She sat across from me, a Soviet-era wooden table between us. I was leading a medical mission to a tiny village in Moldova, the poorest country in Europe. Once part of the Soviet Union, Moldova struggled to survive as an independent country. For many, to live in Moldova, is to live with little hope of anything ever getting better. The young people are most affected by the collapse of the Soviet Union. They have little job opportunities. They cannot travel freely except to a few “approved” countries. They are prisoners in their own country. . As a Moldovan pastor once told me, “The world either has never heard of Moldova or does not care about us”.
She was unsmiling, eyes downcast, shoulders drooping. At 15 years of age, she had the striking features so typical of eastern European women. Through my interpreter, I asked the usual questions as I took her history. In a barely audible voice, never looking up at me, she spoke of having abdominal pain off and on for the past several months. Further questioning revealed no other worrisome symptoms. I reassured her, gave her some vitamins, and spoke to her about why we were there as a medical team. After praying with her, she quietly thanked me and left without another word.
Not long afterward she was back. This time complaining of chronic, recurrent headaches. I was surprised she returned but I did not give it too much thought. I addressed her concerns, reassured her, and sent her on her way. As I was seeing the next patient, I could see her standing to the side looking at me with what? – sadness, hopelessness, desperation? At first I was irritated. Had I not already seen her twice? Could she not see that I was busy and there were many other patients? She continued to stand, waiting, looking. It was then I realized there was something more going on than I had realized. This was a cry for help.
I called her over and asked if there was anything further I could do for her? She became anxious and began looking around the room as if looking for something, or someone? She brought up a new physical complaint and I reassured her. “How are things at home”, I asked? Where did she live? Did she live with her parents? Was anything going on at home she needed to talk about? My gut told me that there was something very wrong. After all, Moldova is the central hub of human trafficking in Europe. Was she trapped in that most horrible of situations?
With compassion and caring, my interpreter translated these questions. Her chin began to quiver and the tears to flow. She nodded her head yes, softly saying that her older brother was sexually abusing her and had been for over two years. They lived with their grandparents as their parents were both working out of country as is very common in Moldova. Financially, it was the only way many families could survive. The grandparents knew nothing as she was too afraid and ashamed to speak up. Her brother would beat her if she did.
My heart broke for her as I fully comprehended her situation and the fear she lived with every day. Whether human trafficking or domestic violence, the trauma, the pain, the guilt, the shame, the hopelessness are ever present. She could not return to that environment. I spoke to the local pastor and explained the situation. He would have his wife take her into their home and get her help. It would be a long road to recovery for her.
I do not know what happened to her after we left. Always there is the realization that this is too common a situation. How often do we miss the subtle cries for help because we are too busy to “hear”? We live in a hurting world. People are not always “fine” as they say when you ask them the proverbial question, “How are you”? Too often they are not fine or good or wonderful. It is easier to say so than to admit the painful reality in which they live.
We are often allowed into the most intimate aspects of a patient’s life – the good and the bad. The sacredness of this relationship is a special privilege. How often do we miss a “cry for help”? Medicine is much more than the medical care we provide. There is also an emotional, physical, and spiritual component – caring for the whole person. To do so we must be ready to see the need in front of us, otherwise we will miss it. There is too much at stake. People are crying for our help. Are you hearing them?
Andy Lamb, MD