Medicine at the frontier

There is plenty to choose from: hundreds of chickens stacked layer upon layer on the back of trucks and pick-ups, gawking around at their last views of the world as they head to a certain fate; herds of goats wandering anywhere they please, eating whatever they find or dusty donkeys laden with impossibly large cargoes, picking their way through rush hour traffic.

I am particularly fond, however, of the interaction between man and buffalo.

buffalo

You see, for a man from Africa like me, the African buffalo is a very bad tempered fellow – highly likely to visit his anger on a frail little human. Not so it seems, the Asian buffalo! This is without doubt a gentle giant.
On the way home from work each day, I find myself smiling uncontrollably at the site of groups of buffalo, hot and tired after a long day in the sun, thoroughly enjoying being bathed. This simple spectacle takes place in the river that runs through our town. The buffalo, their heads just visible above the water, relax in a state of bliss as their human attendant scrubs and rinses them each thoroughly, hopping from back to back until he has pampered them all.

Something else which lightens up my day is witnessing groups of buffalo loping by, all with henna-coloured hair! Yes, bright oranges and reds between their horns – just for fun of course.

But the sight which made me think to write this post, was that of a small boy (weight: 30kg) who couldn’t have been more than 6 years-old driving a very large buffalo (weight: 800kg+) across the street. In order to do this he was using his stick enthusiastically on the buffalo’s large behind.

No African buffalo would ever put up with such treatment! But this placid soul continued to stroll leisurely along, seemingly without a care in the world.

Pakistan can be a perplexing place, filled at times with anger and hate – unfortunately this is too true of most other places as well. But in the midst of this, we might take a lesson from a peaceful buffalo, and not let the little things get to us.

So, perhaps I can suggest that a luxuriating bath, a new dye job or a gentle walk, can all be ways to leave the frustrations of life behind for a while.

Have an Asian buffalo day!

Due to the difficulties of working in a resource-poor setting, this happens all too frequently here in NWFP. But, many of our young patients, due to the excellent care they receive from MSF staff, do survive and will hopefully go on to thrive, and it is important to remember this in order to keep the spirits up.

So, this is a story with a happy ending.
Safina is 4 yrs old, and she has asthma. In this sense she is like many other little girls around the world; little girls who would love to be playing with their friends but who can find themselves limited by fits of coughing and feeling short of breath. But for Safina there is the added challenge that she does not always have access to the medicines she needs and the supportive medical care that could bring her illness under control.

Joe with Safina

I first saw Safina in the ER. She lay propped up on the bed, eyes closed and breathing very quickly, her chest almost completely closed due to an acute attack. The effort of breathing was rapidly exhausting her and we needed to act quickly. The MSF team went into well co-ordinated action: attaching a nebulisation mask filled with a life-saving bronchodilator, adding supplementary oxygen and establishing an IV line so other emergency medications could be given.

It took quite a while for Safina to settle and we were on edge for about an hour because we feared that the work of breathing would become too much and she would collapse.
But, with time and careful support her chest opened and her breathing became easier, she opened her eyes and looked around. What a relief! From the ER we were finally able to transfer our now stable little patient to the MSF-run in-patient ward.

Over the next few days she continued to receive the medicines and care she needed, and when I reviewed her on the ward round today the difference in her condition was remarkable. She sitting up with a brightness in her face that had been completely absent on that first day I saw her.

Moments like this are what make working here worthwhile.
And, while Safina will continue to face obstacles to staying well in a place where money and medicines are scarce, the presence of MSF in NWFP means that at least she has survived to have a chance at life.

It is easy to take breathing for granted, after all it seems so natural, so effortless. But when we stop to consider that there are some for whom the next breath is an intense struggle, perhaps we will be a little more appreciative of life as it flows in and out, in and out …