A doctor in DRC: Bolomba, soon a memory

09 November 2017

Ludvig has recently completed an assignment as part of MSF's emergency team in the Democratic Republic of the Congo. He's shared his diary with us. Today's entry was written just a few days before he left the remote village of Bolomba, where he and the team had been fighting a dangerous outbreak of measles...

And so, suddenly, there are only three days left before I leave Bolomba for good. On Monday, I'll get on a motorcycle again for a crazy, 11 hour journey towards Mbandaka. From there, I'll fly on Wednesday towards Kinshasa - and then, in 10 days and counting, I'll fly to Brussels and then Stockholm. A few months ago, I would have considered 16 hours Kinshasa-Stockholm to be a busy trip, but I've got a new perspective on travelling here – like so much else in life...

It is probably the most isolated place I will ever visit. 

I spent last week in Itotela. It is probably the most isolated place I will ever visit. No mobile phone coverage. It was even hard to find coverage with the satellite phone. A narrow, muddy path as the main road. Thrifty with food. Apart from bananas, which were abundant: let's just say it will be some time before I eat them again...

The rainforest was the only neighbour, which in itself was pretty nice, as it got a little cool at night.

The hospital in Itotela is basically a small copy of the hospital here in Bolomba. The disease evaluation is also largely the same, except that the number of measles cases is smaller. This is partly due to the fact that the PUC (the emergency team) mass-vaccinated the children in the area of ​​2014, which means that in principle the only children susceptible to measles are those born after that date, or who weren't vaccinated as part of that campaign.

However, in exchange for the lower levels of measles in Itotela, the prevalence of malnutrition is significantly higher. And malnutrition is by far the most challenging condition we treat here. Undernourished children are, firstly, extremely sensitive to infections and, secondly, much more difficult to assess clinically. They often don't get fevers because their bodies lack the means to mobilise an elevated body temperature, and they always look dehydrated (the skin is often loose, etc.). But at the same time they are extremely sensitive, as the heart, kidneys and liver are adapted to the minimum resources and are overloaded easily. It is simply very difficult to distinguish a malnourished child who only needs nutrition, from a child who one minute later may stop breathing.

Photo taken form the back of a motorbike shows the driver's helmet and the wet path ahead

Photo: Ludvig Bolinder / MSF

So there's only three days left here in Bolomba and my strongest feeling is - home sickness. As expected. Everyone says the same: when you approach the end of your assignment you only want to go home, whether it's been three, six or nine months. How long my stay in Sweden will be is completely unclear at the time of writing.

I pass Eldris on Monday. A quick coffee on the move to mobilise my last forces, then I just carry on.

 

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