweet little boy. I'm afraid that the Trauma ward might not be all too pleasing for you, especially since the Burn ward made such an impact on you. Just keep remembering your little 'fella, and that there will be more kids and adults like him to come. You have always been so good with kids. Think "happy thoughts," and Disney, and I'm sure you'll find some other needy people to put smiles on their faces. :)
I heart the penguins. Bring one back for Roo to play with :)
The penguin pictures are great! There's a few you should print and hang on the wall. :)
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