I have just returned from a graduation trip with my youngest son - which is another topic. But while there, I was reminded again and again of how fortunate we are in the United States with medical care….even if the system is not perfect. Most Americans have access to emergency care.
We were in a remote area of Peru, traveling by train from one city to another, when our train slowed to let another train switch tracks and pass. It was then that I noticed several people running along the train tracks trying to get the train’s attention. One of the people looked to be a mother and she was carrying a child (not a baby) on her back and you could see that the child was bleeding. Suddenly our train came to a halt and the door to our train car opened and they pulled a bleeding and obviously injured child on board. The child appeared to be seriously hurt and her head and face were covered with blood.
It is at this moment that you remember your “trauma” training and I got out of my seat to see if I might be able to help. The majority of the people on the car spoke Spanish but there was a bilingual tour guide on board who became the interpreter. I let him know that I was a pediatrician - at which time he told me that the little girl, who was 11 years old, had been kicked in the head by a donkey. She had been “doing her chores” and had bent down to untie the donkey when it kicked her on her left frontal/temporal area.
First thing…lots of questions for the mother. The little girl appeared to be in pain, and very quiet, but it was difficult to tell if she was in shock or just scared as she would not speak, but would respond to a few commands from her mother. Past medical history…she had never been to a doctor! The injury had occurred about an hour earlier. I asked if she had lost consciousness, had she vomited, did she remember what had happened? Replies..No, no, yes. The mother had not done anything but put the child on her back to get her to the train. She had never been on a train before.
There was a first aid kit on board…and it did have gloves and some gauze and “antiseptic” wash. We also had lots of bottles of water to irrigate a fairly large wound and what felt like a possible skull fracture. Besides trying to clean the wound (on a very jerky, bumpy train ride) and applying pressure and wrapping her head I just had to wait and keep her awake for the next 30-45 minutes until we reached the town.
I was told that when we got to the station they would have “medical” care there waiting for her. I assumed that meant an ambulance. But, the medical care was a wheelchair. At this point she began vomiting…again a worrisome sign. We took her to the street where they found a “tuck -tuck” and loaded she and her mother to take her to the “clinic”. No ambulance, no doctor,o hospital. They told me that they would have to call for an ambulance to get her to the city which was about 2 hours away in order to see a doctor and have access to X-rays and CT scans…and all of the things that we have so readily available.
As I watched the mother cradle her daughter in her arms inside this little tiny “taxi”…I could only squeeze her hand and reassure her that her daughter should be okay. Then I said a prayer for little “Margot”.