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sunny 80 °F

Yesterday I was on call again, naturally, when a little girl came into the ER. I was already in the room taking care of a different patient, but when I heard the girl sobbing I went over to her bed to see what was going on. Pulling back the curtain, it was clear what was wrong with her: the girl's right leg, from thigh to foot, was covered in burns and blisters. Big, floppy blisters hung from the back of her calf and heel, leaking purulent fluid onto the sheet beneath her. The nurse handed me her chart. Temperature: 104.

I came closer to the crying girl and saw her mother standing by.

"Que paso?" I asked, "What happened?"

The mother explained that the girl had been burned when she bumped into and spilled a pot full of tajadas frying in lard.


"Viernes," replied Mom. Wait, really? This happened on Friday and she's just now bringing her daughter in on Tuesday? After confirming that yes, it was viernes and yes, viernes definitely does mean Friday, I was still a little shocked.

I asked the obvious question: Why did she wait so long to bring her daughter in?

The mother lowered her eyes and said quietly, "Falta de dinero." Not enough money. At this point, I chattered on for quite some time about this hospital being different, not turning away people who didn't have money. Unlike other hospitals, this one isn't here to make profits so we can help patients who don't have enough money and we'd never turn a patient away who couldn't pay. She nodded and mostly just kept looking at the floor.

I went on evaluating her daughter, glad that she had at least come in today and not tomorrow. Later, I was talking with some of the other American docs about this patient. We were all pretty horrified that it had taken 5 days for them to get to the hospital, but once other people started telling stories of what goes on in the public and private hospitals on a regular basis I could see that her story was not only not unique but was based on logic.

The largest regional center is Hospital Atlantida, the public hospital in La Ceiba. Despite being public, it is not by any means free. In fact, patients have to prove that they can pay before they are treated. I've heard stories of children showing up with visibly broken arms who are turned away because their parents have no money. Many families use all of their money just getting to the hospital, and when they arrive will sit outside the doors for days waiting for family members to bring money.

Some kids with broken bones end up with worse fates than a whole lot of pain and possible infection, though. As it turns out, amputation is a lot cheaper than complicated orthopedic surgeries involving plates and screws. Because of this a lot of young people end up with amputations after fractures simply because their families cannot afford the more complex surgery. This happened to a 19-year-old man here who was a local soccer star. Ironically, he broke his leg playing soccer and unfortunately the surgeon here at LdL was gone at the time. The other doctors sent him to Hospital Atlantida, thinking that he would get decent medical care (what an assumption). He came back with a below knee amputation and the entire hospital was shocked.

Because of stories like this, Loma de Luz often keeps critically ill patients and performs surgeries usually thought to be outside the scope of general surgery because the alternative is potentially lethal. We thought long and hard last week before finally sending a newborn in respiratory distress to the NICU there despite the fact that we barely have enough nurses, let alone an incubator, ventilator, or surfactant.

So after some thought, I can see where the mother was coming from. It's their first time at the hospital, so it would be fair for them to assume that this hospital would be like every other one and would ask for money up front before treating her very sick daughter. Of course, we did not. If money is an option here, we send patients to speak with someone about discounts and payment plans, or just covertly write "no charge" on their chart before they leave. Followup in clinic after hospital stays is often something that patients have trouble affording, given that they spend a good chunk of money on their hospitalization. This was the case for the family of a 5-week-old girl who I took care of in the hospital last week. When her mom told me that she couldn't come to the appointment I wanted to schedule for a few days out, I had to promise her we wouldn't charge in order to get her to agree. Luckily, she did come in (and the baby is doing fine). I'm so thankful that we have this option.

As for the little girl, her fever has come down significantly, though she is still pretty unhappy that she has to be in the hospital. We're doing daily betadine baths and using every non-adherent dressing we can find to wrap up her leg. Only time will tell if she'll need skin grafting or surgery to help her fully straighten her leg out, since the burn wraps nearly the whole way around it at the knee. Updates to come...

Posted by vagabundos 12:46 Archived in Honduras

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