The Pediatric Ward

I believe that you can understand the health of a community by looking at its children. I have visited the pediatric ward several times now, but today more than ever, I am distraught. I am saddened & I am holding back tears from the disparity that exists so plainly before me. Before coming to South Africa I completed my pediatric clinical rotation in New Haven at Yale New Haven Hospital. It is with that hospital fresh in my mind, that I cannot help but compare. I think that I am upset today because the reality of the situation of the community is not only increasingly more complete at this point in my experience, but I am also now more attached to its well-being as a whole.

Many of the children run to us & surround us as we enter the ward. It is actually a very difficult thing to experience. The children appear, so many of them, so very in need of touch- so very in need of so many things in fact. Immediately my instinct is that I want to bathe them all. They have nasal drainage dripping from their noses & many faces are encrusted with what appears to be yesterday's nasal drainage as well. Some are coughing, some are limping, many are bandaged, some are burned, and these are the ones that can walk over to us with enthusiasm. Many others are confined to their beds, either because of age or condition. The beds are metal, somewhat rusted, and seemingly 30-year old versions of the ones they have in the pediatric wards at Yale. The patient charts are placed in abandoned boxes of what I think once held X-ray film. These "Agfa" boxes are strung up to the foot of the beds. There are children in the beds with meningitis- very common in this high HIV setting. Other common diagnoses include failure to thrive, & TB. Some children await a diagnosis of HIV, as they are being treated for vomiting, diarrhea & fever.

Today one child is presumably waiting to die, because her liver has failed. The doctor informs me of her poor prognosis, explaining that the only hospital capable of a liver transplant is on the other side of the country, in Cape Town. She looks around 6 years old, but may be younger. Because of poor nutrition, malnutrition, & chronic debilitating conditions such as HIV & TB, I find that many children look much younger than they are. This girl exerted so much effort to breathe, that you could hear her grunting with each inspiration from halfway across the room. It hurt me just to watch her breathe, & left me wanting to do something more. Her family arrived at some point while I was there. I assume it was her family, but no one spoke to them and they did not ask any questions. They just stood with saddened eyes next to her bed. When next I looked they were gone.

One child had cerebral palsy & was experiencing uncontrolled seizures. His mother was with him constantly, & seemed to be working so hard to take care of him. My heart broke three times just observing her love. Another mother cared for her 9 month old daughter, who I would have guessed was 4 months old had she not been sitting, unsupported on her bed. Her body & most notably her head, were so small. Her beautiful, bright eyes appeared to bulge slightly, perhaps from their size in comparison. There were some mothers scattered throughout the ward, some children on the floor reclining, some on foot, & many in beds. I could see all of this with one watchful glance, because there are no private rooms & no curtains to draw- everything is exposed. The children at our knees & in our arms do not wear underwear. I saw no diapers, just the gowns, white & blue.

Then, there is even more reality. Many of these children have no family, no parents, & have no one visiting them. Some are actually on the ward partially because they have no where else to go. Perhaps this is the case, we wonder after leaving, for 2 of the children that were acting out towards the other children. Perhaps they have no one available to give them love. This is part of the troubling state of the greater Msinga community, and much of South Africa. Where a generation of mothers & fathers with households of pediatric age children are lost to, or dying from AIDS. The number of children in this ward alone, infected with HIV is undoubtedly staggering in comparison to a ward in the United States. Theses children, the future fathers & mothers of the country, already affected by such physical hardship at such a young age- a lifetime of ARV treatment, managing side effects, & dealing with stigma.

I am in no position whatsoever to assert any hardened facts about this crisis, only to say that it is one. The people of the hospital here, work wonders in the community, and I by no means wish to criticize the incredible work that they do. There are true freedom fighters here in this community of health care, working everyday on the fight against the injustices of health disparity, wealth disparity and racial disparity. People here have devoted their lives to this, and make great changes in the lives of many each day. I am grateful and honored to be amongst so many of them. I only wish that I could move mountains & do more.