Monique was a darling child with an engaging, infectious smile. Her sweetness and endearing ways made her the star of the neighborhood. She would sit semi reclined in her wheelchair with its integral head and neck support, shaded from the late afternoon Sun by her family’s carport. Passersby obligingly drew near because of her singular vulnerability and warmth. As each person approached, Monique’s face erupted with happiness revealed by an innocent, appealing beauty from her merry eyes and inescapable grin. This was the apex of her communication skills. Monique could not speak. She could not walk. Her body movements were futile and in-coordinated. She could move her head. She could move her face. Monique’s mother had to abandon attempts at working, to remain home and care for her invalid daughter, ensuring that she would not be neglected by marginally trained and uninvolved ‘professional’ care givers. Consequently, Monique never suffered from skin breakdowns or had urinary tract infections, in spite of having a permanently indwelling Foley catheter. Her shiny, thick black hair was always freshly shampooed and impeccably combed. The family was at subsistence level, living in section eight housing, surviving on welfare and food stamps, and state and federal aid programs for incapacitated children. Monique suffered from cerebral palsy, and though she was unable to verbally communicate, and could only smile and blink her eyes, she responded appropriately enough, so that everyone who encountered her knew this little girl was quite the sentient being, disastrously trapped in a useless body.
Directly across the street from Monique, lived another girl with Cerebral Palsy. Her name was Juliana. She was a much higher functioning patient, able to walk with unpredictable spastic movements, and could marginally speak a sort of garbled, ill pronounced language all her own. Juliana suffered from grand mal seizures which occurred with increasing frequency as she matured. Unlike Monique, Juliana rode the short bus to school and might have eventually been able to function somewhat independently, had she not experienced a fatal seizure one afternoon, alone in her bedroom, and strangled on her own oral secretions. The Sun beat down with the usual summer intensity, one Sunday afternoon, and Juliana’s lifeless body lay on a fire department gurney, with one hoseman pushing from the head of the apparatus, and squeezing an Ambu bag attached to the endotracheal tube protruding from one side of Juliana’s mouth, while another hoseman pulled at the foot. A third man stood on a bottom rail of the gurney, holding on to a side member with his left hand, while doing compressions with his right hand. CPR was interrupted only momentarily as Monique and the gurney were quickly lifted into the waiting rescue vehicle. Compressions and ventilations continued to the ER, where she was pronounced dead.
Monique’s family moved away from the neighborhood a long time ago, shortly after Juliana died. Now we have Junior to amaze us with his extroverted friendliness and warmth. Like Monique, he has the engaging, infectious smile of the mentally handicapped. Junior is about seventeen, going on seven. Better able to walk and talk than Juliana, he regularly plays softball in the street with children ranging in age from half of his own, to perhaps two or three years younger than he. His functionality is such, that he may well be able to bag groceries one day, or even ask the famous words, “Paper or plastic?”
The etiology of the disease afflicting these children and their families is inadequate or non existent pre-natal care. This is a common affliction of the poor and one symptom of the general health of a population which receives its primary care from an emergency room. As in other facets of health care, treatment is delayed or ignored until it is too late to render simple, inexpensive measures which would avert chronic disabilities or death. Planned Parenthood offers free or low cost pre-natal care to the poor and disenfranchised. This is determined on a sliding scale depending on a patient’s ability to pay for services. Since 1942, Planned Parenthood has provided a range of services to over three million people in the United States and its caring extends to over one million clients out of the country. It screens for breast, cervical and testicular cancers, and performs pregnancy examinations. Planned Parenthood tests for and treats sexually transmitted diseases, and performs comprehensive sexuality education. It is unique in that it also offers counseling and therapy for the suffering associated with menopause. Termination of pregnancy is also a service, amounting to only fifteen percent of Planned Parenthood’s annual revenue, a service which is not federally funded. Abortion is the primary focus of the religious right, but it is obviously only a small part of the agency’s concern. Planned Parenthood has been the primary subject in the American abortion debate, and has been the most well-known target of ‘pro-life’ activists for decades. Clinics have been the target of many examples of anti-abortion violence, including bombing, arson, murder, and attacks with chemical weapons. The pogrom for the destruction of Planned Parenthood, by the religious right and its ultra conservative political allies, serves to deny reproductive healthcare to millions of both women and men, and further ensures a strata of the working class condemned to a lifetime limited to an ultimate goal of asking whether the customer wants “paper or plastic”, and maybe being lucky enough to sack groceries.