She shook her head no, eyes brimming with tears, chin quivering with emotion. Again, I told her that without further care, her son would never have use of his arm and possibly would die. Her voice trembling, she told me her husband would beat her if she returned home without the boy. She placed her son on their horse, his newly bandaged arm in a make-shift sling. I gave her antibiotics and medicine for pain, still pleading to let us take him to the nearest hospital. Shaking her head again, she turned and led the horse back into the mountains of central Honduras, the boy silent, staring back at me, the contrast between his tiny body and the horse striking.

Only an hour earlier, they had arrived at our clinic. She heard an American medical team arrived for the week and desperately wanted her son to be seen. The day before, while he was cutting bamboo with a machete, a miss  – swing cut into his left forearm arm. She bandaged it with the cloth as best she could and made the several hour trip by horseback to see us. I was amazed how stoic he was at only eight years of age, his toughness forged by his life circumstances. No tears, no sound, his ebony eyes watching my every move. I removed the blood-caked bandage revealing a gaping wound traversing his left forearm, exposed muscles appearing to be completely cut through. Remarkably, the main arteries were intact.

A nurse cleaned the wound, and then I began to explore the extent of damage carefully. He needed urgent surgical attention to save his arm and possibly his life. The nearest hospital was several hours away. My host partner, Ricardo, began calling. In a matter of minutes, a physician was on the phone, a friend of Ricardo’s. IV fluids and antibiotics were started, a sterile dressing carefully applied. In less than an hour, he was ready to go by car. I explained to the mother all we had done and the arrangements we had fortunately been able to make. Without our intervention, he would be refused care at any hospital because of her inability to pay. This is an all too common scenario in many countries – no money, no care. I was anticipating tears of joy and gratitude. Instead came the side-ways shake of her head and the flowing of tears.

I have led over 40 medical missions to countries in Central America, Eastern Europe, Central Asia, and northwest Africa, experiencing their unique beauty and the richness of their vastly different cultures. I have also seen the desperate poverty and ever-present hopelessness with which the people live. We are most fortunate to live where we do without the daily struggles to survive common to many in the world. The eyes of that little boy are always a reminder of that to me.

Andy Lamb is an internal medicine physician. He can be reached at Bugle Notes.

Image credit: Shutterstock.com