I have amazing women in my life – a wonderful mother, grandmother and aunts. I have written about them before, so this Mother’s Day I am sharing a story I have told them, and I know they won’t mind it as a tribute to all mothers.
My rural Family Medicine rotation earlier this year was not just rural – it was classified as DEEP rural. The majority of the people living in the area had no water or electricity. Many of them had pulmonary disease, despite never having smoked – the so-called hut-lung disease. The nearest referral hospital was more than two hours away and was reached by traveling roads with near-dongas as potholes.
Most of our patients were unemployed, or otherwise self-employed as subsistence farmers who struggled to subsist. Almost none of them had cars, and so when we did refer them to the “nearby” hospital they were sent with patient transport vehicles that were chronically overfilled. Patients who had to go to even larger hospitals with more specialised abilities had to find their own way – although the doctors often helped them out with bus fair using their personal income.
One day in the Outpatients Clinic, a mother and her young son presented for a follow-up visit. He looked to be about twelve years old, but upon opening his patient-booklet we saw that he was in fact seventeen years old.
This young boy had grown up failing to thrive. Mom and many healthcare providers had been worried, not the least by his regular bouts of lower respiratory tract infections.
But only two years ago had a young doctor fresh out of medical school noticed that his cardiovascular examination was problematic. He had a displaced cardiac apex and most ominously, a third heart sound.
He had dilated cardiomyopathy and was now in heart failure. He was rapidly sent for assessment by a cardiologist 400km away. Because we were in OPD, I have no idea if they ever figured out what the cause of his cardiomyopathy was. Because the nature of rural healthcare in the region is that patients travel a lot and are often patients at several clinics, nobody knows when it really started. What we do know is that he was worked up and it was found that his heart failure was terminal. He could be treated symptomatically – with ACE-inhibitors, Beta Blockers and Loop Diuretics, for example – but the only way to save his life would be a heart transplant.
…For which he did not qualify.
Because in a country like ours where organ donors are few and transplant surgeons are fewer, every transplant has strict criteria. One of the problems was that he did not live near a big transplant centre, which is required of patients near the top of the list – and his family was not in the financial position to change that. But there were other criteria, presumably, which he did not meet either
He was quite ill when we saw him. We discovered that the young boy and his mother had not really been counseled on his prognosis, and so we tried to do so, the massive language and cultural barriers in spite.
When it dawned upon his mother that he would die without a heart, and that he would not get a heart, she sat up straighter. Patients in the public system are so used to not getting things simply because they are not private patients. And so she asked,
“How much will it cost me if I pay for a private doctor?”
And that broke my heart. Because we had to explain to her that at least in this regard, the rich and the poor were on the same list. That selling all her land and all her cattle, working day and night, would not get her child a heart.
This woman, who struggled so much financially, was willing to make the worst financial decisions just to get enough money to buy her son a heart. I could see she would have given him her own heart, if she could.
They did not leave with smiles on their faces. But the mother left with her arm around her child, protective as the lioness, a rarely seen moment of tenderness between a mother and her teenage son, who would most probably not see his eighteenth birthday.
So here is to mothers. The ones who sit up with their sick children through the night. The ones who diligently feed the unhappy babies their medicines. The ones who would go hungry if only their children’s tummies were full. The ones who can tell when something is wrong – and are usually right.
May we save the world not only for the children, but also for the mothers.