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Jose Antonio's family are having many difficulties.
He had been unable to keep his food down, vomiting frequently. We were very concerned the transplanted esophogas was sealing shut or narrowing. I took Jose and his mother to see Dr. B in Santo Domingo, the surgeon who performed the transplant. Dr. B did several x-rays with contrast to determine if liquids were going down correctly. I have the x-rays from 5 years ago after the transplant so Dr. B was able to have a good comparison. Dr. B encouraged Jose to eat slowly, chew his food very well and drink lots of water when he eats. He told us the same after the surgery and reminded us that the transplant will take many years to heal and he must be very careful.
Not knowing any of Jose's current family history, Dr. B said that Jose and his mother are very malnourished and need psychological counseling. Dr. B is also a certified nutritionist.
I explained to Dr. B that the family is very poor and do not have a lot of food. I thought that when food did appear in the home that Jose ate so rapidly, not taking time to chew and swallow very well the he gets choked and vomits. He concurred that this was probably a good analogy.
Dr. B is a medical professor at the university in Santo Domingo and requested to borrow the x-rays of immediately after the surgery and 5 years later to demonstrate to his students. I agreed and will pick them up on my next trip to Santo Domingo.
I knew that Jose's father had witnessed a murder last year and his life was threatened. He was a motorcycle taxi in PoP and one night dropped off a passenger at his destination. Seconds later a 4x4 pulled up, shot the passenger then threatened Jose's father, telling him to leave or he would be killed. Later Jose's father later had an accident on the motorcycle when someone pulled out in front of him and was hospitalized in the public hospital for a month. He has been in the home, paranoid to go out. Jose's mother takes care of a neighbor's 2 boys (in addition to her 6 kids) and doing laundry for this family, earning very little to feed her family of 8 people.
The kids are all very behind in school with the oldest boy and Jose not wanting to attend at all. While their mother is of petite stature, the children are all under developed, under weight and have no energy like normal kids, seeming very lethargic.
Jose's father started episodes hallucinating and becoming violent, beating his wife and the two oldest kids, 14 and 16.
After one day of much chaos Jose's uncle (by marriage) who is in the military, took the father to the military base dispensary for evaluation. I learned a military pediatrician comes to PoP every Thursday from Santo Domingo so I took the mother and kids to the base for evaluation. I explained the family situation and Dra. P said that Jose was suffering grade 2 malnutrition as well as the other kids. She prescribed pediatric vitamins, parasite meds, highly fortified milk in powdered form, a nutricious balanced diet and blood and urine testing. These tests must be done soon. Dra. P checked the two oldest girls (ages 11 and 14) to see if they were violated. Thank God they were not.
Dr. G, a general medicine doctor is at the base full time (Dominican time that is) and evaluated the father and mother. He ordered general blood and urinalysis testing as well as aids and drug and alcohol testing. Both of their results were negative for aids, alcohol and drugs. They both tested positive for anemia and infection. The father's blood pressure was high.
Dra. P ordered us to the "Tribunal de Menores y Proteccion de Mujeres" to see the prosecuting attorney. After explaining the case to the PA and the father talking out of his head like a crazy person, the PA referred us to the psychologist in the same building. This is a newly established facility for the protection of women and children. The psychologist said the father is suffering from post-traumatic stress syndrome and ordered him for psychiatric counseling. The father is on medication -- not sure but I think anti-depressants. The psychologist has been counseling the mother and kids.
All this has been through a series of several difficult weeks for all.
Jose was also suffering a severe case of ameba parasites, the worst of all. The pediatrician provided parasite meds for the entire family. I encourage them to wash their hands before eating and after using the bathroom. It's difficult for them to understand.
The oldest sister is having difficulty with headaches and I took her to see Dr. P, the military opthamologist who comes once a week from Santiago. Her vision is fine so he ordered additional tests which we have not been able to complete due to lack of funding. She seems to be suffering from depression. At fourteen years old, she's just passing to 5th grade.
I have been trying to provide food for them but certainly it has not been enough to increase their weight. They do not have a refrigerator to keep milk or juice chilled nor do they have a stove to cook. They use a make-shift hibachi type coal stove where they can only cook one pot or skillet of food at a time. I believe all the kids and parents have been burned from the stove sitting on the floor inside their little house.
We've come a long way with Jose's health, I am trying to do my best to keep him and his siblings from starving to death.
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