1/29/15:
The day dawned rainy, cool.
A slow drizzle shows through the 12 X 12 foot
orifice in the outer wall.
It permits us to watch the play ground from the
relative shelter of a stairwell.
The children are assembling for the morning
session.
They line up in the bleachers that run two
sides of the cement basketball floor.
It appears they arrange from youngest to older,
left to right, with an angle in the middle where the seats turn a corner.
The kids are under a shelter cover.
A few teachers have umbrellas.
Everywhere, the clothes are brightly colored.
And the children are quiet, docile, still, a
Victorian England ideal.
Not.
They are kids like kids anywhere.
They run.
They hop.
They holler.
Young teenage girls in uniforms was 3 and 4 to
a gaggle, looking at boys from under long lashes.
The young men swagger, aware they're being
watched.
Really pretty ordinary.
Except that it's cooler here than Omaha,
Nebraska.
…...................
The kids come in by class and age.
First, a bit older. Maybe 3rd grade
equivalent.
Even in 3rd grade, the ages are as
uneven as the heights and weights.
Some are effusive, bubbling over, chatty.
Some look at us with hooded eyes, wary of the
Gringas.
A quick assessment shows most are healthy.
Except for their teeth.
Whether it's diet or want of dental care, the
state of these children's teeth is appalling.
Maybe it's both.
But from what is becoming clear in the realm of
the relationship of dental to physical health, there is a developing crisis
here.
And where there is crisis, there is
opportunity.
…....................................
The day warms. So do the children.
She is impossibly small of stature.
And impossibly big of smile.
“Slight” might be a better word.
She runs up and hold up her arms.
Who can resist?
Who should?
A quick snatch and lift and she's taller than
anyone in sight.
The reward for the lifter?
A look of pure delight.
…......................
He gazes warily at the triage nurse.
He has his assessment documentation paperwork.
Always paper.
She looks in his eyes; OK.
A swift glance at his skin; good condition.
An experienced finger-grip about the mid upper
arm: too skinny!
Heart good, no murmurs.
Lungs clear, no asthma.
Belly soft.
Now for the mouth.
Tongue blade is coaxed between teeth that,
clenched, slowly yield.
Tongue and throat in good shape.
Teeth, not so much.
Extensive decay in baby teeth and started in
the few adult teeth that are erupting.
A referral to the dental section, a vitamin,
and
Next.
She's done this before.
…...........................................
The morning is a bit slow as we get organized.
The afternoon is different.
It is now gorgeously warm out.
The team is sheltered from a stiff breeze.
The teachers have hit their strides.
And the children, like children everywhere, are
glad for a break from the routine of school.
(...whoever thinks children in a country like
Honduras are sniveling, fawningly grateful to sit all day in a classroom doing
their sums and working on Palmer-method penmanship lessons doesn't know
children; they are alike the world over.)
They scamper about in the sun, running and
shouting, lining up only when it is their class's turn.
Lined up, but not silent.
As it should be.
…........................
She looked sick.
An experienced ER nurse picked her out from the
crown at a glance.
Skin a bit too pale, breathing a bit too fast,
nostril out.
A worried look.
She is hustled out of the Routine line for
Special attention.
The nurse went over her more thoroughly.
Full vitals set. Temperature was too high.
Head and neck exam ok.
Heart good.
Lungs: a clear difference. Right back mid lung
field sounded like someone was opening Velcro right under the stethoscope. The
rest of her lungs were clear.
Abdomen was soft.
The rest of her was good.
Mom is with her.
Pneumonia;
the translator ensures Mom knows our thoughts.
An antibiotic is dispensed right now, a dose
down the hatch right now.
Acetaminophen and a cough syrup round out the
medications.
A few instructions to Mom and she is on her way
home.
Lab? Couldn't tell us she was well.
Xray? Couldn't say she didn't have pneumonia.
It's not the well who need the doctor, it's the
sick.
….............................
The dental clinic labors on.
The load is impossible, the need immense.
Children whose parent is not in attendance are
screened for a future procedure.
Those whose parent is here receive advice.
Often, the advice is removal; it's all that can
be done.
The parent nods yes, the translator ensuring
they know what is intended.
A few shots to numb the jaw; there is no easy
way.
Rare is the child who protests; their parent is
soothing, holding a hand.
During the extraction, most parents look away.
The children are incredibly well behaved.
They sit as still as any child can.
No spinning, screaming, parent bribing,
exchanging a trip to McDonald's for a modicum of compliance.
The tooth, or rather, the tooth remnants are
out.
There is very little bleeding.
Acetaminophen, instructions, a gauze pack.
And the parents are truly grateful.
Even the children say “Gratias.”
….............
1/30/15
Last clinic day.
And it proves to have interesting cases still
in store.
(Hint: You don't want to be an interesting
case. You're welcome.)
“Doc, what do you think about this?”
Coming from one of our nurses, I knew not to
expect the usual.
His hair was too light.
His skin lighter than cafe au lait.
His eyes were a light yellow-brown that seemed
wrong.
And they moved.
How they moved.
His eyes went independently in every direction.
His eyes moved like an iguana's, all quadrants.
Albinism.
Random nystagmus.
A syndrome.
How was he seeing?
How is his brain processing this random data?
Likely, it is not.
He is likely seeing the world in swift,
herky-jerky pictures.
No way for visual centers to be trained.
But there is not much to be done for him, here
and nearly everywhere.
But I wonder.
What if Google Glass could adapt it's technology?
We see at 30 frames/second.
Could a fast computer, hooked to a sensor that
tracked his eye movements, display the scene that his eyes should be seeing at
the peak of their arc?
I think there's a technology potential here.
….................
It is late the final day; just a few children
left.
That's when it always happens.
“Doc, would you look at this one?”
“Hey, Doc, this Mom just wants to talk to
someone.”
Two.
….............................
“Buenas tardes. Que passa?” Spanglish. Good
afternoon, what's going on?
“He passes out.” she translates.
“Tell me more.”
“He is walking and just passes out.”
“I need to know what she is seeing when he
passes out. Does he shake? Is he awake? Has he been hurt? Start over. What does
she think?”
The
Spirit Catches You And You Fall Down.
He is awake the whole time.
He knows he is going to fall.
He always falls forward.
He never hurts anything beyond scraping his
hands.
He's never hit his face.
He's never has a seizure.
He just lays there until Mom helps him up, then
he's normal.
No one in the family has seizures.
There are no early cardiac deaths.
He plays football (soccer) just fine.
This never happens with strenuous activity.
It's only been t he last year.
...and so it goes.
His exam is normal, including a normal heart
and neurological.
Intellect is at least average, I think higher.
I suspect he is OK; I tell Mom.
Rather, the interpreter carries the message.
I note a vague disappointment in myself that
this didn't turn out worse.
That feeling swiftly corrects when my second
thought intrudes.
There may well be nothing to do for him if this
had been a bad cause.
So, wellness is a cause for celebration.
….................................
Swiftly the story comes out. In a disordered
jumble, though.
It seems he isn't doing well.
Mom can't get more specific.
“What grade is he in?”
“4th.”
“How is he doing?”
The child stares at us, not disinterested, not
interested.
But I'm interested.
His left eye is at half mast.
The eyeballs move normally, though.
Both arms and hand move symmetrically.
Ditto for his legs.
Speech?
Just a few slurred sounds.
“When did he first speak, say his first word?”
“Cinquo anos.”
“5 years old????”
“Si.” No surprise or consternation.
“When did he first walk?”
“Ses anos.” No alarm.
“6 years?” Certainty is needed. Even the
translator looks surprised.
“He is 12?”
“Si.”
“And in 4th grade?”
“Si.”
“Does he read and write?”
“Si.”
I'm doubtful.
“Has he ever seen a doctor?”
“No.”
“Never?”
“At all?”
“Never at all. Until you.”
I hand over paper and pen.
His first name is Jose, last name ends in “z”.
(You won't need more.)
“Escribe su nombre.” Write your name.
Perfectly formed, symmetrically spaced: J s o z
That's it.
“Haga esta problema.” Do this problem.
2+2=
My last 2 is not very well formed so I correct
it with a squiggle.
His solution?
2 + 2
That's it.
Except that he has precisely reproduced my
error/correction.
He has my attention.
“Has he injured his head?
“Si.”
2 years ago, he fell off a wall and hit the
right side of his head.
After that, his left eye drooped.
And Mom reveals her concern:
“Does he have a rock stuck in his head from the
fall?”
She might be right, he may have had a brain
bleed, but there is a deeper problem.
The learning disability predated the fall.
I suspect he has a form of cerebral palsy, a
birth injury.
I toss my pen on the floor and ask him to get
it.
Execution is perfect.
I repeat my clumsiness but add a request to put
it on another table.
The pen comes back to me.
I negotiate with his teacher, translator
helping.
“Are there any special education resources
available?”
“No.”
“Can we set up a special test and program?”
“Si.”
Having a daughter who is a teacher is going to
help.
“Let's do this. Test him in the major domains:
math, reading, writing, etc. Then place him in that grade level until he can
test to the next grade.”
The conversation was more complex, but the idea
is easier here.
There are 12 year olds in 2nd grade
because their parents can't afford to send them to school full time.
And I talk to Mom.
“Jose may not be like other kids. But his sight
is good, he uses both arms and legs well. He can draw well. He may not be a
doctor but he will be able to function and, with the help the school can give
him, I suspect he will function well. I don't think medications will help him.
I think the school can. And I think he can have a good life.”
Mom departed, smiling, son in tow.
No tests, CT scans, MRIs. Just talking,
examining, probing.
And a school that will help.
…......................
1/31/15
Today, we are packing to go home.
Yesterday was filled with thanks from the kids,
the school, the community.
One can debate our impact.
I can debate it.
But for a least a small group of people here in
Honduras, they remember there are Americans who care.
And the Americans remember a group about whom
they cared and care.
…............
Another long day, but not so long as we've had!
Leaving is prolonged and chaotic with the kids
running all over.
An impossibly small girl is playing with a
nurse, alternating listening to each others hearts.
The girl is fascinated by the bright yellow
stethoscope.
The conclusion?
The only one you can.
A little girl went home that day the proud
owner of a bright yellow functional stethoscope.
Maybe a future nurse?
….............................
Descending the mountain by bus brings to mind
the complaint the priest lodged with St. Peter.
“I was a priest of God. Yet you gave this low
life taxi driver a higher celestial place than me!”
“Father,” came the reply, “When you worked,
people slept. When he worked, people prayed.”
…..............
The graveyard is cut into the mountainside.
Into rock. The real stuff.
The grave are so shallow, out of necessity and
lack of alternatives, families pile stones high to frustrate the vultures.
….....................
The capital city looks weird.
After only a week in the mountains, the sight
of a city brings out thoughts of chaos.
Where are all these people rushing off to?
Street vendors; how do they make a living/
Disable at intersections.
The occasional dignitary/politician forcing
their motorcade of huge SUVs through traffic that is already struggling.
Makes one wonder if the city life is
better.....
…....................
From the valley, we take a bus trip up
(another) mountain.
We visit Santa Lucia.
Beautiful church where a baptism is occurring.
We walk through town.
We are obviously tourists; the inhabitants,
invariably polite.
There is an eccentric genius in this area,
maintaining a private preserve with walking trails.
A haunted house site with a structure he built
from abode as done centuries ago.
An agave plant 8 feet tall and twice as big
around.
An area devoted to demonstrating how the 7
continents will live together using sample vegetation.
Small fish ponds with fountains and srays.
A good hike.
The local version of the corner grocery makes a
good rest stop.
Then an excellent meal, varied in dishes, high
in the mountain.
(All expenses upon leaving the mountain are
paid by the individual, not the foundation.)
Placita d'Susy.
Susy's Little Place.
There is a playground for the kids but no
attached McDonald's.
The ride is staffed by a young lady in clown
getup. She poses for a picture.
We stop for some tourist shopping. The Honduran
currency converts 21:1 with a discount for Greenbacks. Local currency seems
like play money.
Dusk drops quickly this close to the equator.
We are back at the hotel, showered and ready
for bed.
…...........
2/1/15
Up too early.
A soft bed seems like too much comfort.
Out we roll anyway, most to shower, some to
breakfast, some to Mass.
Church is a short walk away; the sunshine is
glorious.
And where we're going...we'd better get a last
dose!
72F here, 12F predicted for our arrival in
Omaha.
Such thoughts can distract in church.
We enjoy the sun all the more on the walk back.
Final pack, check out, bus, airport.
We are being pulled back into the modern
transportation system
For a while there, life was calmer,
expectations manageable.
Back to reality, our reality.
And you.
-30-
…............
Yours from Honduras;
Us
No comments:
Post a Comment