Realities

MCV Hospital, the institution connected to my medical school in Richmond, is known affectionately as a "knife and gun club." In medical lingo, this means that our hospital is where all the worst cases and worst patients come to be treated, where medicine is at its most raw. I have heard life at MCV described as being like a MASH episode, and there are certainly lots of challenges to be faced in a place like this. But the stuff I saw in just two hours at Dhaka Children's Hospital today was like nothing I have ever seen before. I will warn our readers that the stories I am about to relate may be considered graphic.

I met my attending physician at the entrance to the "new" wing of the hospital, which served as a general pediatric ward. In this room were 20 beds, each filled with a child, a mother, and various relatives. A few nurses in white outfits milled around. The children ranged in age from newborns to perhaps 10, there being no good facilities to care specifically for any age group. Our first patient was a quiet girl at the end of the hall. She recently had been given a provisional diagnosis of acute lymphoblastic leukemia. I asked the attending what her chances would be, and he told me that they should be good, but that in these conditions the risk of nosocomial (hospital-derived) infection was high and that facilities were limited to treat her. Thus, her survival chances would drop significantly.

Another child, an adorable nine year old girl named Munni, who looked to be in good health, came in with the same condition. After we examined her and moved on, her caretaker came up to me, and in very limited English told me that he wasn't her father but her uncle. Her parents were very poor, he explained, and could not pay for her treatments. All I could say was "dookidoh (sorry)."

A similar situation occurred when a man came up to our attending physician with a clear plastic envelope containing the health records of his son. I assumed that he was trying to confirm his treatment regiment, but after he left, the attending told me that the man's son had died a number of months back, and that he was trying to figure out payment of his bills.

But beyond the overcrowded conditions, the lack of clean floors or proper sanitation, the thing which most affected me was the story of a dying child. I was standing in the ward when a mother came rushing in, carrying her child. The child was obviously in distress and had already been intubated (a tube placed in the trachea to promote clear breathing). The problem was that no ventilator was attached to the tube, and the mother was feeding the child oxygen only through a mask. Blood smeared the child's face. The nurse came and adjusted a few things. The doctor came and made a few hurried directives. The mother sobbed hysterically. When he seemed to have a moment, I asked the doctor, "shouldn't the intubated child be in the ICU (intensive care unit)?" Yes, he explained, it should, but there was no facilities for a child this size and no beds in the ICU. There were no monitors, no ventilator, no way to accurately monitor vital signs. "This child will die," the doctor told me. I asked the diagnosis, and he replied "Tuberculosis." TB is a highly contagious disease, and so I asked him, "shouldn't this child be isolated?" "Yes," he responded, "but we have no facilities." So a dying child would be left in an open ward with twenty other children which might also become infected.

I write these things without trying to implicate anyone. In the two short hours I spent in this ward, I came to deeply respect the doctors who treated these children. They work incredibly hard against nearly impossible odds. But they have few facilities and next to no support. In the end, children die needlessly. Perhaps the situation can be summed up in the tired eyes of a young doctor just coming off a long night shift in which he had sole care of 80 children (no, that is not a typo). It was a good night, he explained, "only one child died."