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Choices we make

Everyday we make several choices, what to eat, what to wear, which means of transport to use. Most of these are seem normal to us but sometime these decisions can be confusing especially if we don't know the best choice or have enough resources. Normally we don't think too much about our choices. Its easy to be judgemental about some choices others make when we don't have the full picture.

Recently I was reminded about the choices we make. One of our new patients who was reffered from a nearby centre called and asked to see us. Its not unusual for patients in the village to ask to be seen later. Most times is that they are seeking more information or the relative who is to pay for the treatment wants to talk to the surgeon. Most of the time they request our secretary to book them an appointment to come and have this discussion with you.

Our lady patient, lets call her Maggie had broken her leg bone after falling off a motor cycle four months ago. The leg had been casted with a long white plaster reaching her mid thigh for 4 months. This was quite a long time , most times the long leg cast that reaches the thigh should have been converted to a PTB cast- cast below the knee to allow her to walk. Unfortunately after they removed the long leg cast much later, the fracture hadn't united well and there were signs that the leg will heal bent at an awkward angle. She had come to us for a second opinion. Our advice to her at that time was that since the leg will heal badly, the best method that will allow her to get back to work faster was surgery. The time in hospital she will spend is 4 days inclusive of the day she is admitted. She had huge financial constraints and we had agreed to do her surgery at a subsidised rate, the implant supplier had agreed to give her a crazy discount.

Maggie works in the market and everyday she's away, she can't earn money. She has not been to work since the fracture. She is also a mother of 3 children. The last born are a set of handsome 1 ½ year old twins. We schedule to see her in the clinic on a friday. She comes accompanied by her mum, 1st born daughter who is 8 years old and her twins. They come fairly late in the afternoon in a hired 8 seater matatu( mini van) that in Machakos are locally called Maruti (to distinguish it from the regular 14 seater minivan called Matatus) .

We put her on a wheel chair and the Maruti driver goes away and says he will be back shortly. Maggie requests that we reapply a cast because she can't afford to pay for surgery. We would waiver the surgeons and anaesthesia fees but she still couldn't afford to pay for the Surgical implant & hospital fees( operating room charges and bed charges). She barely afforded the cost of the cast.

As Maggie is having her cast applied, I chat with mum. I notice that one of the twins is asleep in her arms and the other one is playing on the floor with her sister. I ask how come one is asleep. She says that baby isn't well. I come to have a look and see that the child has sunken eyes and looks dehydrated. "Baby has bad diarrhoea.." she says. I ask her if they have been to hospital, she said they didn't have money to see a doctor because she needed the money for the cast. They chose the cast over taking baby to hospital( Mother child health clinic) because they didn't have enough money. The cast will help to stabilise her leg then she could possibly go back to work in the market and help her to move around better while caring for her sons. The grandmother had made the decision to buy ORS( oral rehydration salts) for the grandson. I understood her dilemma. I asked her to wake up baby and helped her mix some ORS and to give the boy. I instructed her to give him a full glass slowly. If he vomits, wait a bit the start again. The young boy child looked very weak and he could not hold up his head.

When I came back later I found the young chap playing outside on the grass with his siblings. Thankfully, the child didn't have any other problem. As we awaited the Maruti to arrive 3 hours later, Levis and I were struck by the tough decisions this family had to make. Cast vs Surgery then Cast vs Mother Child Health clinic visit. I wonder what I would have chosen if I was in her shoes.. What would you have chosen?

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