Congenital Abnormalities Undiagnosed and Untreated

Walking the market or visiting the school, the health worker in Barangay Trinidad can witness many birth defects which have gone unrepaired and untreated; neglect of the corrupt Philippine government. My first experience of this was on my first day in the Barangay – it becomes a matter of fact once you digest that there is no treatment available. In some cases, I wonder, are there other potentially-debilitating defects associated which have been undiagnosed? What are the long-term health consequences of such defects? As a midwife who performs neonatal examinations, I know that where there is one defect, there very well may be others. In particular, when I see children with a mid-line defect, such as a cleft lip/palate, I wonder how extensive of a physical examination has the child had, if any at all?

Some of the more common-place ones I have witnessed:

Partial blindness from malformed eye: There is a boy with an abnormal eye in Billy’s basketball play group. He does not play basketball, but sits on the sidelines and observes the game with the younger kids. Vision impairment will have a major effect on his ability to earn a livelihood in a rural peasant community. I imagine, however, that the child learns to compensate with his good eye as much as possible; but with the common tool of the peasant being the machete, and knowing the regularity with which the health workers repair machete wounds, it must be a risky compensation.

Deafness & impaired speech: There are 3 children who are mostly deaf and who hence have impaired speech in a family of 6 children. The parents wonder why this is happening to them, but no medical professional has ever visited them and reviewed their medical history and pedigree; there are no services available to this family, and no funding for the children. Women in the community have no access to iodized salt, and goiter is fairly commonplace among women of childbearing age and this might be the root of the deafness. I have not seen anyone using signing with these children, and when I asked Nanay if his parents use sign language, she was unsure.

Cleft lip/palate: Although I have seen other unrepaired clefts, there is a girl in Sophia’s play group that must be about 10 who has a marked cleft, and for some reason, this strikes me as the most regretful neglect of the Philippine health care system. Perhaps it is because I am very knowledgeable about the available intrapartum diagnosis, neonatal nutritional monitoring and support, early structural and cosmetic repair, dental care, and counselling available in Canada for parents of and children with a cleft. It makes it hard to look the politicians in the eye when we meet when I know the suffering of these children.

Club foot: There is a young boy of perhaps 10 who walks on his ankle bone as his foot is markedly clubbed. The ankle appears to have a dense layer of scar tissue, but I do wonder about pressure wounds and circulation issues, not to mention, life-long pain.

Extra digits: A minor and virtually non-issue, but a large number I am seeing, and something that we would not even question repairing in Canada.

I know this entry is disjointed, but my time is so tight and I only have access to the internet very sporadically, and then only for an hour at a time. It might be another month before we have internet again, so take care everyone!