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An elective in Brazil

Kate Cheeseman, 4th year medical student at University of Newcastle-upon-Tyne With a grant from MMA HealthServe
Brazil is an inspiring country for a medical elective. I went to Belo Horizonte, the third largest city, because my parents run a shelter for homeless children there. This gave me the opportunity to learn about the provision of healthcare, partly by accompanying doctors and partly by using the public health service for the shelter children. The most exciting part of my time there was looking after an abandoned baby. Any baby would be amazing to look after but Aline is more amazing than most babies.

Aline arrived at the house with a social worker when she was four weeks old. She was all wrapped up in a little green blanket. Her head was a strange shape with one ear sticking out and her neck was twisted so that she was always looking over her right shoulder. She opened her left eye a crack as if she wanted to see what was going on and then began to let us know she was hungry.

We gave her a bottle of formula milk made up from a tin whose label proclaimed the merits of breast-feeding. I felt a bit nervous about bathing her because I knew very little about what was wrong with her or if there was anything special I needed to do. Once she was undressed I saw that she had a lot of stitches in her shoulder. Her legs and feet were bent at an angle that would have been impossible for most people and her fingers overlapped and were folded over and they could not be straightened. She was not very impressed with having all her clothes removed and being bathed but she was quite happy to be fed and soon settled to sleep.

Aline’s mother had not wanted to be pregnant and tried to have an abortion, which is illegal in Brazil. The first time she saw a doctor during the pregnancy was the week before Aline was born when she was in a lot of pain. An ultrasound scan showed that it was an ectopic pregnancy and her doctor immediately sent her to the main teaching hospital in Belo Horizonte. The baby was developing inside her mother’s abdomen with her placenta attached to intestines and mesentery. The surgeons decided to deliver the baby immediately by laparotomy. Her mother refused to look at her and swore at the medical staff when they asked her if she would like to give the baby a name. Aline was a name chosen by a nurse.

Aline spent the first three weeks of her life in the hospital. Besides being an ectopic pregnancy she had congenital syphilis that may have also contributed to her deformities. She was ventilated for the first week and needed to be treated for pneumonia and sepsis. She also underwent surgery to remove a mass of excess skin from one of her shoulders.
Before she arrived all we knew was that Aline had been treated for syphilis. I struggled through translating the notes that were sent with her. At first it appeared my Portuguese was even worse than I had thought because it was such an unusual story. One of the paediatricians supervising my elective explained them better and he was very surprised too. Later at the hospital where she was born I found almost everyone knew about Aline and wanted to know how she was. A paediatrician who had treated her came to visit us and brought some baby clothes for her. My parents live almost an hour by bus from the hospitals and doctors would not normally visit their patients at home. Apparently Aline was very popular with the nurses who said she was very cuddly. I think she is too. I wondered sometimes in the middle of the night if she had grown to expect to sleep in someone’s arms.

I never met Aline’s mother. She is a prostitute and she desperately did not want to be pregnant. I felt indignant that she would not look at Aline when she was born and that she had tried to have an abortion, but I know very little about her life or about Aline’s father. In some ways I was pleased to find she did not want a baby at all, rather than rejecting Aline because of her deformities.

In fact, by not attending antenatal care Aline’s mother probably saved her baby’s life. It is so incredible that she survived being an ectopic pregnancy. If her mother had attended antenatal care then the surgeons would almost certainly have operated when Aline was too young to survive. It would have seemed the best thing to do because the mother’s life was at risk and the baby was very likely to die anyway. If she had not been an ectopic pregnancy maybe the abortion would have been successful. Psalm 139 says, ‘For you created my inmost being; you knit me together in my mothers’ womb. I praise you because I am fearfully and wonderfully made.’ God knew all about Aline too, even if she was not in her mother’s womb. This baby’s life had already been miraculous and she was only seven weeks old.

Aline has improved noticeably even in just one month. Her head is less misshapen, her ear does not stick out as much; she can turn her neck to look straight ahead and even a little to the left; she can open the fingers of her right hand, she is growing and generally she does everything a baby of her age should do. I was worried that her brain might have been damaged but so far she seems to be developing well. It was wonderful when she smiled for the first time.

She is seeing physiotherapists at the hospital every week and she has a referral letter for an orthopaedic assessment, although they said that they are not taking on any new patients at the moment. She has just had her second appointment with the physiotherapists and they were very encouraging. They were pleased with the progress she has made this week and told us to continue to change the position we hold her in and how she sleeps and to exercise her neck and shoulder. They said she would not like having her shoulder moved but it is important so that she does not grow up with a paralysed arm. They were right, she hated it. We both ended up in tears. Apparently it will get easier.

Whenever people are talking about abortion someone always seems to bring up a theoretical case of a baby who is very unlikely to survive and the mother’s life is at risk. Whichever side people are arguing they tend to agree that abortion would be the best thing in this situation. If I were asked for my opinion now, I would find it more difficult to answer than before. I still think it would be irresponsible to encourage a mother to continue with a pregnancy that was likely to end in the death of both her and her baby, but I don’t think the answer is as clear as I used to. In this particular case I am so glad that no doctor was asked for advice until Aline was a full term baby and both she and her mother survived.

I hope the children’s judges will find an adoptive family for her soon. God has already brought her through an incredible beginning of her life and I know that He will take care of her.
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