Sex, Drugs, and Public Health

This kid wasn’t on the schedule.

On the morning of the last surgery day, we found the mother standing outside our little office, clutching X-rays. By her dress, it was clear she was Quechua and very likely lived beyond the city. When she spoke, her Spanish was so heavily inflected with the language of the Incas that we had to repeat and re-phrase things.

Her five year-old had a fractured femur, treated with a cast a week prior in her remote town (a four hour ride away). She was concerned that it wouldn’t heal correctly.

The X-ray thru the cast revealed that she was correct. The two halves of the femur overlapped by several inches. If it healed, the leg would be shorter.

I called over the head orthopedist. “We’re full,” he shook his head. “We leave tomorrow.” I handed him the X-rays.

He shook his head again. “This needs to be fixed.”

She wheeled in her five year-old. A strikingly beautiful girl with long black hair. The two of them were taken down to E.R. to be admitted while our surgeon found room on the schedule.

I was assigned to follow up in the E.R. : make sure the kid didn’t eat; check lab work (would transfusions be needed?). Looking at the paperwork in E.R., I found a mistake. Pointed it out to the nurse.

“This says the patient is a boy.”

“Sí.”

“But – ”

“He has long hair,” the nurse rolled her eyes. “They’re Indians.” Controlled distain dripped from the last word.

His mother approached me with small, deferential steps. “I don’t know what to do,” tears began to well in her lower lids. “My husband says that the cast is good enough. He says if Jesus is not well after surgery, he’ll divorce me!” she trembled.

Pretty ballsy decision you made, Señora. But a good one.

I reassured her that, without surgery, it was likely her son would have difficulty walking. Without promises, I said it was probable that things would turn out better with the bone held in place while healing.

After surgery, up on the ward, Mom remained anxious. The poor kid was in pain. I gave her liquid analgesics and instructions how to give them.

Then the kid’s father walked in.

The man had the short stature of the Quechua but looked strong – most likely a farmer. He greeted me and Steve, then thanked us for what we’d done. It seemed overdone, compelled by social pressure (an Indigenous, treated in his own country as a second-class citizen, speaking with a couple of North Americans). We made a point of saying – enunciating carefully – that he had made the right decision to seek out surgery. That, because of his decision, it was likely that his son would have a better outcome than with the cast only, making sure not to promise an outcome.

Mom looked more relaxed after that.

Steve demonstrated the importance of keeping the cast dry with correct placement of a urinal. I gave Mom some money to buy more Tylenol and Ibuprofen (she had no cash). We set up an appointment with an Ecuadorian physician. Hoping for the best.

Insights:

1. Prejudice and social marginalization of Indigenous people in South America

is no less than in the U.S. What’s notable in Andean countries (Ecuador,

Peru, Bolivia) is that this racial discrimination continues even though

Indigenous constitute a much higher percentage of the population (25% /

45% / 55%) than we see here.

2. Rural health care is grossly inferior to that available in the cities.