Choices
A lot depends on the choices we make. But we often take for granted the gift of having multiple good options from which to choose. If you have multiple possible options, this probably means you live in the West. Should I send my kid to this private school, or that public one, or even that one, or homeschool? All are possible when you live in a place like America. When parents in Congo ponder school options for their children, they first must think, do I have the means to buy my children school uniforms, pens, notebooks and close toed shoes? Do I have the means to pay monthly tuition (there are no free schools). Can I get by at home without my children helping me carry water, take care of the baby, handwash our clothes, and prepare food over charcoal or wood? These aren’t life and death choices, just life altering ones that lead some toward a vast future and some toward a limited one.
She could barely say hello to us as chills wracked her body. She’s a survivor of war. Most people in this camp share the story of fleeing to Bunia 4-5 years ago, escaping the rebels, with only their clothes on their backs. They left family support, fields, crops, homes, gardening tools, seeds, pots and pans, everything. We came to visit Esperance today because she recently lost her child to an acute illness, complicated by anemia at our national partner hospital, CME. I wanted to find out, why are so many children still dying in this camp, when we provide free medical consultations on site twice weekly, and free transfer to and care at our hospital? As I interviewed women who have recently lost children, I found a wide variety of barriers and challenges, but they all held in common that they had to choose between two evils. Their options are too limited. As she shook with chills, Mama Esperance explained that when her son, little Shukuru (‘to give thanks’) Isaac, fell ill she brought him to our doctors consultations on site at the camp on a Monday. By deciding to bring him for medical care, she already had to make a hard choice: take her child for medical care and not eat that night, or go work in someone else’s field for the day to be able to feed her family that night, but not get medical care for her child. She chose her child over food for her family.
At our clinic, he was treated, but did not improve. By Wednesday she felt like he needed more medical care, so took him to a neighborhood clinic where he could get IV medications. But this begged the question, why take him somewhere that costs money when we can provide him with free care?These are the answers we found. The clinic is close and our hospital is far away. She can go back and forth between him and her family, making sure all are cared for. She also didn’t know she could go to the camp office and they could refer her to our hospital since her child was sick on a day we weren’t consulting at camp. And more, there is a strongly held belief in Congo that oral medications don’t help, only IV medications will really improve your health. Small clinics dot so many streets and are often run by people with a high school education or less, trying to make money off of desperate families who put their hope in injectable medications. Four days later, Shukuru grew sicker and sicker, but likely the employees at the health clinic were not well enough trained to recognize the warning signs. When it became glaringly obvious that he was very ill, they brought him to the president of the IDP camp, and he gave them a transfer slip to our hospital. He arrived at 7 AM and died shortly thereafter. And why? Because this family’s options were too limited, their beliefs misguided, and they didn’t have all the information they needed. My heart broke as I realized that this death probably could have been prevented. That is why I went to the camp this morning, to figure out what we can do to widen these desperate families’ options and to mitigate preventable deaths?
At this exact moment, this mother was making another potentially life and death choice. As her teeth chattered and her shoulders shook, she told us that she couldn’t go looking for healthcare for herself today. She has no one to look after her children if she leaves. If she leaves, who will feed her children? Who will look after them and tuck them safely in bed at night? Along with the darkness of night, debauchery falls on the camp with rampant drunkenness. Many fall prey to physical and sexual abuse. If she’s hospitalized, she could be away for days. How will she eat at the hospital when she only has one set of pots and charcoal stove? Either she starves at the hospital, or she leaves her family to starve. She’s stuck between two evils and doesn’t have enough options. She has an impossible decision to make, but she has to make it. She chooses self-sacrifice and waits at home, hoping the chills will end.
Every day at the camp I’m faced with impossible dilemmas and witness more pain that anyone should endure in a lifetime. But I also count myself lucky because I have the faces of those I’ve watched suffer, and the knowledge of their lack of choices right before me, and then haunting my thoughts, not releasing me. Because I have generous friends, there are a lot of options. After conversations with many women in this camp, we’ve come to see that one of the biggest barriers of families getting their kids to our hospital on time is the lack of food. What will they eat while there? Yes, they get medicine, but it only does so much if there is no food. Last week, a group of about 40 women helped us understand this reality. Too often, they’ve made the hard choice to not bring their child to our hospital, because they risk too much in leaving their other kids at the camp. So, just this week, we got a local restaurant to start cooking two meals a day for all of the hospitalized IDPs and their caregivers. I should probably back up and say that there is no meal service in hospitals in Congo. You are obligated to be accompanied by a family member who will bathe you, help you to the bathroom, cook for you and do your wash. When we announced the news that we would provide food during hospitalization last Friday when I was caring for patients at the IDP camp, every acutely ill person we referred for inpatient treatment accepted readily to go. A third option was provided. And they rejoiced in this provision.
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