Février

20 March 2017

Today is Thursday and I want to tell you about this child. For simplicity’s sake, let’s call him Février.

Février wears a PSG (Paris Saint Germain) jersey—the only thing I have seen him in since we first met. Février probably doesn’t know any of the PSG players and will never see them play because Février was born in the Central African Republic (CAR). And because he and I, an MSF doctor in CAR, have met, you can assume that things are not going well for him.

Février’s mother brought him to a local health post near the CAR border with Chad. He was referred to us because of abdominal swelling.  When I asked how long the problem had been going on, my first question to any patient, this seemed to confound the family.  First, the story is two months, then a year, then . . . unclear.  Somehow time seems to be measured differently here. Or is it? The length of a day is pretty obvious, but other than that, what is a week or a month to a rural farmer? Fortunately for Février, he doesn’t seem to be in much pain.  Unfortunately, he looks like he’s pregnant. 

Tomorrow makes four weeks in CAR exactly, and since arriving I have become the de facto radiologist in the Bossangoa hospital because of my experience doing ultrasounds back in the U.S. One of the other expat doctors had asked me do an ultrasound on Février’s abdomen, which is how we met.

Him sporting his Angel Di Maria jersey, me clutching my ultrasound probe, I had a look inside Février’s distended belly—I had no idea what I was looking at. My ultrasound training was robust, but more focused on finding bleeding in a trauma patient or a blood vessel for an intravenous line. Finding the source of a major abdominal growth was not in my training. I was lost.

This is how I first got to use a system that I feel represents all that is good about MSF: telemedicine, which essentially connects what I’m doing with the eyes and expertise of consulting radiology, pediatric, and pediatric surgery specialists around the world, from Amsterdam to the U.S. As an intern, my attending physician would guide my probe to the correct position for an ultrasound exam; through telemedicine, the specialists were able to virtually hold my hand so that I could get the images we needed to make a diagnosis. I am still amazed at how well it worked. 

Unfortunately, this story does not have a happy ending for Février because he was unlucky enough to have developed a mutation that led to a complex tumor, a growth that is too all-encompassing to be treated without specialist surgery, chemotherapy, or radiotherapy. And because he was born in CAR, where a struggling healthcare system is just not equipped to provide this level of care.

I share this story because it illustrates the beauty and tragedy that is daily life here.  I can connect to what amounts to the entire world of medical knowledge in order to make a diagnosis. But I lack the resources to connect that knowledge to this child, and to his family. I can only offer pain medication and comforting words. 

I never could get the hang of Thursdays.