Thursday, January 17, 2008

The Local Pediatric Clinic

At eight in the morning there is already a crowd at the red metal gate waiting for the outpatient staff to arrive and begin sorting through who needs blood tests and who can be given a prescription, who will have to go to the hospital in town and who will have to return the next day. They are mostly women in their twenties carrying infants and toddlers too weak to walk. Colorful printed fabric about the size of a bath towel and tied across the mother's chest holds each child tightly against her back. Some of the mothers have dressed in their finest clothes, elaborately wrapping bright cloths or scarves around their heads, African style. The toddler girls are wearing party dresses full of tulle and lace in fluorescent colors. A handful of older children stand next to their mothers,everyone straight and tall and watching the gate.

It opens and they move roughly into the compound and around the corner to the covered outdoor waiting area with benches of moulded concrete painted with numbers to designate the occupant's place in line. No one pays much attention to the numbers, especially since there are two sets from one to tweny-five and there is no direction as to who should sit where. Instead each mother and child sits in a place out of the sunlight slanting in under the roof and already dry from the morning washing down.

The nurses come in with the crowd and reappear in their whites from changing rooms behind the waiting area a few minutes later. In a manner a teacher would use in a classroom, one of the nurses addresses the crowd of about thiry women and their children, a few fathers and their children, and myself. She tells them to pay attention. She then speaks in Krio going over the rules of conduct in the waiting area: children must use the toilets and not the floor, all garbage including food wrappers and fruit peels must be thrown in the waste bucket she is pointing out, if a child vomits or otherwise makes a mess there is a bucket of water and a mop the mother must use to clean up, cell phones are to be turned off. You may be asked to leave if you disobey any of the rules. "Are you listening to me?" she asks in Krio. When one of the younger mothers, looking no older than fifteen, fails to respond, the nurse points her out and asks again. "Yes, ma," is the accepted reply.

Then the nurse leaves and everyone waits. Babies are bounced on knees and passed around. One of the babies vomits on an admiring stranger, and the mother goes off to get the bucket. Cloth diapers under plastic guards are changed, at least one is in process at any time. Toddlers wander or just sit silently and stare and everyone knows that these are the very sick ones. There is a great noise of crying mixed with the tiny tinny voices of toddlers talking urgently to their mothers and the lower punctuated hum of mothers talking to one another.

After about half of the children have been registered by one of the nurses, another nurse appears and whispers in her ear. The first nurse then directs all the remaining children and their mothers to move away from the registration area and return to the waiting area. She then addresses the crowd and tells us that we are going to hear about planned parenthood. She calls on one of the mothers, who stands up and leads everyone in prayer. She then defines planned parenthood as spacing the birth of children so as to allow for adequate breastfeeding for each child. She says a baby every six years is the best plan. The nurse thanks her and announces that she will address the other issues related to planned parenthood, namely poverty and the proper education of children. This done, she asks whether everyone has understood. A chorus of "Yes, ma," satisfies her and she signals that registration will start up again.

This scenario has been repeated each of the three times I have brought a student here for treatment this week. I have come either because the parent does not believe the child will be treated without my presence or because the mother was away and the child left in the care of a teenaged uncle and an unattentative step-father. Each of these children was registered, then had his or her temperature taken and finally seen by a nurse practitioner who joked and teased the child into telling her what she needed to know. This same nurse practitioner also confronted me on my second visit asking why I had to accompany the parent and child. After I told her the answer, she proceeded to reprimand the father severely for not taking responsibility for his own child.

Between each of these steps was a wait of about forty-five minutes. After seeing the nurse practioner we were sent to the lab for blood tests, the results of which were given in between one and two hours. Two of the three students were diagnosed with malaria, one of these two was also identified as having sickle cell anemia, and the third was diagnosed with a probable case of parasites and stomach problems resulting from eating too much dry gari, shredded dried cassava that is the cheapest snack the students can buy at school.

All three children are doing better, most likely as much because they were given so much attention as because of the medicine they received. I also made sure each one ate lunch on the day of the visit. This place is a true blessing for the students at our school.

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