An Afternoon at the Public Hospital

Warning: This story involves the death of an infant. I do not recommend reading if you are pregnant or for whatever reason do not need to think about a sad story today. Recording this helps me process it. The story is not graphic. It just highlights the reality of public health care for the poor in the Philippines.

I was at the public hospital on Saturday visiting a woman in our community who's 1-year-old son is sick with pneumonia. Thankfully, he is improving and will be discharged soon. I've been to the pediatric ward many times before but I usually do not stay for any length of time. On this day I stayed for hours and during that time watched a scene that I figure must be a common occurrence.

First I'll describe the setting. The pediatric ward is a huge open area in the shape of an I. Each length is lined with two rows of beds - some large beds and some elevated beds about the size of a crib. Most beds have two patients. The care-takers (usually a family member) of the children are either also lying on the bed or sitting or standing nearby. It is crowded. There is a huge nurse's station at one end of the ward. There are no curtains dividing the beds and everyone can see what is happening around them.

My friend, a young mother of four, stands at the bed where her son lies next to a six-month-old baby with a feeding tube and an oxygen mask. The baby also has pneumonia. When I first met this baby's mother, she was sitting on a piece of cardboard on the floor leaning her head against the crib sleeping, clearly very tired. She and my friend have gotten to know each other over the past 4 days in this place. These two women, as well as the two mothers of the children in the next bed over talk to each other as if they know one another well. They ask questions and discuss what the nurse's latest instructions tell of the status of their children.

When the nurse came by and without word handed a slip to a neighboring mother with "heplock" scribbled on it, the other mothers noticed and asked her, "He's getting off the dextrose? Maybe he's going home soon." Everything is public business and it's not rude to ask personal questions of strangers. In this place there is a strange sense of community. The concept of confidentiality is foreign. This is a big difference between my culture and the culture of the Philippines.

My friend points out a child nearby who looks to be about 3 or 4 years old. She tells me how earlier she saw the child convulsing uncontrollably and there were no family members to attend to her. The nurses couldn't do anything because there was no family member to send to buy whatever medicine could help her. She lies there in a coma alone.

Then she points out an infant in a bed about 20 feet away who was recently intubated. A family member is delivering air to the frail baby by squeezing an ambu bag every few seconds. I prayed that something would change but the situation did not look good. We looked away and tried to talk about other things.

Within the hour my friend brings my attention back to the failing child because now there is a doctor listening for a heart rate and soon the artificial respiration stops. I can see both the mother and the father clearly. The mother has her head in her hands crying and the father is leaning over the baby crying. I can not see the baby's face and can not bring myself to look more closely like others are doing. There is a crowd standing around watching in silence.

I turn away to avoid the cry that was ready to pour out. Everyone within eye shot is watching. Everyone knows what is happening. Many are quiet. The feel in the ward is heavy with sympathy and sorrow. Someone tells me the baby is four months old. I can hear the women around me talking about what may have happened. They don't seem to know but are confused why such a healthy looking baby (I heard them say the baby is fat, meaning healthy) could be so sick.

Occasionally I look and see that they are changing the clothes of the pale child. I can see that the mother is withdrawn and doesn't want to look or touch her child who is now gone. Someone is standing next to her with their hand on her back as she cries. The baby is wrapped in a blanket and held by what appears to be the grandmother. After about 30 minutes the whole family exits the ward and half the bed is empty.

I have been thinking about this family ever since, wondering what they must be going through and how difficult it must be. Over the past three years, many of the pregnant women I have cared for have lost a young child. It seems more common here than I want to admit.