How Much is Your Daughter’s Life Worth? (12/10/2001)

How much would you spend to find out if your daughter’s injury was fatal or could be corrected?  $200?

How much would you spend for surgery to correct a life-threatening problem? $2000?  How about if you could possibly afford $200, but not $2000?  To spend $200 to find out that your daughter needed surgery that you couldn’t afford, or that she had a fatal injury anyway would just frustrate you and put you in debt.  To put it into perspective for a North American, maybe the figures of a $100,000 and $1,000,000 would be more comparable. 

Two Saturdays ago, we had big plans to work around the house.  It was a sunny day, in the 70’s, clear blue sky.  Becky was making bagels to give out as Christmas gifts.  I was emptying the bodega (storage shed) for a much needed cleaning and sorting.  Then our plans changed drastically.  The doorbell rang.

 

It was a messenger looking for our empleada (housekeeper).  Luisa works in the mornings doing routine household chores, freeing Becky’s time for home schooling and other activities.  Luisa’s husband, Tino, one of our hospital workers, had gone to La Ceiba to cash his paycheck.  He had taken their 7-year-old daughter, Sylvia, with him to spend the day with her grandmother.  No one is quite sure what happened, but as they exited the bus, Sylvia was caught in the head with the back bumper of a passing garbage truck.  She had a huge gash in her head, bleeding everywhere, and was immediately unconscious.  Tino thought she was dead.  A helpful person on the bus arranged for a cab and had them transported to the government hospital. 

 

The same helpful person arranged for a phone message to be sent via the local Hondutel radiophone in Balfate.  The messenger rang our doorbell.  I was in the back yard and thought it was probably some of the neighborhood kids coming to play.  A few minutes later Adam urgently announced “Mom needs you right away in the front”.  As I started toward the gate, I expected to see another machete wound or sick baby, but instead saw, and heard Luisa overcome with emotion.  As we pieced together what information was available, we decided to take Luisa to town to look for Sylvia in the hospital.

 

When we arrived in the government ER, only Luisa was initially allowed in.  I “pulled rank” announcing that I was a doctor from Balfate that needed to see a patient in the ER.  They allowed me to enter.  

 

The ER was full of people bleeding and moaning.  There were some familiar faces from the Balfate area. They had brought in someone who had part of his face sliced off in a machete fight.  I was glad they didn’t go to my house first!  There were many others, most on the floor since there were not enough beds to go around.  Then I spotted Tino and Sylvia. Tino was covered in blood, but oblivious to it.  He was relieved to see Luisa but also overcome with grief over Sylvia.  She was unconscious, covered in blood, with a bandage soaked in fresh blood covering her head.  I peaked under the dressing enough to see an ugly wound. Her pupils reacted and were equal; a good sign.

 

At this point a tired, overwhelmed appearing young lady walked up a looked at me, awaiting an explanation for my presence and actions.  I introduced myself, and found out that she was the government “intern” assigned to do her social service, her first year after medical school, in the ER.  She filled me in on the initial care given, and appeared happy to have another doctor offer some help.  We reviewed the X-rays, which were of very poor quality, but hinted at a fracture in the skull.  We both agreed that Sylvia needed a CAT scan to determine the seriousness of the problem.  The young doctor told me that there was a neurosurgeon in town, if we needed him, but he only worked at one of the private hospitals.  The CAT scan unit was also affiliated with the private hospital, and would not set up an appointment over the phone.  So off I went to see about the scan.

 

When I arrived, the building was closed but the guard said he could call the radiologist and technician.

He quoted me the price, about $150.  I told him I would be right back with the patient!  

 

Back at the ER, as I picked Sylvia up to put her into my car, she woke up!  She began talking rationally, and said she was hungry!  Her mother was much relieved, but concerned that Sylvia couldn’t remember anything about the accident.

 

When we arrived at the CAT scan facility, the guard called the tech to come in.  She quoted a different price, $200, since it was a Saturday, after hours.  She also wanted the guard to verify that I had the money before she would come in.  I confirmed that I had the cash.

 

As we waited, I thought about the medical system in Honduras, and the frustration the poor must feel. In The States, we are accustomed to receive whatever is needed, when it is needed.  Discuss the cost later!  If you can’t pay, don’t worry!  If I had been a poor man with my daughter in this situation, in my frustration, I would have been ready to sign up for the communist army, or anyone’s army, who would promise me the opportunity to receive equal care for my daughter!  Yet, I also could see the point of view of the private medical facility.  Their fees were a bargain!  I wondered how they could ever pay off a million-dollar machine, let alone maintain it and pay the staff with their low fees!  They couldn’t afford to do charity work.  Certainly in the States, we are blessed!

 

After the scan, the radiologist was not available to be reached!  The tech called the neurosurgeon to come review the scan with me.  He was a very congenial guy, who had been interrupted from sleeping in front of a football (soccer) game on his television. We together looked at the films which demonstrated a depressed skull fracture (the bone had been broken and pushed in to the brain) and a subdural hematoma (a collection of blood underneath one of the linings of the brain).  Both were borderline in size concerning the need for surgery, and since Sylvia showed no obvious neurological problems, other than the earlier loss of consciousness, he felt she would do fine with close observation.  I offered to keep her at my home (totally loath of the thought of her returning to the government hospital).  The neurosurgeon gave me his card, and told me to call if there was any change for the worse.  He wouldn’t accept any payment.

 

Sylvia still needed to have her head sutured.  I decided to do that on my own turf in the OR at our hospital.  After leaving my family at our house, and Tino near his, Sylvia, Luisa and I went to the hospital.  As I removed the dressing, I could not believe that there was not more neurologic injury!  The scalp had a gouge in it, with loss of tissue, making closing the wound very difficult.  Right under the wound was a 50 cent sized piece of bone depressed about an eighth of an inch.  No X-ray was necessary to see that!   Sylvia certainly had no loss of strength, as my suture repair turned in to a wrestling match. Was I ever glad to put in the last stitch!

 

That night, Sylvia and her mom slept in our spare room.  I checked on them frequently during the night, doing “neuro checks”.  Luisa insisted on keeping the bright bedroom light on all night.  A luxury for them, since they don’t have electricity.

 

Sylvia did wonderful over the next few days.  It was difficult to keep her from being too active (she is a lot like our Jake!).  She was overjoyed when her brother and sisters visited, but pouted when she couldn’t go home with them.  Her family lives in a mud hut with a thatch roof and dirt floor.  To get there requires a surefooted walk up a steep hill, which in rainy season is especially slick.  I wanted to be absolutely sure the wound was healing well, and she was well overall before I let her return home.

 

When she finally did go home, her mother brought her to work with her the first couple of days, since she could not trust her to limit her activity at home.  I daily checked her swollen face and scalp, and other bruises.  All continues to go well.  Thursday we plan to remove the stitches.

 

We are so thankful for the opportunity to minister to this family in need.  I think having children of my own, I could mentally put myself in their place to a degree, and sense the anguish that many other families must feel when health problems arise that are beyond their financial means to address.  It is for people like this that we are here.  We can be Jesus to them, hopefully demonstrating his love through our actions, and building relationships that will have eternal consequences.

 

Dave Drozek with

 

Thoughts from Honduras