Disparity

Today I saw many sick children but one stands out.  A 9 year old boy that had been abandoned by his mother and left with some extended family member.  I could tell when he entered he was in serious condition.  In the ER, a code would have been called and rapid transfer to a children's center would have been done immediately.  He had been sick for about a week but it was obvious that malnutrition was a big problem as he was emaciated and weighing 19 kgs.  His respiratory rate was over 50 at rest and initial temperature 40+ C with a heart rate of 160.

Here the difficult part comes.  It's apparent this child needs to go to hospital but he hasn't been well cared for in the past and questionable if the adult will take him and pay for treatment.  I've seen it before so my approach is to evaluate, start treatment, give the full course of medications (in case they don't go to the hospital), and hope the child makes it to the hospital.  I treat him with max dose of tylenol, ibuprofen, and start the antimalarial meds and amoxicilllin while waiting the results of the lab for typhoid and malaria.

After about an hour, he is positive for malaria and negative for typhoid but his heart rate, respiratory rate, and temp remains unchanged.  Tough little guy but he is sick as hell.  I emphasis to the adult he needs to go to the hospital and cannot tolerate walking 10km in the sun.  I give her the medications in case she decides to go home instead.

The disparity is here.  Her reason to bring him to the clinic was that her well nourished 4 year old daughter (who weighed almost as much as he did) had a cold.  I guess it is admirable that she would even take him in but it is tough to see the terrible life he must endure.