Wednesday, April 11, 2012


I sat in the waiting room and played with the little yellow card as I waited for Emmet to finish nursing.  He had just received 4 vaccines, and the length of those needles going into his soft fleshy thighs was at least as distressing for me as for him.  I turned over the card reading all the fine print to pass the time as he soothed himself. 

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.


  1. oh goodness....four. my mama heart is having a hard time thinking of this.

  2. Wow. With each story you post, I find myself thinking that this is happening today, not sometime in the past. That what you see every day in your part of the world is the reality. My heart hurts for all those families who have to check that box.

  3. This makes a mother's blood run cold. The world is a scary place without vaccines and medicine. We should never take them for granted. Ellen

  4. It's those small things that smash through the bubble, I think, where you realize how far away are all the things "we" (ie, first-world, developed world, call it what you will) take for granted. Four or more. Exactly. Why four? Two is just bad luck; five beyond comprehension? The bureaucratization of the lives lost makes me clench inside.

  5. Four being the threshold obviously means five and six and beyond isn't particularly "noteworthy". Honestly, the things we complain about! What a very sad little card. And larger circumstance :(