CAR Welcome Package

08 March 2017

Today is Saturday, January 28th.  It makes 24 days since my start of mission, 8 days since Trump took office, and about 8 hours since my first African illness began. 

Do not fear, I am not close to death, and I was able to round on not one, but two services today, so I am not incapacitated.  I am not sure exactly what is happening, but have been experiencing waves of cold sweats and neon green demi-liquid stools. I am sure this is just the Republique Centrafricaine Welcome Package that I have received from one of the lovely malnourished kids in the nutrition ward.  Frederic! Why did you have to be so cute?  I suppose it was too much playing and not enough soap.... 

But what better thing than oddly-colored bodily fluids to use as a segue into my first blog post? I am here in Bossangoa, a small, but seemingly important town (it was the site of the former president’s vacation home, after all) about one hour north of the capital Bangui by plane.  We run a hospital here; I am told it’s the third largest hospital in the country.  Services include maternity, intensive care, neonatology, internal medicine, pediatrics and nutrition. 

I have spent my first few weeks in the nutrition ward and I have been surprised how much I love it, as it is nearly the exact opposite of the medicine I choose to practice: emergency medicine.

The kids hate me, however: my entry into the room each morning seems to always elicit a cacophony of sobs.  Probably due to a combination of their metabolic derangements, malaria, and the inherent fear all children have of strangers. Nearly 100 percent of them just refuse to smile at me, which throws me off: in my ER back home, a grin is a great way to differentiate between “not sick” and “actually sick”. 

Yet despite my patients’ obvious skepticism toward me, there is just something so satisfying about watching the kilos slowly count upwards.  When you finally do get a smile, it is definitely worth it.

When I finish up in the nutrition ward, put away my Plumpy'Nut® and my mid-upper arm circumference bands—an easy-to-use indicator of how well-nourished (or not) a child is—I move on to the salle d’urgence, the emergency room. Emergencies are what I am trained to do, so this is where I should feel most comfortable. But it’s not—at least not yet. It is where my emotional conflict begins.  

Here, I’m seeing patients who are worse off than nearly anyone I’ve ever seen while working for four and a half years in emergency departments in the US. They’re suffering from illnesses which, up until I arrived here, were part of medical history as far as I was concerned. But these pathologies—tetanus, typhoid, cerebral malaria—are a daily reality here. 

This is the source of my internal conflict: should I be appalled at myself that I am fascinated by these diseases?  Intellectually, I am. But should anyone still have to live like this, where a bicycle accident and a scraped knee can bring about a potentially fatal tetanus infection? Between the writing and editing of this blog post, we have had two people die from tetanus! The constant pursuit of knowledge and experience makes for the best clinicians; but there are very few clinicians alive who have seen smallpox, and I’m sure all would agree that we are the better for it.

These are some of the thoughts I have been having today while enjoying my CAR Welcome Package. Speaking of such, I will have to cut this one short as the sweats are back again. 

À la prochaine!