I am a neonatologist with an interest in improving global health for children. Recently I visited my friend Donnie, a volunteer health care worker living in Cambodia, to join him on a few medical outreach missions to remote villages. People living in these villages rarely receive medical care, especially during the rainy season when travel becomes more precarious. Before I left, Donnie e-mailed me seeking medical advice on a three-year-old boy named Peeka.*
Peeka had prune belly syndrome, a rare, potentially life-threatening, congenital disorder of the urinary system. The disease is characterized by a triad of symptoms: poorly developed abdominal muscles that cause the skin of the belly area to wrinkle like a prune, urinary tract problems, and undescended testicles. Children with prune belly syndrome often require surgery. Peeka’s parents had traveled to the city to have him evaluated. Doctors told them that there was nothing they could do. They just had to wait and see. Overwhelmed, they gave Peeka to his grandmother.
After I arrived in Cambodia, we traveled a half-day on muddy roads, many of them under water, to conduct clinics in rural villages in Kompong Thom. The monsoon season had turned the rice fields into a chain of lakes filled with men flinging fishing nets into the brown water. Unable to see the road, we cautiously navigated our way to a house high up on stilts and were greeted by a group of 10 people waiting to see us. We waded through the water with our medical supplies and walked up the steep stairs to the room where we would conduct a clinic.
As I finished examining a patient, I saw an elderly woman enter the room, carrying a small boy. He had a big belly that protruded out from the opening where his blue shirt was missing two buttons. Donnie, who was translating for me, told me that this was Peeka and his grandmother. I greeted Peeka’s grandmother, and she smiled, her face full of wrinkles that rippled around her eyes and mouth. I offered her a plastic chair, and she sat down with Peeka, who quietly stared at me with giant cocoa-colored eyes.
Peeka’s grandmother removed his shirt so I could examine him. I patted his sandy brown hair, and he stared back at me. Other than his abdomen, Peeka looked healthy and appeared to be growing well. His grandmother said he played with other children and had no problems going to the bathroom.
I gave Peeka a package of crackers and he gave me a big grin. He happily ate his crackers while we arranged for his grandmother to bring him to Phnom Penh to have his kidney function checked at the hospital. I explained to her that she should take Peeka to a doctor if he had a fever, recurrent vomiting, or complained of pain, since he might have a bladder infection or a bowel obstruction, both complications of prune belly syndrome.
As we left to go to another village, we stopped the jeep and said good-bye to Peeka and his grandmother. She stood knee deep in water holding a torn umbrella and Peeka, who was still eating a cracker as he waved at us and smiled. Although I was worried about Peeka, I knew he was in good hands. His grandmother was a strong woman who had survived over six decades of harsh Cambodian wet and dry seasons. She understood what it meant to wait and see, but I knew she would also be a reliable advocate for Peeka if he got sick.
My painting, “Wait and See,” is a tribute to Peeka and to sick children living in low-income countries who, due to poverty, have no choice but to wait and see if they will survive.
Unfortunately, millions of children with medical conditions are not doing well and have limited access to medical care. Many of these children are not able to wait and see.
They die instead.
Ryan M. McAdams, MD
Dr. McAdams is associate professor, Division of
Neonatology, Department of Pediatrics, University
of Washington, Seattle, Washington; email@example.com.