“If this child dies, at least I still have seven others…”
This was a response from a pediatric patient’s mother. We had been suspecting he had a form of hematological malignancy but our facility didn’t have advanced tests and treatment modalities that could further help in the course of his management. I had just delivered the news and recommended that she takes the child to a tertiary center for further management, “doctor, my husband and I are farmers, we could barely afford to arrive here in the camp from our village, we cannot afford to take our child anywhere else, let alone pay the hospital bills. If it’s God’s will, He will heal him,” said the teary mother.
Growing up, I assumed that people who had many children especially those in my generation were not well informed about family planning and birth control methods or had no means to access them, majority of this group being in the rural community.
After qualifying as a medical doctor, I was hired by an organization that provides free medical care to refugees from a neighboring country. This free medical care was extended to the local population surrounding the refugee camp. While living, working and interacting with the local population there I learned how well informed they were about family planning including the birth control options they had but most still had many children. This was partly because they had cultural and religious affiliations that superseded their acceptance of the scientific explanations even when it sometimes compromised their health, some women felt like they had little to no say about how many children they could have, it was the husbands’ choice since they were the providers. Another common belief was that the more children you have, the greater the chances of survival for the family in case some died along the way.
As a general practitioner in my country, I have come to understand that our patients need more than just medical care and education/information they receive from our health facilities, they need interventions from the level of the community that would aid in improving their overall health and well-being and we who are directly involved in their care need to act as their advocates to facilitate such interventions. An additional lesson I learned from working for the organization was the direct impact public health interventions had on hospital admissions as well as patient morbidity and mortality.
The camp is a well demarcated geographical location that hosts more than 50,000 refugees which makes it easy for the organization to send community health care workers to implement these interventions and monitor the progress within the camp. The communities are periodically given health education which empowers them to make well informed choices. In addition to that, they are supported by other international organizations with some basic needs including food, clothes, shelter, running treated water, psychosocial support, free education and free healthcare including free referral to higher centers if the need arises, this helps to mitigate the challenges they already face by being a disadvantaged group. Some of these measures have not yet been adopted by my country.
I chose public health because I believe there is more I can do to address the health inequalities currently present in my country especially for the disadvantaged communities in the rural areas, for a future where women are empowered, get to have a say in family planning and more.
The child in our story being a local didn’t get the opportunity to go to a higher center. Unfortunately, he died while still in our facility a few days later.
