Sex, Drugs, and Public Health

During the screening Sunday, we were sensitized to look for “syndromes” – kids who looked different enuf that we had to be aware of possible congenital defects, some of which could present dangers in anesthesia or surgery. We had, after all, seen a few kids with Cerebral Palsy, two with Osteogenesis Imperfecta, and a suspected case of Congenital Psuedoarthrosis.

Ximena caught our attention immediately. Pale skin, large head, big for age (she weighed more at 7 months than another girl with the same problem at one year, 4 months).

Then Dad walked in.

It felt a little weird to converse with him in Spanish, but that was his native language. A gentle giant from another land.

Like many other small children we saw, this girl had congenital hip dislocations. The pediatric orthopedist planned to reduce both dislocations. He would do it “closed” i.e. without surgery. Just put the hip where needed, then place a cast.

Once the child had recovered from anesthesia and the family was on the floor (ward), the surgeon asked me to translate for him. He explained that the hips’ acetabulum was much flatter than he’d thought (should be shaped like a cup to hold the ball-like head of the femur). He was concerned that the femur might easily dislocate again before the bones grew adequately to hold the femur within the pelvis’ acetabulum. Because of this, he did only one hip. The other could be done in the future once this hip was secure.

The parents had concern and anxiety all over their faces. “Will you be back to do the second surgery?’ they had me ask the North American surgeon.

“No,” he reassured them. “The Ecuadorian surgeons can do this just fine.”

Their faces, tho polite, told us they weren’t buying. “When will you be back?”

“We don’t know for sure. Maybe in a year.”

“Can the second hip wait for a year?’

“No. Not that long. Really, the Ecuadorian surgeons can do this. It’s not that difficult.”

It took a lot more talking before the family was as reassured as we could make them. They were appreciative and gave gifts to all the members of our team when we left.

Insight:

A major trap in these medical missions is the unspoken message that North American doctors are better than the locals. It undermines confidence in the medical care available to the people 51 weeks a year. I like the way the Pediatric Orthopedist handled this.