Friday, March 4, 2011
Last week I drove Sandra, her grandmother and her uncle to a 6 AM appointment at Hospital Bloom, El Salvador's public pediatric hospital. In order to do that, I had to get up at 3:30 AM, meet Sandra and family at 5:00 in Ciudad Arce (they live in the municipality of San Juan Opico, but Ciudad Arce is closer to their very remote home in the hills). They were probably up even earlier to walk down long rough roads in the dark, but they were there on time, and we set off for the capital.
I'd already discovered that invariably appointments at Bloom are set for 6 AM, but I couldn't figure it out - surely the doctors didn't start their clinics that early? By 6 AM I'd found a parking place and we lined up outside the hospital, a commanding multi-story building, with a lot of other parents and children, a woman selling atole (a hot corn drink) and a clown selling balloons. The guard checked Sandra's appointment and let us in. We went down the hall, found the ophthalmology clinic, and sat down. And after quite a while we noticed that a long line was forming in front of the desk outside the clinic - ah yes, no one told us about that part of the ritual. I have to confess that we jumped the line - we really had been among the very first to enter the hospital, and it didn't seem fair to have to go to the very end. It may have helped that I was a gringa, because the secretary let us turn over Sandra's hospital card and appointment. And then we waited some more and after another time that seemed longer than it really was, the clinic secretary got us all lined up in chairs according to arrival time. An orderly procession had been created. This not-very-good photo gives some sense of the feeling of the corridor, full of mothers and some fathers, each tenderly carrying or watching over their child.
It was about 7:30 when we finally got in to see Dr. Dominguez, who checked Sandra's eyes (she has congenital cataracts), scheduled her for pre-tests and surgery, and told me the size of the interocular lens she will need. But those lenses won't be provided by Hospital Bloom, nor will the heart valve needed by Richard, a little boy we met in San Rafael Cedros. Unless the families can raise the money to buy the lenses, or heart valves, or tests that the hospital doesn't perform, or medications that the hospital pharmacy doesn't have in stock, health care gets stopped in its tracks.
This isn't the fault of the staff at Hospital Bloom or at any of the other hospitals. It happens because El Salvador is a poor country and in a poor country's health care system the extras - interocular lenses, heart valve replacements, expensive medications - just don't happen unless someone steps in to help. The children who can profit from ordinary care do well in this system - El Salvador has a good record of pre-natal care, vaccinations, and treatment of normal childhood diseases. And if the lenses or heart valves or medications can be purchased, all the surgery and hospital care and follow-up appointments are completely free. In El Salvador, the cost of health care is relatively inexpensive - doctors and nurses are not paid much at all by U.S. standards - but the cost of 1st world technology is prohibitive.
Children with costly or complicated illnesses are often, in effect, triaged out. Sandra and Richard who needs a heart valve replacement and Gema who needs medication Bloom doesn't carry are lucky to have encountered one of our PeaceHealth mission teams and found sponsors. But for too many children here and in every poor country in the world, the miracles of health care that we take for granted and see as any child's right in the United States are simply too costly and not available.