Hello friends and family!
As always, I hope this finds you well and happy. Today is the first day of the next year in the Islamic calendar, so welcome all to the year 1393! It seems to be the proper way to celebrate here is a massive picnic in one of the northern provinces, but for those of us who can’t make it up there we’ll just appreciate a day off with beautiful spring weather.
Things are moving along here. We’re headed into a season of “end of mission” for some of my team members. I think four of the team of 16 are leaving within the next month. A few of their replacements have arrived and it’s mixed emotions. Sad to see these people I have bonded with under intense circumstances move along, but excited for their ‘release’ and next adventures. Also, fun to get new personalities and talents in the group – they haven’t heard our stories yet!
Preparations are being made to ensure the safety of the project as the presidential and provincial elections near. Historically this is a time of increased conflict, but we are constantly reassured that this population is very specific and selective in their targeting. We believe we are a benefit to all actors involved and therefore have no reason to fear for our safety. From everything I’ve seen, I agree with this and will keep my head in the PICU/NICU sand trying to do my best for the patients there.
I’ve hit the mid-way mark for this mission and I’m trying to take a moment to reflect. Especially in such an isolated context, it’s easy to get frustrated by the huge boulder of need and inertia in our path, but I’m also seeing the downward slope ahead of me as I finish my time here. There are so many goals I’ve set or have been set for me that I’d like to see through, I’m starting to get frantic. No more excuses, just feet to the ground, pushing forward. At this point I feel like I have the trust and confidence of the staff and my MSF superiors, so I just have to take advantage of the time I have.
I continue to have extraordinary patient encounters. Most of them can’t be captured in pictures, many of them disappear without giving me the chance to see the result of our work. Sometimes I am struck by the horrible circumstances these families face, other times I am humbled by their perseverance and ability to show love despite what life has dealt them. For a couple of weeks we had a newborn in the NICU that the nurses called “Dr. Kim’s baby.”
I received a phone call from the medical director of the trauma hospital next door run by Emergency NGO. They had a married couple who were injured when they drove over a landmine, the husband lost both legs above the knees, the child in the car died, and the wife lost one leg up to the hip joint. The wife was pregnant, basically term, and the baby was in peril by the time they got to the hospital. They had done an emergency C-section and had no neonatology at their hospital, so I was taken over by ambulance with oxygen to retrieve the baby. They had done an amazing job resuscitating the baby and I was presented with a blanket-filled box (similar to one full of reams of printer paper) with small tube sticking out the top and the ambubag [bag valve mask] attached.
I dug into the blankets to find a pink, chunky baby who wasn’t very responsive to touch. We rushed him back to our hospital where the nurses were waiting to place the IV and start the fluids. I was surprised to hear a weak shriek and realized we had lost the endotracheal tube during transport, but the sound was melodious in my ears. He was placed in the incubator (next to another neonate, of course) to stay warm, have oxygen and get IV fluids and when I came in the next morning the nurses said “take your baby! He’s been crying all night!”
As the mother would not be able to take care of him and no family members were coming, the expat nurse and I did our best to fill in. We did feedings, changed diapers, gave baths, and generally held him as much as possible. He joined me as I checked other neonatal intensive care (NICU) baby charts, visited the doctors lounge for a respite from the noisy NICU, and was adored by all his “uncles” – NICU nurses and doctors.
Unfortunately, we couldn’t fill in 24-7 so we found another NICU mother to help care for him when we couldn’t be there. She was a 13 year old first time mother (her story is another astonishing one) and had more than enough milk for her 1.3kg (2lb 13oz) baby. She doted on him daily, but he proved to be a difficult feeder and required nasogastric feeding.
About a week after the accident and his precipitous delivery we were given permission to take him over to see his mother. Such a beautiful scene, no words to describe it. She hadn’t realized she’d given birth until two days after the accident and had been asking about him daily since. She spent a quiet 40 minutes with him before we had to return to the hospital and she gave him the name Mustafa. At one point I laid him on her bed to wrap him as we left and realized I had placed him where her leg should have been. His improvement in feeding was very slow going and ultimately his family came and took him home against medical advice. Daily I pray for the family to have patience with him and his feeding and that his mother heals quickly so she can join him at home.
Recently I’ve come to realize the PICU/NICU doctors and nurses are truly my personal heroes. Of course, I get frustrated with them on occasion as any supervisor does. However, this is an arduous job and these men have been doing it for a long time before I came and they will continue to do it well after my nine months are done. I admire their endurance and commitment to their work and caring for their community.
Thanks as always for your love and well wishes. Happy new year to you and your family!
Kimberly Sudheimer – Doctor
Kim wrote this post on 21st March 2014.
Kimberly is a paediatrician and is currently working as a paediatric supervisor at Boost Hospital in Lashkar Gah, Helmand province. Boost is one of the only two functioning referral hospitals in southern Afghanistan. MSF started to support Ministry of Public Health to work in the hospital from 2009 to help improve the provision of medical care in various departments, including maternity and paediatrics.
All the people featured have given their consent to appear on Kimberly’s blog.
MSF Field Blogs reflect the views of the author alone and not necessarily those of Médecins Sans Frontières