Lauralee in Lankien

Tukul 3 is uncharacteristically quiet and cool. There is only one tiny patient here, lying on a wooden bed under a mosquito net. She is all of 5 days old. The baby’s mother divides her attention between her sick newborn and her older child who plays quietly in the corner of the tukul.

The baby is unable to breast feed. Her tiny fists are balled up against her chest and her arms and legs are stiff. Sounds, lights and movement can all cause painful muscle spasms. Even a lick of wind can do it. She must be nursed quietly in the cool dark tukul away from the other patients. Her mother is having a hard time understanding why she cannot touch and hold her baby.

The baby has tetanus, or “lockjaw”. Tetanus is a terrible painful disease; victims remain fully conscious and can feel the muscle contractions. In newborns, tetanus is caused by contamination of the umbilical stump by the bacteria Clostridium tetani. Contaminated instruments used to tie and cut the cord are usually responsible.

The baby is being tube fed; she is getting an antibiotic, antitoxin and diazepam for the muscle spasms, but that is the limit of our capabilities. If the infection attacks her respiratory muscles, we can only support her breathing for a short time.

In this setting, mortality from neonatal tetanus (tetanus in the first 28 days of life) is probably close to 90%. In developed countries, neonatal tetanus is rare to non-existent but in places like southern Sudan it is a common cause of death in newborns. WHO estimates that up to half of all neonatal deaths in Africa and Asia are caused by tetanus.

The tragedy for this baby is that neonatal tetanus is utterly preventable. Immunization of pregnant mothers with tetanus toxoid and clean deliveries can decrease the incidence of neonatal tetanus to almost zero.

It was the end of the 19th century when scientists first learned how to prevent neonatal tetanus. But here we are, more than 100 years later, and babies in southern Sudan are still dying from it.

The twins are back and so am I. They are big for twins, a boy and a girl, named after the nurses in Nasir. Oh, well.

After 10 days in Loki and seven solid sleeps, the world looked brighter.

The Top Ten Reasons for Returning to Lankien

Number 10: Pride

Number 9: I have more blog entries to write.

Number 8: My husband is away watercolor painting on the east coast of Canada anyway.

Number 7: There are more birds that need identification.

Number 6: I have not learned everything I could learn in Lankien.

Number 5: My mission does not feel finished.

Number 4: I did not say good-bye to anyone.

Number 3: There is no one to replace me immediately and I have not done a "hand-over" to a new doctor.

Number 2: I would be leaving MSF and the project short-handed. Patients would suffer and so would my colleagues in the field.

Number 1:

I have packed all my stuff. My tukul is empty. I am going to Loki for a ‘break’ and I am not sure I am coming back.

Zac, the base nurse, eyes my bulging backpack and says, “You are coming back aren’t you?” He has seen this before and knows the signs. I say, “Yes, of course”, but I feel guilty as I say it. I am filled with self-doubt. Perhaps I am just not tough enough for MSF. Perhaps I belong somewhere else? The thought is disappointing; I had planned to do several field missions with MSF over the next few years and then stop when I was too old and decrepit to withstand the rigors of the field. But perhaps I am already too old and decrepit?

The full team has been back for a week. The work is considerably easier and I am on call only every fourth night. But I still cannot sleep. The bags under my eyes grow larger by the day. I had hoped that I would start to feel better this week and my thoughts of escape would evaporate but they haven’t. I am going to Loki to rest, talk, try to sleep better, and to think.