Stories From Health Workers: Needs on the Border
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Planet Care
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In February 2004, three GHAP members (Grace, Manny, Tom) visited Paw Bu La Hta, one of the many villages that is composed of villagers displaced by internal conflict. Although originally a loose collection of temporary shelters, since 2001 the shelters have been improved by villagers so that they resemble more traditional bamboo Karen homes. Since 2000, we have supported a clinic in the village, and it has become the pilot site for many health programs, such as malaria control, vitamin A supplementation, de-worming, and TBA training.
Like the infant girl in the story, this baby was orphaned at birth. Despite advances, such tragedies continue when healthcare is scarce.The health workers had recently constructed a small bamboo hut to take care of inpatients who were too sick to return to their homes. One of the patients, a 6 month old infant girl, had severe diarrhea. She was very small for her age, with listless eyes, but would make occasionally efforts to drink oral re-hydration solution, and was receiving intravenous fluids. She was also being carefully held by an older Karen woman, perhaps 40 years old. "Where is the mother?" I asked. "She died during childbirth," said one of the health workers, who had recently finished training at Mae Tao Clinic.
When we inquired further, we learned that the deceased mother was the daughter of the village head. She was only 16 years old, and had developed severe anemia after a bout of malaria. Although she was told to go to a nearby Thai hospital for delivery, she refused, and attempted to deliver at home. Her aunt was a traditional birth attendant (TBA). During the delivery, the young teen had heavy bleeding. Already compromised by her severe anemia, the young teen died at home. Her aunt adopted the infant, who survived despite being underweight at delivery.
This story reflects so many of the problems on the border, and the need for some of the programs. The daughter of the village head was actually somewhat better off than most of the villagers. Why was she so anemic? Repeat episodes of malaria are common in the village, which is why the GHAP malaria program is so vital. Poor nutrition is the norm for most young women living in her situation. Why did she die of hemorrhage? Perhaps the Traditional Birth Attendant could have done more if she had received more training. Why did she get pregnant at such a young age? Lack of access to family planning, lack of knowledge, and perhaps cultural norms played a role here. Why was she afraid to go the hospital? Fear that she might be arrested as an illegal migrant, or asked to pay money her family could not afford. The cost of a caesarian section, for example, is about $250. The foster mother was forced to rely frequently on rice water to feed the baby, as infant-formula is an unaffordable luxury. The infant, not able to benefit from her mother's breast milk, was malnourished and contracted diarrhea frequently; her chance of survival is slim.
-- Tom Lee, MD
Copyright Planet Care
