Ignite your compassion

A long(er) post, but my favorite.

The other day we had a lecture on the public determinants of health. We had been educated on the poverty of the people we were serving, but the statistics did not stick with me until today. 41% of the population in the Toledo district of Belize is illiterate. This fact alone is a huge determinant of health. Having proper education leads to proper understanding of resources and the ability to use them to obtain good health (clean water, proper diet, understanding signs of infection or illness etc). Many things stem from education itself so 41% of a population struggling with literacy is a big feat to overcome. Additionally we learned that many of the females drop out of school in order to provide for the family (by selling goods etc) or because they become pregnant. These situations only continue the cycle of poverty that strikes these people. They have no other choice than to drop their education to have enough money to live, and to drop their education is to put their health at risk. But that is the price they have no choice but to pay. On our mobile clinic yesterday, we entered a far away village on the day of their kindergarten graduation. The entire village’s 5 and 6 year olds were wearing caps and gowns and singing songs. Because of this, no one was at the clinic, so we snuck off to watch the children sing. When we reached the school, we heard them singing “Welcome parents, welcome here.” To the tune of happy birthday. Beyond the great value of education being demonstrated, it was absolutely adorable. Towards the middle of our clinic day, we finally had a patient. A mother brought her 1 year old baby named Letty to us. She had sores covering her entire body like I had never seen before. They were dark and crusted. Some of the ones on her legs were open and bleeding. She was crying fiercely as we examined her. It was impetigo (a bacterial infection of the skin that commonly affects infants). Many children acquire impetigo, even in the states, but I had NEVER seen it take over a child’s entire body. Normally the child has one or two spots before coming to the doctors, but this mother had waited for us for who knows how long. She stated the rash started 4 days ago but we know it had to have been well over a month. Maybe it was her own level of education and understanding of the disease that affected her decision making or maybe it was her limited resources. Either way, it broke my heart. I wrote the prescription and went to give it to the mother when suddenly she was gone. I started to panic. I did NOT travel 2 hours across a terribly bumpy road with car sickness to not treat the ONE patient that needed me. I asked if anyone saw her leave but no one had. I waited and waited until our director said we had to begin packing up. My heart sunk to the bottom of my chest as I heard the baby’s cries echo inside my head. I wasn’t leaving until I found them. I took off running throughout the village. I slipped on mud and my hair came loose from my pony tail, but I kept on. I knocked on door after door asking for Letty and her mom. Most people shook their head and directed me farther into the community. I was sweating and panting but I couldn’t leave without treating this baby. I refused. FINALLY, I saw her across a field. She was carrying Letty on her back in a lapub (a traditional piece of cloth warm over the mother’s head). I ran up to her and told her she forgot her medications. She apologized and said her other daughter was graduating kindergarten and she didn’t want to miss it. She knew she needed medication but she also wanted her daughter to value education. She was a hard working mom with a million things on her plate. I smiled as I gave her the medications and hugged her saying she was doing all she could and that both her daughters would be smart and healthy. That is all she ever desired. Having a higher education can expand a life by 5 years! Some of these people are simply not given that luxury. As clinicians, we need to address these social issues. What good is prescribing medication for an infection if the infection is due to a water supply? Won’t they simply go home, drink their water, and become infected again? What good is prescribing diabetic medications if the individual doesn’t understand a proper diet? Or doesn’t have a way to OBTAIN a proper diet? Many of these people eat only what they can afford. These social constructs have been studied to impact an individuals health 7 times more than medical intervention. 7 times more! As a clinician, this is huge. I need to ask the proper questions to see the full range of a problem. Are you loosing weight because of illness or because you cannot afford to eat? Are your wounds not healing because of the bacteria in your skin or because you do not know how to keep it clean? Do you desire to have children at the age of 15 or have you simply not been told of ways to prevent it? These questions are the ones worth asking. We know the resources we can give them; food pantries, housing shelters, transportation services, home health etc. Sometimes this is the assistance that saves lives. Getting the full picture, beyond just the medical treatment, is what differentiates a good clinician from a clinical advocate. I want nothing more than to be my patients advocates; to have them trust and confide in me because they know I will fight for them beyond the hospital walls. The drive to the village along with the car sickness was more than worth it to treat Letty. I would run through miles of villages and be covered in mud head to toe if it benefited a single patient. This is not because I am a “good person”, but rather because it is my job. I have devoted myself to this work and what good is only doing it part way? I want to fill as many of my patients needs as I can (not just the ones I can sprawl upon a prescription paper.) How can you advocate for the people you serve in your job? The people you love? The strangers on the street you may not even know? Compassion is the fuel that drives advocation... But fuel is no good unless it is ignited.