Eyes on the Prize

Lately, I have spent a lot of time burdened by questions that arrive on a daily basis here in the village. They are almost exclusively in regard to the medical work that I do on the porch. Don’t get me wrong – I love what I do – most days.

I feel blessed and humbled that God allows us to be here and also blessed and humbled (and a little frightened some days) by the trust that people put in my ability to help them. If only they knew how many hours I spent pouring over books and looking up medicine and making sure my diagnosis is correct and that the medicine I am giving is not interacting with something else. So, in regard to kids – it is fairly uncomplicated. I have permission to help most of the kids who arrive on my porch seeking help. It does get complicated occasionally, as I will explain later. But for the most part, it is great.

Adults are a whole other issue. While I have been given permission by the medical supervisor in the area to treat kids, I have been restricted to only helping the adults who have already been treated by another clinic, but have not gotten better. Why? Well, kids tend to get sick faster than adults and don’t have the ability to get themselves to medical treatment. But the goal of the medical supervisor – and mine too – is for the clinic that they are building here in town to get finished. That way, even when we are not around, there will be medicine available to our friends here.

If EVERYONE comes here for free medicine, then there is no incentive to build a clinic. I keep telling everyone – let’s get the clinic finished, and then kids and women and men can all get medicine. And I believe what I am preaching – in theory. It is all well and good – until a sick adult shows up on my porch. Then things get hazy.

See, there are 2 clinics in the area – both about 10 miles in either direction from us. Both are staffed by health care workers. So, in theory, I can feel good about sending adults there for treatment. The problem is that, often, they don’t actually have medicine at the clinic. And what they do stock is one kind of antibiotic, one kind of malaria medicine, and usually some aspirin and Tylenol. Rarely do they have all 3 at the same time.

The clinics might be staffed by competent people – but even the smartest, most compassionate medical people can’t help sick people if there is no medicine. The other alternative is to get transport to Faranah, the main town in the area where there is a hospital. The problem there is that you have to pay 20,000 fg just to get there (and of course, you will eventually have to get home…). That is about 2 days pay for the average worker.

Then you have to buy the medicine. And you may or may not get good medicine. Recently a person came back with a medical chart that said they had been given Chloroquine at a government hospital – a medicine that I have been told is illegal to sell in the country because it is no longer effective against malaria. And they will end up paying, at the least, 50,000 – 100,000 for medicine that is often ineffective. Now you are up to 9 - 14 days worth of wages for the average farm worker – and often they still aren’t better.

As an alternative, people often go to the market stands to buy medicine from people who mostly can’t read and who mostly are interested in getting money. So, for malaria, you might come away with Chloroquine (again- useless), maybe Tylenol – though it is usually mixed with something else, bottles of vitamins, and maybe some birth control pills or steroids. Kids and adults can come away with the same doses.

So, I turn people away on the principle that we want incentive for the clinic to be built. And we do – because in the long run, it will benefit the town and the people in the surrounding area. Meanwhile, I sit here with LOTS of good, effective medicine that they could get for maybe 20,000 – 40,000fg. So what do I do? Help people with the short term goal of treating them and ignore the long term goal?

That is what my heart tells me to do – because I HATE to see people suffer. On the other hand, if I did that, I would quickly have HUNDREDS of people on my porch – and the clinic would NEVER get finished. Or do I turn them away, knowing that it will eat up a lot of their money and usually they won’t get better anyway? With that, hopefully the suffering will entice people to finish the last, very small portion of the clinic that needs to be done and everyone in the area can benefit.

Many days those choices are very hard as I look into the eyes of people who are suffering. I know what it is like to have a sick family member and be desperate for treatment for them. Often, I send people away, and they come back with medical charts that just make me angry when I see the needless money that is spent on useless medicine.

Daily, I try the best I can to show compassion, to explain why we are desperate for the clinic to be finished, and occasionally give out a few Tylenol. My prayer is that they will see that I care and that I really do want to help.

In another case involving a young boy is another example of sacrificing long term goals for short ones. This kid suffers from what I think is osteomyelitis (a bone infection). I started him right away on antibiotics and began to talk with the dad about going to the mission hospital. We could see the knee (where the infection was sitting) swelling more and more as the antibiotics did their job. I tried twice to drain it but without success. I put my foot down and told the dad – you HAVE to take him. Alright he said – I will go to my village and get money. (We offered to pay for the transportation for the boy and his entire hospital stay – the dad just needed to come up with the money to get a helper down there.)

By the time he returned a few days later, the kid’s knee was huge and ready to be drained. I was afraid to do it – fearing that if I did, the dad would think I had made him better and refuse to take him. But I couldn’t take the look on the boys face and was trying to imagine bouncing over terrible roads for 8 -10 hours to get to the hospital with the knee like that. So, I drained it.

I got cups and cups of pus out of it. I gave him pain meds and sent him home. The next day, dad came back to me and said – he slept SO well last night – now he is ALL better and we don’t have to go to the hospital. I could have kicked myself. Why did I drain it? I should have just left him like that so the dad would see how serious it was. I gave the dad a stern lecture and we are in the process of seeing if he will indeed take the boy to the hospital. I have explained – until I am exhausted – that I took care of the top infection, but there is still sickness smoldering underneath!

Choices are hard and I can only hope that people see compassion and love in me – whether I help with the treatment now – or keep my eyes on the goal of a clinic here in town. Some days, nither choice seems right!