Thursday, August 28, 2014

Broken Hearts in India

This is Sam.

Sam is a little under the age of 3 and lives in Kodaikanal, in the mountains of southern India. Like many of the other local families, Sam's parents probably make less than $1.50 a day... which has to go a long way towards housing, food, clothing, water, and other necessities for the whole family.

Sam spends his days at one of the creches along with many of the other 3-5 year olds in the community.  Here, he is provided with high-calorie meals, multivitamins, and regular health checks in addition to the lessons taught by the teachers and the opportunity to play with other kids.

Unfortunately, Sam doesn't get much of a chance to play with the other children at the creche or participate in some of the activities. 

That's because Sam was born with multiple ventricular septal defects, meaning he has several holes in his heart. 

 Sam stole my heart my very first day at the creche before I even knew about his condition.

He was an adorable, quiet, very small boy in an inside-out red sweater who seemed a little sad and was keeping mainly to himself. I couldn't figure out why he wasn't participating in the activities with the other kids. Then, when the doctor came for the weekly health checks I learned about Sam's congenital heart defect.

I listened to his heart and heard the loudest, most obvious murmur I have yet to hear, distinctly hearing the whooshing of the blood being shunted from one side of the heart to the other through the holes. The oxygen-rich blood in the left side of the heart goes through the holes back to the right side of the heart and mixes with the deoxygenated blood. This puts an enormous strain on the heart and lungs. In order to try to compensate, his heart has become enlarged and pumps at a much faster rate than normal. He also has pulmonary hypertension, which means that breathing is not easy for him, and he must take a host of daily medications in order to combat his heart failure (including digoxin and furosemide for the medical people who are reading this).

Despite how young he is, Sam is by no means oblivious to his condition and is an extremely smart little boy. He doesn't play with the other kids because he knows that just a little bit of activity is too much for his heart to handle. We could tell that there were some days when he felt worse or was more sad. One week he would sit and play, shyly smiling and laughing as I showed him pictures of my dog, the next week we couldn't get him to smile despite all of our best efforts.

All of the volunteers felt invested in Sam's case and we wanted to know what was going to happen to him.VSDs are actually one of the more common congenital heart defects but can often close on their own with time or conservative treatment based on how large they are. In cases such as Sam's where the VSD results in pulmonary hypertension and heart failure and is too large to close on it's own, surgical intervention is required to close the holes.

While open-heart surgery on a young child is a big deal in any part of the world, finding the means to have the surgery done is not much of a hardship in the US and other developed countries. This is not the case in Kodaikanal. The doctor informed us that for now they were waiting to see if his condition improved and if he became stronger for surgery, but even if that was the case, the resources and funds that he would need were just not available. He told us that Sam would most likely not live to be a teenager.

I struggled in that moment, feeling overwhelmed by so many emotions: frustration, sadness, anger, gratitude, determination...

Here was this sweet little boy, who should have his whole life in front of him, but because he was born in a part of the world that has less opportunities than where I was born, he isn't going to get the chance to live a full life.

Saying goodbye to him my last day at the creche was a very difficult moment, and my heart still breaks every time I think about Sam, but he is my reminder for all of the reasons I want to be a doctor.

In those moments when it doesn't seem worth it, and I lose sight of why I am doing this, I'm going to remember Sam and keep working towards a world where all children, no matter where they live, have access to the care that they need.

If you would like to also help make steps towards my goal, please consider donating to the organization that I volunteered with so they can continue offering medical care and nutrition to underserved kids all over the world: