One Boy

I noticed him on the first day in Loubugumou. To the dozens of children not in school, the sight of two white people with clipboards was the most exciting event in months. They let us know by gathering round, asking us endless questions in Luganda that we could not understand. We answered with English that was equally incomprehensible to them. Together we made a game, a vain attempt to start them on the road to literacy, calling out letters printed on the bottom of a water bottle or scratched in the dirt.

Letters in the Dirt

One boy had come with the others to pay his respects. He looked to be about ten years old, leading a group of two or three younger children for whom he had decided to be responsible. He was unlike the others. When he saw what my digital camera could do, he made no attempt to see endless pictures of himself. Instead, he hurried to find a young girl of about four, carrying her back so that she could join in the fun.

He stayed longer than the others, smiling, drawing doodles in the dirt that covered our pickup, and raising his shirt to reveal a protruding lump the size of a small fist where his belly button should have been.

I stopped watching the passing motorists. "Amna," I called out, in my calmest possible voice, "I know I’m not qualified to tell but does that look like an umbilical herniation to you?" Translated into English, umbilical herniation means "Intestine pushing its way out through the belly button."

"Oh yeah. It’s easily treatable. We used to see them at the clinic in Ghana all the time."

"You’ve seen these before?" I asked, "So, without treatment, what’s the likely outcome?"

There followed a look that spoke with silent finality.

In theory, every Ugandan has access to universal health coverage. It remains only a theory though. Coverage extends to those able to afford travel to the hospital, medications that are almost forever out of stock in the public wards, and lost time helping to support their families.

To the best of my knowledge, eighty percent of Ugandans work in subsistence agriculture. With luck and hard work, they grow what they need to feed their families, with a little remaining to buy clothes and tools. With poor luck, transport costs, and unexpected hospital bills the average Ugandan family will begin to lose what little they have.

I looked over at our guide, Jerome.

"Amna, do me a favour," I asked with forced casualness, "Ask Jerome what would happen if we told the boy’s parents that his problem is both potentially dangerous and easily treated."

She returned a moment later. "He says the problem is common here. The parents will expect you to transport and treat him yourself."

Here was my dilemma: Similar things happen every day. It wasn’t a revelation to me. I had known the statistics for a long time. Thirty thousand people die every day from hunger and preventable illness. Every day. Six thousand are children. Though I knew this indirectly, until that moment those children had always seemed like someone else’s responsibility. There I stood, a budding health professional with the resources and connections to whisk this boy away to the side of a well-trained surgeon and back again.

Was it my responsibility this time?

I continued counting motorcyclists, trying to decide what to do. I opted to wait for an opportunity to check with some of the doctors from whom I’ve been learning in Kampala.

The response came during rounds of the hospital the following day. "It’s quite common here," I was told, "Generally, you don’t need to worry about it unless the bowel becomes twisted or the blood supply is interrupted. Then it’s serious. Actually often the larger hernias are safer than the little ones."

"Oh good," I said, feeling both surreal and relieved.

On the drive back to Loubugumou, I considered this re sponse. The boy was in no immediate danger. I had dodged the responsibility. There was nothing I needed to do. Still, I had not dodged the question.

Between malnutrition, unsafe water, and poor sanitation, these children have far more than umbilical herniations with which to contend and no reliable access to health care with which to do so. In a country with supposedly universal health coverage, they are the rule not the exception.

What if the boy had needed treatment urgently? What difference if I poured my resources into treating this one child? Did he deserve it more than the others?

Worst of all, what kind of a system would prompt me to ask such a question?

The resources exist to protect all of these children. In Canada alone, we spend more each year on ice cream than we do combating global poverty. If the numbers were reversed, proper nutrition, safe water, and actual health care could be made available to every one of them, not only in Uganda, but also in several other countries as well. I’ve read it before. Somehow though, when I reach a Baskin Robbins or the frozen foods section of a Loblaws, it always seems so distant.

Having had two weeks to think about it, I’ve come to some conclusions. The resources exist. We have the power to make them available. That boy is no more my responsibility now for having been right in front of me than he was before.

He was always my responsibility.

The trade, economic, and political imbalances that lead to extreme poverty are subjects wide enough for several books but the central point is this:

There is a global system that allows for this kind of poverty. Canada is powerful enough to help change that system. We can influence our government to represent the causes in which we believe – We have the power to change that system. "It’s not my fault," "It’s not my responsibility," and "I’m only one person," are about as valid an excuse for apathy as "I was only following orders."

When we arrived in Loubugumou the following day, the children were there, happy to see us. We began our observations as they laughingly clambered over the pickup truck, shouting and joking in Luganda. Several of them were running around without shirts nearby in the tropical heat. This time, I noticed what I had not seen before: countless umbilical herniations, only smaller.

"All that is needed for evil to prevail is for good men to do nothing."
  –Edmund Burke