Thursday, March 6, 2014

A Human Encounter

Today in clinic was an immersion into the marrow of life. As we did our medical debriefing at the end of the day over dinner, what was clear to me was in this one, single day in clinic the Xavier students and the medical team all had profoundly meaningful encounters with the people in Patanatic today. The encounters were not all the same, but each uniquely significant and will no doubt be carried with each of us as we wrap up this trip. I am sure the students will write about some of these human encounters in their blogs. I'm sure they will share these rich experiences with their friends and families in more depth when they return home. I will briefly write about a few here.

The day was diverse. The clinic day ended with Stephanie Renny, Rabbi Abie's assistant, literally giving the shoes she was wearing to a girl in clinic who had cut the toes out of her own shoes since her feet were too long for her sneakers. What a practical, selfless gesture of accompanying that little girl in her poverty and trying to alleviate the simple poverty of having grown out of shoes.

Dr Richard and his students saw a 16-year-old girl who came in because her hair was falling out after having been raped 5 months ago. She has not reported the rape, sought medical or psychological care. It has consumed her and she is getting no help. Richard's interpreter, Michel, a 22-year-old wise, kind person who we have known for four years was able to tell the girl about free psychological therapy for rape victims at the hospital in Solola about 20 minutes away. We can all only hope and pray she seeks out this help to try to overcome the damage that was inflicted upon her.

There were many other stories from the clinic day today that break open the raw beauty of human encounter, but the one closest to me was getting to see Luisa again. She is the now three-year-old that we diagnosed with cerebral palsy two years ago. She was just one-year-old when we first met her. She had an aspiration pneumonia at the time, was surviving only on breast milk, and was tongue thrusting and blocking all other foods. She is microcephalic, having a very small head circumference. Seeing her at one I was not sure we would see her the next year, thinking she would weaken from malnutrition and succumb to an aspiration pneumonia. Well, some how she made it through to her second birthday. She had two clinic visits and was seen by other visiting medical teams that year for respiratory infections. But last year just after her second birthday I was glad to see her still alive. She was not gaining much weight and still was not taking much nutrition other than breast milk. She could say one word, "mama." That was enough.

As this year's trip was drawing to a close we had not seen her yet. Today she came to clinic. She had not been seen in clinic or sought care outside of Patanatic for the entire last year. She had been healthy. The family had been able to get her to weekly physical/occupational therapy in Panajachel about 20 minutes away. She was doing very well. She now eats all different textures of solid foods, and is still nursing. She is growing again on her growth curves. The family bought her an infant walker and she is able to manipulate her legs enough to scoot around their home, which thankfully has a tiled floor (many families have homes with dirt floors). She still just says "mama," but her mom thinks she is trying to say "papa" now. She is still very happy and brings great joy to her family. After her clinic visit I asked her mom if our occupational therapy student could accompany them to her home to measure the walker and get a better assessment of what addition aids we may be able to provide to her. Talk about education outside of the classroom. I am sure Rachel will remember this experience her entire life. She eats all meals in her mother's lap so we left some money here with our interpreters to purchase a high chair for her. Now that we have the walker measurements we can bring down a bigger one for her next year. Two years ago I was not sure she would survive this long. Now I am looking forward to seeing her next year.

It is these profound human encounters that this trip brings to us as a medical team, and to these Xavier students that makes me keep coming on this trip. Somehow in the last three years I have become the primary care physician for a little girl with profound disabilities in Guatemala even though I live in Cincinnati. Her mom sees me as her doctor, and it is a role I cherish. I am honored to accompany her, to walk through this broken world with her.

There is a Hebrew concept called tikkun olam. I am sure any other member of the medical team could speak more eloquently on this topic as they are all actually Jewish and I am Catholic, but it means "to repair the world," humanities' shared responsibility to repair this broken world. It is through these human encounters that we begin to repair the world, tikkun olam.

Lauri Pramuk, MD
March 6, 2014

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