Doctor, can you come and see a child? I think something is very wrong.”
It was our head nurse. It was late afternoon. I rose from my desk and followed him across the compound to the clinic.
“[The health officer] has seen him already, but I think you need to see him too.”
I cannot deny the now-familiar feeling of unease in the pit of my stomach. It had been five months since my arrival in the project in rural Ethiopia, distant from any higher level care facility. Cases like this, where I was specifically summoned — the expatriate physician — were never simple. Entering our simple but clean and well-staffed health centre and making my way around the curtain to the cot that was our “triage” area, I hadn’t even begun to speculate what was to be found on the other side.
The young mother on the cot smiled as I greeted her in terrible Amharic. Her older son, about three years old, stared incredulously at my white skin and light hair. Behind me, one of our nutrition assistants was questioning how to determine the child’s ideal weight.
The source of his confusion became apparent when the mother pulled her shawl off her eight-month old infant. I could barely make out the small half moons of his dark irises within the whites of his eyes, forced downward by the pressure of fluid on his young brain.
“His head circumference is 69 centimetres. We don’t know how to figure out the weight of his head to figure out his real weight. What do you think we should do?”
His parents had noticed his head was “growing” several months before. They had taken him to see the health worker in their community, which was even more remote than the one in which I was working. They had been advised to bring him to our clinic. But they had no funds for the trip, so they were overjoyed when our outreach team made a trip to their village, and they were able to obtain free travel to the clinic.
That joy was short-lived. Only one facility in Ethiopia is able to provide surgery for hydrocephalus. Located in the capital, the cost of such a journey was beyond the wildest imaginings of this young family. Ongoing follow-up, with its associated travel and expense, was equally impossible, even if funds should materialize for the initial procedure.
“What is the problem with that child?” asked the nutrition assistant as I jotted orders for therapeutic feeding, as well as medications for the common infectious causes of hydrocephalus, on the rare chance his condition could be treated. I explained, as simply as I could, the faulty drainage system of cerebrospinal fluid and resultant accumulation within the ventricles. He asked me if this ever occurs in Canada.
“Yes, sometimes,” I answered, already knowing what the next question was going to be, and feeling the flush of embarrassment creep into my cheeks as I pondered the answer.
“What happens there?”
“The children have surgery to place a drain for the fluid.”
“And they are okay?”
“Yes, usually. The drain needs to be checked regularly to make sure it’s still working, but most of the time, the children are all right afterwards.”
“I see,” he said quietly.
Ten days later, this family was again travelling in our Land Cruiser, this time returning home. Dropping them off in the centre of a dusty village where they would catch a ride onward, the young mother smiled and waved at me as she disembarked from the vehicle. Her husband took my hand, shook it, speaking as he did.
“He is thanking you for taking such good care of his family,” said the health educator.
“Tell him he is very welcome,” I said. The inadequacy of such a statement stuck in my throat. “Tell him he has a beautiful family and he is taking care of them very well,” I added.
The young man beamed as this was translated to him. We pulled away as they waved at our vehicle, and I quietly cursed the inequality that made my practice in Canada seem like it existed on a different planet entirely.
In a way, it does.