Wednesday, September 21, 2005

58 DENGKLOK - Lady Living on the Street; Child With No Anus


Near Bogor’s Empang Market, I came upon a shopping street that looked as if it had not altered much in appearance since the time of Dutch colonial rule; the buildings were relatively small and seemed to be a mixture of neo-classical Dutch, with squat shapes and cheap Doric columns, and Art-Deco, with cool classy rectangles and curves; the paintwork on most of the buildings looked tired and grey with dust. As I meandered along this street I spotted a fragile old woman sitting on the pavement. She had a fist-sized lump on her neck and yet she managed to give me a sweet smile.

We made conversation. She said she had difficulty talking, eating and breathing. She had no family and lived on the street. My invitation to take her to the nearby Labar Hospital was accepted. A young doctor agreed to admit her as a patient, in spite of the fact that she was a street-person and had no family to guard over her in hospital.

While I was in the accident and emergency ward, a dark and gloomy place, I listened to the hysterical wails of the mother of a girl aged about four. The girl had what looked like a hole in her torso, just below her stomach. When I asked what the problem was, the young doctor explained that the child had been born without an anus; she had to use a tube attached to a bag; the family were desperate for a permanent solution to the girl’s problems; the Labar hospital was too small to provide the sort of operation required by the girl. The mother was plainly dressed and obviously not rich. I offered to take the mother and daughter to a hospital in Jakarta. The mother consulted her husband who had been waiting in a corridor and my offer was greeted with enthusiasm.

Jakarta’s Kota Hospital, which had been recommended by the Bogor doctor, is a big sky-scraping concrete shoe-box, like a giant council block in Sheffield. We were introduced to a surgeon, a big man in his fifties, who seemed to have more of the appearance of a plumber than a doctor. The surgeon agreed to have the child admitted to the hospital. I agreed to return the following evening with some money.

"You don’t have to pay," said the surgeon.

"I thought everyone had to pay for treatment," I said.

"Not everyone has to pay," said the surgeon. "Poor people don’t have to pay. And some people who work for the government have insurance."

"But I’ve never before come across a hospital where payment is not required."

"I assure you, there is nothing to pay."



After school next day, I hurried to the Kota Hospital and found the surgeon in a corridor.

"Your friends have gone," he said.

"Without an operation?" I said.

"Without an operation. They decided to return to their home."

I wanted to find out more, but the surgeon shook my hand, praised me for my kindness, and hurried off.

So, what was I to make of it? Had the parents changed their minds? Had the hospital decided it did not have the money or the expertise for the operation? And if the girl had stayed longer, and had had the operation, would it have been a success? I will never know. I never saw the family again.

At the weekend I motored to Bogor and called in at the ward of the Labar Hospital where the old lady with lump on her neck was staying. She was nowhere to be seen. A nurse claimed not to know of the lady with the neck lump. I left the ward and wandered along a corridor. There was a door on my left. I opened it and entered a small room with one bed. On the bed was my patient, eyes closed and looking grey. I touched her arm. It was cold and hard. The lady was dead.

At the reception desk I insisted that I must see the director of the hospital.

"The director is not here," said the receptionist, looking slightly shaken by my obvious anger. "But I’ll make an appointment for you to see him tomorrow."

Next evening I met the director, a small, grey haired, former army doctor, who had a reassuringly worried manner.

"We are sorry about what has happened," said the director. "The old lady had cancer. It had affected her ability to breathe."

From the director there appeared to be none of the arrogance or deceit that one sometimes encounters among members of the elite. I felt disarmed. I shook the man’s hand and left.

Would the lady have lived longer if she had remained sleeping on the street? There was no way of answering that question. What I did know was that both the Labar Hospital and the Kota Hospital were run by the government. Government hospitals were cheap but, according to my driver, they were best avoided.

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