Just Like Day and Night

My heart stopped beating for a moment when I saw again how a scalpel cut the uterus, blood here and there, and the head of the baby who then appeared from the open womb. The bluish baby cried. The resuscitation team then made the baby warm and after several minutes, the bluish colour of the baby turned to pink. The baby came to the world, healthy. It was an amazing process.

Another day, my heart was wrenching when I saw a baby who was just born, gasping. She was only 1,5 kg baby who struggled to live. She tried so hard to make her alveolus not collapsed. Resuscitation process was going on. She got positive pressure ventilation to help her breath, but it didn’t work. The next step was coming : chest compression and ventilation, but it didn’t work as well. Her gasping sound vanished. Her heart rate was turning slow and weak. Then another step of resuscitation came: intubation and giving a medicine called epinefrin to her body. I watched and prayed, hoping the best for her, but…no breath, no pulse. Her skin was also turning blue. Seeing a mydriatic pupil in her eyes made my heart stopped beating again. Nothing more we can do. She died. It was thrilling ( and amazing, though) to see how the baby was born, struggling to live, and die. It was sad to see how often babies born prematurely or low birth weight are died in this country. Prematurity is the leading caused of death in neonates in Indonesia, according to Riskesdas, 2010.

In a one sunny day, I saw a four months old baby who was unconscious lying on his bed. I put my two fingers on his sternum and pushed them hard, but the baby was not reacting, not even crying or opening his eyes. He was only moving his hands slightly. Oh God not again, I murmured. Almost every week since I have been doing my internship in this government hospital I saw again and again children with tuberculosis in severe cases. Mycobacterium Tuberculosa (TB), bacteria that is most known to cause pulmonary TB, had already spread on the baby’s brain. He got meningitis TB. I saw the same cases 14 years ago. I thought nowadays it’s getting better, but the fact is not. TB in this country is really an endemic, frightening, whereas in develop countries the disease is already vanished since decades ago.

Her mom’s story even made me feel sory. The baby shouldn’t have stayed in that bad condition if her mom was not so naive, and the midwife knew that common cold in a baby under three months old is really need more attention and should have been referred. “He got cough since two months ago. I already brought him to a midwife several times, but she never refer me to the doctor or hospital,” said the mother.Even worst, when the baby got seizures few days before he lost his consciousness, her Mom also didn’t bring him to the hospital immediately. “I thought it was not seizure. I didn’t know, so I just took care of him at home.” Oh Dear God, how can you create a mother as naive as her. *Sigh*

“So, is there any adults who have pulmonary diseases or cough or is taking medicine for 6 months in your surrounding?” I asked her. “Yes, his father,” she answered quickly. Oh Dear God, this country is really in trouble. Just several days before I saw a very skinny 12 years old boy with positive TB bacteria in his sputum, and ‘damage’ Rontgen picture in his lung. Another day before, I also witnessed a three years old skinny kid with milliary TB, which means, the bacteria is already spread in his blood. Then it found out that his grandmother was taking TB medicine. Several weeks before, I also watched a 10 years old boy who was sitting in his bed, trying to breath normally. There is fluid accumulates in his lung, pleural effusion we call it in medical term, and in his case it is due to TB infection. Indeed, TB cases are so many, not to mention everyday cases in clinic, and even worst: undetected cases. Scarry.

The day changed. Another patients came in, a 9 years old girl lying in her bed, restless. Sometimes she mumbled confusedly or cried and if we asked where it is or what is her name, she was just quite. Her mother said, she couldn’t communicate appropriately since several days before and she got fever since two weeks. Her parents already brought her to Puskesmas, and then they referred her to the hospital. She got typhoid enchephalopaty or we can say a severe case of typhoid fever as the bacteria already spread to her brain. Besides her bed, laid down a 10 years old boy who was at somnolent condition due to the same disease. Almost every week I could see the patients changing, but not the disease.

Almost everyday, in the hospital, there are some kids with shortness of breath laid down in their bed, fatigued. When came to the physical examination, crackles or slem often evidenced from their lungs. Their disease is pneumonia. Some of them even got meningitis due to pneumonia caused by bacteria. Several years ago, when I just graduated and worked at a clinic, came to me a one year old baby, gasping and blue. I couldn’t do anything, just said to the mother,”Go to the hospital, NOW! I could never forget the baby and his disease, pneumonia, which some times can be life threatening. So sad that the disease is also very common in this country, one of the leading killer of children in Indonesia.

The scenario above is happened in a government hospital which mostly is for low in come people: fourteen patients in a quite big room, with rusty beds, old and grayish or yellowish sheets (it is supposed to be white, right?), old and dull tiles, smelly bath rooms, uneducated parents who are mostly just say ‘yes’ to what the doctor said or don’t understand what the doctor is talking about, and the list goes on and on.

On the other hand, in the other part of the town I saw some luxurious hospitals with very clean rooms and bathrooms, good beds, new sheets, there is even playing rooms for children. Typical parents who come to this hospital are also different: smart parents who already goggled the disease of their children before they go to the doctors, parents who are dare to speak up and say no if don’t agree with the doctors, parents who are already panic when their children got one day common cold, etc…etc.

It is just like day and night. We live in the same earth, same country, even same city, but the discrepancy is so high. The typical diseases somehow are also different. Low middle income people come with end stage of the disease, the opposite come with daily common problem that sometimes even no need for treatment.

Unfair? Yes. For sure, this country still has a lot of home works: the discrepancy, the uneducated or ‘over educated’ parents, the infectious diseases that are supposed to be vanished only with simple actions like sanitation and clean water supply, the prematurity that mostly is a result of immature marriage or uneducated parents, and the list goes on and on.

What to do? I don’t know, just trying to apply an old phrase : think big, act small, just do the best you can do, not only for yourself but also for others. As a hadith said: “ The Best of People are those who are those that bring most benefit to others,” right?

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About the Author: Agnes