Caleb is nearly 4 years old. The Ear Nose and Throat Clinic has sent him to see me because, in addition to his snoring and trouble sleeping because of huge adenoids, he may also be having seizures, and is really hyperactive, and doesn’t really talk. He and his mother have been waiting 2 hours to see me, because the clinic here sees people as they arrive, and I have been busy admitting children from the surgical clinic, seeing a newborn with an abnormal penis, following up children with abnormal test results on the ward. So now I have a few minutes to quickly see what Caleb’s problem is before seeing another scheduled patient and reviewing a sick boy in the emergency department.
Caleb flits around the clinic room like a mosquito – touching, grabbing, playing, snatching. In the midst of the boy-tornado, his mum tells me her story. Caleb, she says, was born after a prolonged labor, and was probably pretty stressed. He didn’t cry when he was born – mum doesn’t know for how long. She left the hospital the same day because her marriage was troubled – violence, she says. And her breast milk supply didn’t come in well. Her husband didn’t stay around for long – Caleb was a difficult baby. It has been just the two of them for most of his life.
The last few months have been very hard. Caleb is a very active boy – he runs, he yells, he bites, he scratches. Babysitters have not lasted – some have beaten him, bitten him back. And without childcare, mum has missed a lot of work as a dressmaker. And so 3 months ago they fired her – she has had no income for 3 months.
I ask how Mum is supporting herself. She has no family supports – she left home at 12. And while that alone is significant, I don’t have time to delve more into it. She tells me she has been begging. And sometimes, to get what she needs, people take advantage of her. I assume those people are men. She has just been evicted from her home and last night slept at a neighbour’s.
Caleb can’t talk – he can say one word, Mama. For everything else he gestures, he points. She knows he can hear – “Open the door” she tells him in Kikuyu – and off he goes to open the door. She knows he can feel – when she is sad, he comes to her and hugs her, pats her back.
Mum has thought about leaving him. Walking along the street, sometimes she thinks, I should just keep walking and not look back. But then she tells me – this boy is my life. I love this child.
And then, she just cries.
I would like to test his hearing, I would like to assess his brain. I would like him to have a developmental assessment, I would like him to see a speech therapist. I would like to screen him for autism, I would like to have his adenoids taken out, again, because he cannot sleep at night, ever. I would like to spend the day liaising with everyone I know to help this family, I would like to tell this mum, it is going to be OK.
Most of these things, I can’t do in Kenya. Those that I can, cost money.
I talk with mum, and explain my thoughts. I hear her need, I tell her, and in addition to seeing what I can do from a medical standpoint, I ask if I can get the chaplain to sit down with her – to talk with her, to encourage her, to be a social worker for her and see if there is anything we can do to help her situation, to pray with her. She is not from our village, so I can’t really access our food bank and fund for needy families, but I am sure the chaplain will know what else we can do.
What can I do, as a doctor, for this desperate family, for the most benefit?
Hesitantly, I prescribe Ritalin for her son. For this not-quite-4-year-old, the only thing that I can do, today, is try to get his behaviour a little under control – so that he can be cared for, so that mum can return to work, so that she feels like there is a little light at the end of the tunnel. She agrees to come and see me again in 2 weeks to see if this has helped at all.
I feel so impotent. I hope, and pray, that this medication will make any difference at all. I hope and pray that the chaplain has been able to help her, to direct her, to encourage her – as I leave her in his hands to do the next task on my list.
I later find out that he has given her some suggestions, and that he has arranged to see her again in 2 weeks to see what else we can do to help. I hope and pray she comes back and that when I see her we are able to access our needy children’s fund to test her son’s hearing. I hope that there is some improvement in her son, that there is some improvement in her life, that through her interactions with us she may catch more of a glimpse of a God who loves her right where she is.