Whose responsibility?


What's new in Serif Umra? Not much except a bureaucratic hurdled permitless team confined to the daily trip between the dispensary and the eating dish for conversation. The dispensary holds its own. Yes, Darfur is in the news, not just of its neighbouring presence to Chad but to its historic presence in Chad. Chad is about 110 km to the West of us, thousands of refugees are fleeing at this very moment and here in SU, it’s the daily grind. We held more than 6000 consultations in the month of January and treated severe cases from a wide array of diseases. We tried to have the insight to treat first and refer when necessary. We are now trying to analyse where these beneficiaries of our service come from so we can go to them. We ought to go to the hardship and not expect them to endure any more.

Responsibility has been on my mind a lot recently, called into question often, when I feel like fighting all the time to the end for the life that belongs. One of the essences we sometimes meet in primary health care is the responsibility of the individual to take care of himself: eat right, exercise, be diligent. What is the responsibility of the parent and mine then in the case I encountered this week?

Petite pineapple of 12 months came in with a sudden onset history of severe difficulty to breathe. Began the night before. The mom is not sure if he had inadvertently inhaled some pip or pop. He was well before. No cough fever etc. She took him in the morning to the traditional healer who duly amputated his uvula (that little dangly tongue-like thing at the back of your throat). Uvelectomy here is the norm. Trying to dissect this would take an anthropologist so I will shy away. She came to us directly afterward. When I trip upon him in the ward, because the alarm bells are out for service, I survey swiftly the blue babe-in-arms. Differential diagnosis is an emergency with an upper airway obstruction either due to acute epiglottis or foreign body inhalation. Now it's about 6pm in the evening. Night time brings with it the threat of more than nightmares. But I think for this chubby there will be no limits. So radio call to the log to ask for the car for referral to the other MSF project. Some logistic glitches to overcome. Log team to the rescue and voila! Ready to go. Dilemma: the dad insists he needs to go with the mom and baby to Zalingei. We however have a policy of one caretaker per patient in the car. We inform him so but he refuses then to send the child. How to disentangle this one?

I instinctively say ok. Let him go and be done with it, I'm not spending any more wasted moments of this child's chance of survival on a matter of rule. However the team engage in a discussion about responsibility of the parent here. If he says no, we cannot do more. He needs to accept that it is his responsibility ultimately and must accept it as such if his child dies. Alas, I voice my dissention at the decision thereafter he is duly informed again of the rule and if he not abiding….no go.

He abided. Case made. I lost and of course feel slighted. I more than feel slighted because this exact point is illustrated in dissecting my responsibility I bear for the death of another child with somewhat similar circumstance.