The Cry of the Poor

 

“For Christians, the poor are not a sociological category, but the very ‘flesh’ of Christ, a flesh that hungers and thirsts, and experiences infirmity and imprisonment.”

~ Pope Leo XIV

He is two months shy of his first birthday. Today he traveled from his community about 3 hours away by boat- his parents report fever, cough, runny nose, and difficulty breathing for about five days. The severity of his illness is made manifest by his eighty breaths per minute, tugging in his neck and in between his ribs, and his need for four liters of oxygen to maintain his tissues well oxygenated. He breathes so fast it’s almost impossible to capture when one breath ends and the other begins. Even with antibiotics, steroids, and nebulization treatments, his respiratory status remains tenuous. In his air hunger, he stretches out his arms in what appears to be a desperate plea for help when I go to listen to his lungs. We quickly realize he will need more advanced breathing support and specialized care. We set up a “Bubble CPAP” or homemade continuous positive airway pressure (CPAP) system using our available resources, and we hope this will help open his airways so that he does not have to work as hard. We work on transferring him to the city of Iquitos, but boat transfers have been halted due to a lack of government funding for gasoline. The referral hospital in Iquitos informs us that there is only one seaplane for the entire department, an area about the size of California with no connecting roads and only navigable by boat. The child is placed on the list behind patients of higher priority: a woman with eclampsia (seizures in pregnancy) and a man with a penetrating wound to the abdomen. Each day that passes feels like a battle against time- heavy rainstorms, sicker patients, and poor distribution of government resources all work against our efforts to keep this little one alive. Though his work of breathing has improved with CPAP, we worry he will soon tire out. Three days later he is finally evacuated to Iquitos with his mother where we hope he will finally receive the care he needs to recover. The next morning I find his father in our hospital- paralyzed, tears streaming down his face. His son, I learned, passed away in the wee hours of the night. His pain is palpable in the intense shaking of his body as he mourns the loss of his infant son. 

She is almost two years old and weighs just over six kilograms (fourteen pounds). We receive a call from one of the rural health posts to hospitalize her for complications from severe malnutrition. When she arrives she is weak, cold to the touch, and difficult to arouse. Her mother is crying for fear that her daughter may not survive. We immediately check her blood sugar which is dangerously low, and we quickly give her a bolus of dextrose to bring her blood sugar up to a normal level and wrap her in a warm blanket. It is a miracle she did not start seizing or lose consciousness on the four hour boat journey to the hospital. Just one look at the child’s face clues me in to one of the reasons for her severe malnutrition. She has a cleft palate, a defect in the hard plate of her upper mouth. Her mother explains she has not been able to undergo surgery as her daughter’s weight was too low the last time they met with the surgeon. Their family does not have the money for special formulas, and she has also been suffering from diarrhea for more than two weeks. In a short time, her temperature and blood sugar recover, she is more alert, and we are hopeful she will continue to improve. We admit her for blood sugar control, rehydration, antibiotics, and an intensive feeding schedule. The first few days her weak, fearful cry greets me every time I approach her. With each day her cheeks slowly begin to plump and the number on the scale steadily rises, and after two weeks, she has gained enough weight to be discharged. She now receives me with a joyful smile that seems to hide the once-obvious defect in her upper lip. We are hopeful she will be in good health for the next cleft lip and palate campaign coming to the city of Iquitos in the Spring. 

He just celebrated his eightieth birthday. He presented a few months ago with fatigue, weight loss, and easy bruising all over his body. Some quick blood tests reveal low levels in his blood counts, likely due to a bone marrow disorder or blood cancer. As I explain the situation to him and his wife, her love for her husband is visible in the tears rolling down her face. We quickly coordinate a referral to a hematologist, or blood specialist, in Iquitos. Due to delays in his care at the public hospital and insufficient funds, the family returns with him to Santa Clotilde, distraught and hopeless. His blood counts continue to drop to the point where he requires blood transfusion. After careful discussion with the patient and his family, we decide to pursue palliative care, though we fear he will pass away before his more distant family members are able to visit him. To our surprise, weeks pass by and he asks to go home, where we occasionally bring him IV fluids and pain medications. More than two months have passed, it is Christmas Day, and we find him sitting on his rocking chair outside of his humble home perched over a small cliff overlooking the river. He is accompanied by his wife, a few of his children, and a multitude of grandchildren. The light and joyful Christmas spirit tempers the hot, heavy air while warmly enveloping the vibrant, tropical banana trees that surround us. Together we sing Christmas carols with great joy, all of us grateful he is able to celebrate another Christmas Day. Among them is sung this traditional holiday hymn from the Peruvian jungle:

“Pero hay tantos pobres que sufren las penas     
No tienen regalos en la Navidad.                       
Las ollas vacías, triste Navidad.                       
Suena el manguaré, suena el manguaré,          

Pidiendo justicia suena el manguaré,             
Libertad pidiendo, suena el manguaré.”            

“But there are so many poor people suffering
They have no gifts at Christmas.
The pots are empty, a sad Christmas.
The drum sounds, the drum sounds, 
Crying for justice, the drum sounds,

Crying for freedom, the drum sounds.” 

And as I listen to the words being sung, and as I sing them myself, I recall the cry of the poor in its various forms- a father for his deceased infant son, a mother for her growing daughter who almost lost her life, and a wife for her cherished husband whose any moment may be his last. I reflect on the cry of our Savior, once a poor infant who would also suffer from hunger and thirst, infirmity, and imprisonment. And I remember that it was on that first Christmas Day on which sounded, and continues to sound, an eternal cry promising a peace, justice, and freedom that only He can provide. 

“If the stories of the sacred moments and movements that led to the birth of Christ teach us anything at all, it’s that our yes to God will not make our lives easy. Giving God full access to our future doesn’t eliminate our troubles in this world, but it does give us new hearts- hearts of joy, peace, and of stillness.”

~ Be Still Day 23: Just the Beginning, Hallow App

Wishing you all a blessed Merry Christmas and joy-filled New Year! Thank you for your continued prayers and support!

Top Left and Middle: Caring for an infant with homemade “bubble CPAP;” Top Right: Suturing up a piranha bite in a boy who went fishing in the river; Middle Left: Christmas caroling with a patient outside his home on Christmas Day; Middle Right: Children participating in the traditional posada dressed in their Amazon ponchos; Bottom Left: Hospital staff reenacting the Nativity of Jesus during our annual posada which brings Christmas cheer to 500+ children from all over Santa Clotilde; Bottom Right: Working with nursing students while performing a lumbar puncture on a patient with unexplained neurological symptoms.