Thursday, May 19, 2011

The story of Ramatou - “They will know us by our love”


Friday morning I was at the office for a meeting and got a call from our sewing teacher that Ramatou (one of the girls in our Girls at Risk school) had passed out in class, and that no one was able to bring her around. It had been 20 minutes and she was still unconscious. I told them to use cold water on her and that I was on my way. When I arrived she was conscience, but barely. Her eyes were glazed and her pulse was rapid. We took her to a local clinic in the community and they gave her an I.V and medication and she slowly came around. At first she seemed panicked and disoriented. Her sister said her fever had reached 44 on the thermometer, but no confirmation on that from the Doctors. She stayed the afternoon until the pain was under control (that was what caused her to pass out) and then they released her. You see, Ramatou has a herniated intestine. She has been suffering with it for almost a year now and goes through bouts of intense pain. Her family has not dealt with it for 2 reasons. The first being that health care is expensive for them and they simply can’t afford the surgery she needs. The second reason is that they are highly uneducated and come with a “village” mentality which is really fatalistic. They just see death and pain as so normal that they don’t go out of their way much to fight back against it. We left the clinic with a paper needed to go try to get a surgical consult this coming week. The hernia could explain why Ramatou looks so emaciated. Poor girl is 15 years old but only 77 pounds.

However, by 7pm that evening the pain was back with a vengeance and Ramatou was screaming out in pain and passing out again. You could see a big mass on her stomach that was hard as a rock (about the diameter of an apple). So they called me and I came and got the mom, and aunt and cousin and we all headed to Niamey’s National Hospital. Now this hospital is a place I really try to avoid. It is chaotic, dirty, smelly and downright unhygienic.  The first triage area was for children (since she is 15) and we waited with 60 or so other people. The room is open to the sky at the edges and smelled like stale food, urine and cats. Oh yes the cats. There were stray cats wandering around, nibbling at extra food people had brought. Most people show up at the hospital with a pot of food, a sleeping mat and a jug of water. They know they will be here a long time and there are no services. Heaven forbid if you need to use a bathroom! (I have gotten very adept at holding it!). The people shooed the cats away and just sat back in the metal benches, or lay sprawled on the floors between the benches, dosing off with their children while waiting to see a Dr. Most of the children I saw were under the age of 5. Considering 1 out of every 4 children in Niger die before the age of 5, this is not surprising. The walls were covered in what looks like a thin coat of black soot and the floors were so caked in dirt and filth I even washed my flipflops when I came home.

After only an hour and a half of waiting the Mom got impatient. She went up to a Dr. and demanded if there was space for Ramatou. When told the ward was full, she quickly seemed to give up and said we would just take Ramatou home. At this point Ramatou was dozing on my shoulder and still whimpering in pain. I kept thinking “What if the hernia bursts or becomes completely strangled? This could kill her!”. The Mom asked me to go ask the Dr. if there was any space. I know they wanted me to go because I have the white face, and maybe the Dr. would take notice and at least look at Ramatou.

On a side note, I hate this dichotomy of life here. I can use my white face to ensure people are at least seen by a Doctor or given a fair crack at something, but then what makes Ramatou more special than the poor kid next to her? Why should one person get special treatment just because they are with a foreigner whereas others can sit and die in that room without ever being seen? And yet if I don’t fight for Ramatou- who will? How can I use all I have for an advantage and yet I can’t possibly extend that advantage to everyone?

So the Dr. notices the green card I am carrying which is the surgical referral from the clinic earlier in the day. He tells us to go to the surgical ward for a consult since we have already seen a Dr. today. I am not sure if he is being sincere or just passing us off on someone else. At any rate, we head down the hall to their “true emergency” room. This is where all the bad stuff is, mostly motorbike accidents being the major cause of death in this country for anything not linked to illness.  There are at least 20 narrow hospital beds crammed into a room a little bigger than my living room, and each bed has a seriously injured person on it with a family member attending to them at the side. Forget privacy, everything is open. For the first hour I sit outside in the hallway with the Mom and Cousin while the Aunt and Ramatou sit on the edge of a hospital bed inside. There was not enough room for Ramatou here either so she is sharing a bed with another young girl who was also brought in unconscious (I saw her being carried in).

We waited and waited. After about an hour they called me in to talk with the intern doctor and explain to him (The medical people all spoke French). He agreed it was a hernia but thought likely it could last until later in the week for a surgical consult since they were so full. But we needed to talk to the head doctor, who was currently in the operating room. So we settled in to wait some more, this time I was inside with Ramatou and just sat next to her, balancing my butt on the very edge of her hospital bed. Thankfully her bed was next to one of the air conditioning units, so we got a little bit of air. There was a man wheeled in with a head injury and some kind of body injury. He was keening and wailing at the top of his lungs, clearly in a whole lot of pain. Others were crying, doctors were talking, and a crowd of people was being held back just at the doors to get in (all family or friends who wanted to visit somebody) by an army officer. It was chaotic. Ramatou laid down alongside the other girl. These two poor girls, each with a head at one end of the bed, shared such a small bed as it was. There was a young lady next to us about 4 feet over in another hospital bed. It was clear she had been in an accident and had a giant head gash. I watched (I am not usually squeamish at all) while they froze the skin around it and prepped her for stitches, but when they flipped back a 4 inch square of her scalp to look at the skull underneath for a fracture, I started to feel whoozy myself and had to sit on my haunches in front of the cold air for a few minutes to get my blood pressure back up so I didn’t pass out myself! Seriously! After that I was determined to try not to notice all the blood and gore all around us. I started to hum the song “All in All” and just hung out with Ramatou while we waited. I kept humming worship songs for the rest of the night and both Ramatou and I were more relaxed. Note to self- don’t look at open head surgery! The other man keeps wailing and it sounds like an eerie version of WHY WHY WHY AIE AIE!

Around 10pm the power goes out. This is totally normal for Niamey- but the emergency room of the main hospital? Wow…. It took about 5 minutes for the generator to kick in. Sure hope there was no major surgery underway! In the dark for the first few seconds, I quickly fished out my tiny yet super powerful flashlight. The Doctor quickly came over to “borrow it” and continue helping his patients. Un-be-lieve-able. Almost laughable seeing my tiny flashlight as the only point of light wandering around the emergency room.

At one point, maybe around 11:30pm the Mom really wanted to leave. Her cousin was telling me she was tired (they both were) and that she just wanted to take Ramatou home. Clearly the hospital didn’t have time for her etc. She had had enough and wanted me to pick up Ramatou and leave and drive them home. I was stuck in a quandary! How could I respect the wishes of a parent and not over-ride them, while still making sure Ramatou got the care that she needed? The doctors in the ER tried to tell her she was crazy for wanting to leave. They said “Do you know how many people never make it to a hospital? How many people don’t have anyone willing to help them? You are crazy to leave! You need to be patient just a little longer…the doctor will come”. Begrudgingly they kept waiting and I kept avoiding the topic lest they make it clear they wanted to leave NOW and I would be in a tough spot to decide. Thankfully in about 20 more minutes the head doctor did arrive and they did rounds and made decisions. He agreed that Ramatou needs surgery but that he could not do it this weekend. He gave us the papers we needed to start the process to get a surgical consult and sent us home with some pain medication for Ramatou.

I drove them home and crawled into my own bed sometime around 12:30 am. I kept just thinking how ready the family was to walk away and go home and just wait and see if she would die. They are fatalistic and feel they have no control or rights over their own health, but also seem so unwilling to go the extra mile to fight for it. I know on their own this surgery would be too expensive (it may only cost a couple hundred dollars likely but even that is way too much for them) but they didn’t even want to spend the time to wait and see the doctor??? As a mom I can’t fathom walking away like that. At one point I had even told the Mom and Cousin they could go ahead and take a taxi home if they were tired and I would wait with Ramatou and bring her home myself when we were done! There are so many cultural things here that clearly I don’t understand- but not making efforts for the health of your child? That’s one I don’t think I will ever understand!

So please pray for Ramatou .I don’t know how long of a wait there is for surgeries here. I don’t really know how to navigate the medical system here, but I guess I am about to learn! Pray that she will manage these days and weeks ahead with no pain and feel God’s presence around her, comforting her. Pray for me for wisdom! I want to respect the wishes of the parents, but also make Ramatou’s life the priority!

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