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 wellstaffed 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."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."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.
CMAJ News Dispatch from the medical front Short-lived joy D octor, can you come and see a child? I think something is very wrong.” It was our head nurse. It was late after- noon. 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 feel- Dr. Rachel Ter Horst ing 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 facil- ity. Cases like this, where I was specifi- Medical practices in Canada seem like they exist “on a different planet entirely” when cally summoned — the expatriate compared to those in Ethiopia, says Dr. AnneMarie Pegg. physician — were never simple. Enter- ing our simple but clean and well- staffed health centre and making my joyed when our outreach team made a “Yes, usually. The drain needs to be way around the curtain to the cot that trip to their village, and they were able checked regularly to make sure it’s still was our “triage” area, I hadn’t even to obtain free travel to the clinic. working, but most of the time, the chil- begun to speculate what was to be That joy was short-lived. Only one dren are all right afterwards.” found on the other side. facility in Ethiopia is able to provide “I see,” he said quietly. The young mother on the cot smiled surgery for hydrocephalus. Located in the Ten days later, this family was again as I greeted her in terrible Amharic. Her capital, the cost of such a journey was travelling in our Land Cruiser, this time older son, about three years old, stared beyond the wildest imaginings of this returning home. Dropping them off in incredulously at my white skin and light young family. Ongoing follow-up, with the centre of a dusty village where they hair. Behind me, one of our nutrition its associated travel and expense, was would catch a ride onward, the young assistants was questioning how to deter- equally impossible, even if funds should mother smiled and waved at me as she mine the child’s ideal weight. materialize for the initial procedure. disembarked from the vehicle. Her hus- The source of his confusion became “What is the problem with that child?” band took my ha
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