A Whole Different Ballgame

The changes in Casa Jackson, implemented since my last visit, are numerous. It seems many of the rules have become more lax, and there are now more volunteers allowed per shift. In some ways, these are great changes. Increased laxity with the rules means that the few rules there are ought to be more easily enforced and more widely followed. More volunteers per shift should equate to more hands on deck caring for the babies, and more time actively engaged with volunteers.

There also seems to be some confusion regarding what type of setting Casa Jackson truly is. The type of setting determines the rules. Some people, volunteers and management, view Casa Jackson as a hospital for severely malnourished children- hospital being a place where strict hygiene and infection control policies must apply at all times to protect the babies from further illness. Others view it as a place where babies are going to receive nutrition, love, and interaction with caring staff and volunteers.

These two views need not be mutually exclusive, but finding a "happy medium" seems to be an ongoing challenge at Casa Jackson. On one hand, relaxing the infection control policies has led to increased peer interactions amongst the babies; the babies are clearly more motivated to move and explore by each other than by any other adult. This bodes well for their development. The official abandonment of the "mask at all times" policy provides far more opportunities to model speech sounds for the babies, almost all of whom are extremely delayed in their expressive communication. With the increased laxity in these policies, the babies are certainly recovering in a far more "natural" environment.

Still, coming from a medical background, it feels wrong to give the babies here any less consideration in protecting them from infections and illnesses than they would be given in a US hospital. I'm very interested to see if there are more colds and stomach viruses going around Casa Jackson due to these policies, or if the relaxation of the rules doesn't affect the rate of kids getting sick at all. I do very much hope they aren't adversely affected, because again, it does feel like a less institutional environment for these kids to be in for several months at a time. I'm still conflicted.

Yesterday, I arrived at Casa Jackson a little early for the afternoon shift. Despite there being four volunteers signed up, there were only three of us there other than the nurses. With a full house of 19 babies, the absence of one person is definitely felt! There are a lot of walkers, crawlers, and scooters right now and it seemed like every step I took there were little hands and feet that had snuck up beneath me. While it gets a little harrowing trying to rush around and change diapers without stepping on anyone, it is wonderful to see the kids moving around and exploring as much as they're able to now.

Due to the short staffing, I stayed with Rafa through the afternoon shift, the dinner shift (a two-hour shift newly created to help the nurses during one of the busiest times of the evening), and into the evening shift. We left around 7:15pm. A six hour day may not sound very long, but with 19 babies who need to be fed, changed, fed, changed, and changed again, as well as held and rocked and entertained, and only five people (including nurses) to do it, six hours feels like sixteen hours. Sixteen wonderful, trying, heartwarming, frustrating, inspiring, fun, ear-splitting hours.

It's amazing to me how some kids are so resilient. Many kids that come into and leave Casa Jackson really do thrive. They don't seem to experience any horribly glaring residual delays, beyond the typical cultural differences that are often viewed as delays by foreigners assessing the skills of kids growing up in this culture. For those kids, Casa Jackson truly is enough.

It's the ones who aren't thriving, the ones who are sick and admitted for months on end, who can't sit up or stand despite being over two years old that worry me. The ones who are too weak to make any progress developmentally, and can't seem to make progress nutritionally either. I'm concerned about the lack of long-term follow-up for the kids. What happens to the kids who may get better medically, but whose parents can't afford to send them to school or the doctor? The kids who aren't visibly handicapped, but absolutely need support? The many, many kids who- once again- just fall through the cracks?

It seems I've given myself a new "to-do" on my list here...