The card, which we will bring with us for each subsequent vaccine, had what you’d expect: places to record the date for each immunization, a growth chart with upper and lower bounds to check his progress, a place to record our next appointment.
At the bottom of the card were a series of statements with boxes next to them. The nurse was to check a box if the baby required “special care.” There was one for a single mother, one for twins, one for a child with low birth weight. All seem reasonable enough. We probably have similar precautions in the US. But there’s one box you’d never see on a routine form back home. It said “Four or more siblings died.”
First of all, I can hardly fathom the depth of poverty that would see that many children perish or the depth of despair that such tragedy would inflict on a mother. On a family.
But, four? four? Why four?
The form was developed by the Ministry of Health. People, experts presumably, sat in a room and decided what amount of sibling deaths would indicate trouble for a subsequent baby. They had to come up with a number. They came up with four.
Their job, I imagine, is to find the right cut-off. Set the number too low and you pull in a bunch of babies who aren’t at risk. Set the number too high and you miss kids who are.
There’s a lot wrapped up in that number four.
First, they decided that four sibling deaths was common enough to make the box mean something. There’s a certain percentage of the population that this is true for, and it’s not zero. That alone is devastating.
And they decided that any number of sibling deaths below 4 doesn’t indicate that this next baby is necessarily at increased risk. So, I’m living in a part of the world where 3 sibling deaths might be more attributable to what? Accident? Environment? Something so outside the family's control that it doesn’t warrant medical scrutiny for the next sibling.
I’m just amazed that I can live in a country (or a planet for that matter) that has waiting rooms like the one I found myself in -- with freshly mopped floors and mothers holding baby girls in frilly dresses waiting for life saving vaccines, but also a place where the number four is the right number on that little yellow card.