Languages have never been my forte. While I have always loved the idea of being multi-lingual, learning languages does not come easily to me. In my years I have attempted to learn Japanese, Vietnamese, Spanish and French – despite my best efforts (and time invested), I am only able to say a few words.
After arriving here in Pakistan, I had an instant desire to learn the language. Communication in my job is so important and I feel so helpless at times not being able to talk with the mothers and children without someone translating for me. But there is not only just one language to learn – there is Urdu, Pashto, and Balochi!
In Chaman we have Pashto lessons once a week. While we try very hard, we spend most of the class laughing at our woeful recall and our even more woeful pronunciation, much to the amusement of our teacher. After my first lesson, the only word I could remember was “Uba” which means water – useful on a hot day, but not going to be a great conversation starter with my patients. Lesson two added “Manana” – meaning thank you – quite useful! But I have a very long way to go before being anywhere near fluent.
But there is one word that I have quickly come to hate – “LAMA”. It is not Urdu or Pashto….it is an acronym for Leaving Against Medical Advice. I know this is not unique to Pakistan, but it just happens far too often and often in the sickest patients here. And it is at these times that I wish I could communicate with the attendants [parents, caregivers or guardians] better.
There are many reasons that the attendants decide to take their child from the hospital, some I can understand, but some I really struggle to understand at all. One such patient was a young baby in the ITFC (inpatient therapeutic feeding centre) who came in with the all-too-familiar story of diarrhea and vomiting with severe acute malnutrition. He was dreadfully sick and during the first day of admission we were playing catch-up with his fluids as he was just having so much vomiting and diarrhea, it felt like we were fighting a losing battle.
But by day two of his admission he was a little better. His weight had improved and the diarrhea and vomiting had seemed to ease. But in the evening of his second day of admission, the father arrived and insisted on taking the boy from the hospital. He said we should have made him better already and the mother was needed at home, and so they were leaving with the child. Our very committed staff tried to explain how sick the child was and that he would die if he was taken from the hospital, but to no avail - he would not stay. So we watched them take this little boy home, away from the life-saving treatment he so desperately needed.
The questions going through my head were: Did they not understand that this decision would likely be disastrous for this young helpless child? Or do they just see children die too often, that they accept it as part of life? I do not have the answers and I do not know what has happened to this child, but my heart can’t help but break for this little boy who could die outside these walls.
LAMA….I hate it.