the ocean

"For the needy shall not always be forgotten,

and the hope of the poor shall not perish forever." 

Psalm 9:18

Perspective.

Yesterday morning I did teaching rounds with the residents. We saw every surgical patient in the hospital. There were 46. It took almost three hours to see them all. Seven patients with typhoid perforations. Two with peritonitis scheduled for exploratory laparotomy after rounds. Seven patients with neglected infections that will lose or have lost an arm or leg.The little boy who lost his arm because he came to the hospital several weeks too late. The girl with epilepsy who burned both of her hands and needs multiple finger amputations, but refuses as her fingers become more black and shriveled every day.

Healthy, straightforward patients seem few and far between- there is the man who can pee now because we took out his prostate, the child with the hernia repair, the thyroid removal. Despite all of the suffering, almost every patient responds with a huge smile when I greet them. Even the kids smile with just a little coaxing and a piece of candy. They are amazing, resilient people. I'm not so strong. By the end of rounds I just want to go home and forget about the suffering somehow.

I find myself thinking...Why does being a doctor here seem so hard? Why does it feel like there is a never-ending ocean of patients needing help?  

Because there is . 

It feels hard because it is hard. 

Turns out, its a big adjustment to move from practicing medicine in a country ranked number three on the UN Human Development Index to the country on the bottom of the list.  Last week, I read an article that was recently published in the Lancet, Malaria and Malnutrition: Niger's Twin Crises. Somehow, it helps me mentally to have a bigger perspective of the health care situation here.

"According to the UN Human Development Index, there is no country worse off than Niger. The landlocked West African nation, which is mostly desert, lingers at the bottom of the index: 186th of 186. Its government, heavily dependent on foreign donations, spends a paltry US$10 per person on health care every year. Vast swathes of the country are effectively wild: without schools, roads, or security. There are fewer than two health-care workers per 10 000 population (23 is considered the minimum number for provision of essential care) and more than 2 million people live in chronic food insecurity, of a population of 16 million." 

Life is hard. But there is hope. So I didn't go home after rounds and hide in my house. I did what little I could. I stayed and repaired a typhoid perforation and a stomach ulcer. Yes, its only a drop in the ocean, but I think I'm ok with that. I'm not here to save the world.

Friday night sunset