June 4, 2010

Uncaring Honduran doctors almost allow a baby to die

Hospital Atlántida, La Ceiba, Honduras
Photos: La Prensa, Honduras

Health care for the poor in Honduras is abysmal. There is no other way to describe it. In much of the country, there simply is no health care for the poor, and when there are emergencies, often the poor don't have transportation to an area where public health care is provided. I read a heartbreaking story from a medical missionary about a woman who had nowhere to take her very sick baby and didn't have the 75 cents or so she needed to take a bus to the nearest public hospital hours away. The baby died.

Here is another example: because of lack of availability of even the most common drugs, it's not unheard of for a doctor in rural areas to prescribe aspirin for infections, and antibiotics for pain. I know that sounds un-freaking-believable, but it happens. Whether it is because of incompetence or lack of drugs or just a lack of caring among some so-called doctors, I do not know.

Even in the large cities, the hospitals frequently do not have the most commonly needed drugs and are known to give out expired drugs to patients. Doctors and hospital administrators are often accused of stealing and selling the drugs. Government administrators are accused of buying the government drug supplies in dirty kickback deals or mismanaging the maintenance and distribution of drugs so that ultimately the drugs are thrown out as useless. If the families of patients do not have the means of finding and buying necessary drugs or other medical supplies from private pharmacies, the patient is just out of luck. If the supplies are necessary to keep the patient alive, well, the patient dies. It is as simple as that.

Here in La Ceiba, a larger town, there is a regional public hospital and a public health clinic, so you might think that Ceibeños are a little better off. However, one US American doctor described Hospital Atlántida as, "The hospital is amazingly primitive and without modern resources. Worse than places I have worked in Africa." He mentioned that the building is about 60 years old and parts of it look as if they hadn't been clean since then. 

He also mentioned that the supervising doctors are rarely there, even though they are paid very high salaries by the government to work six hours a day. Absence of such supplies as gloves, soap, and towels were frequent. In reviewing patients charts of the supervising doctors, he found the doctors "woefully inadequate in the diagnosis and treatment of common infectious diseases".

You may remember that my former maid, Arexy, was pregnant. Arexy's baby was born on Friday, May 28, in Hospital Atlántida. The hospital gave her six hours to get up and get the heck out of there. Their job was done. Most of the women there to give birth were sharing beds, two women to a bed. That's to be expected in Honduras and maybe it doesn't matter. Maybe most times it doesn't matter that they generally kick the women out six hours after they give birth.

What does matter is that Arexy's baby was not ready to leave the hospital. The baby was not eating and was crying in pain. They released her and the baby with no instructions, no suggestions to bring the baby back if he didn't start eating after xx hours or xx days, no nothing. They just gave this obviously in distress baby to his uneducated mother and told her to go home.

For the next two days, the baby screamed constantly, would not eat, did not defecate, and even more alarmingly, started vomiting green liquid.

First, a little about Arexy. She is a humble, very timid person, not unlike many of the poor in Honduras. She's never watched a television show, attended a class or read a book about giving birth or infant care. Even if she had, she would never question the judgment of a doctor or nurse − about anything! During her prenatal care, she was given shots and was too timid even to ask what kind of shots she was receiving and they never offered the information. For the poor, strong babies generally live, and sick babies generally do not.

By Sunday night, the third day of the baby's life, Arexy was very worried about her baby but just didn't know what to do. I wish she would have called us, but she didn't. Thankfully, her sister-in-law, who is a little more forceful, said that they needed to go to the hospital emergency room right now! The baby couldn't wait any longer.

A doctor examined the baby in the emergency room and very rudely told Arexy to take the baby to the Centro de Salud (health clinic) the next day, implying that she was wasting his time. So, what could Arexy do? Nothing, except to do what the doctor told her to do. The following morning, they rushed to the clinic and waited for an examination. The nurse there said, "This baby needs to go to the emergency room! Why didn't you take him sooner?!" So now on top of all this worry and stress, Arexy bears the guilt of not doing the right thing for her baby. Normally stoic Arexy cried as she told me this.

They went again to the emergency room, and thank the lord, this time the baby was seen by a decent doctor who cared whether this baby lived or died. He diagnosed that immediate surgery was necessary to save the baby's life. His intestine was completely blocked. They performed surgery a few hours later.

Now Arexy stays with her baby all during the day, for as many hours as the hospital allows her to be there. She is not allowed to stay at night, and no one else is allowed to help her out by staying with the baby in the critical care unit, not even the baby's father. However, there is no chair, so she stands by the incubator the entire day, every day. They will not let her breast feed her baby. He is being kept alive with an IV, for six days they say. I don't know if this would be normal in a first world country after this kind of surgery, but I would like to know from you doctors and nurses out there.

I just found out all of this yesterday. I was enraged that the doctors could be so uncaring, so irresponsible! But I tried not to show that to Arexy. It won't help for me to say that those heartless, incompetent doctors could have been responsible for the death of her baby. She probably already knows that and feels helpless to do anything about it. The injustice of all of this is unbearable.

I'm praying that the surgery was done properly and that the baby won't develop an infection or any other complications. Those are very real risks in Honduran public hospitals. Arexy says that the baby seems better now. I urged her again to please call us if there is anything that she needs or any problems that she needs help with. She probably won't call on us, but I'll be checking with her daily.

See followup articles here and here.

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