Fieldset
Tetanus, monkeypox, and baby news...

Alexander is a doctor from Sweden. He's currently working for MSF / Doctors Without Borders in the Central African Republic, a country where the health system has been badly affected by years of armed violence. Today, we meet some of his patients from the children's ward...

Her head is flexed backwards, while her arms and legs are contracted. It's called opisthotonos - I dredge the name up from the infectious diseases course I took back in medical school. Last time I saw this was three years ago, during my first assignment with MSF. I've not seen it since.

This infant, ten days old, is suffering from tetanus. And so far, tetanus is among the worst diseases I’ve ever encountered.

Tetanus is among the worst diseases I’ve ever encountered

There's a simple reason that most professionals in the Swedish healthcare system have never even seen tetanus, other than in academic literature: the vaccine.

Tetanus is so easy to prevent with just an injection. Each time I encounter this disease, although it's rarely, I’m reminded of the huge inequality still in the world. Healthcare isn't easy to access. In some cases there isn’t any at all.The political context in the Central African Republic doesn't make it any easier.

Image shows Dr Alexander Nyman and other members of the team crowded around a young patient

Alexander and the team perform a lumbar puncture on the baby to rule out meningitis.  Photo: MSF

The baby was born a week ago, at home, 12 miles outside of Bangassou, the town where our hospital is based. As the birth was in a non-sterile environment, the infection most likely comes from where the umbilical cord was cut.

We are two doctors down this week. The workload is of course taking its toll. The emergency room today is being covered by Dr F, while I'm doing the rounds in the paediatric department, which today is more than full - 41 patients on 33 beds.

Tetanus causes agnonising spasms that are triggered by bright lights, loud noises, or any sudden stimulation. So I leave the infant girl's room dark and quiet, as my round of the busy ward continues.

We protect ourselves with the sterile protective coat, protective mask, hairnet, glasses, shoe covers and gloves. I feel like I’m in a movie.

We reach the end of the ward. There is one patient left. The nurse is putting on a protective coat, and gives me one.

I ask him, "Why? For the TB patient?"  So far we've used only protective masks when consulting with the boy with tuberculosis, not head-to-toe protection like this.

"No, he is discharged. There´s someone else in the isolation tent", says Eric.

image shows a large white tent

Photo: Alexander Nyman / MSF

We protect ourselves with the sterile protective coat, protective mask, hairnet, glasses, shoe covers and gloves. I feel like I’m in a movie.

Outside the tent, seated on a bench are the patient's mum and dad. They are friendly, and very supportive of their son, who’s sitting up in his bed. His name is Jeconnais, and he is nine years old.

It´s not the infection itself that worries me. It´s the pain the boy is suffering from

Last Monday Jeconnais developed a rash, which evolved to blisters on face and body. And that’s what he's here for. The blisters are everywhere, worst on his face and neck; hard blisters.

It´s not the infection itself that worries me. It´s the pain the boy is suffering from. Each blister is putting pressure on the skin, like a boil, and it is extremely painful. He can't walk due to the blisters on the soles of his feet, and the isolation tent which MSF put up is unfortunately very hot. Thankfully there is a fan next to the bed.

Image shows a boy's leg, covered in small, hard blisters

Photo: Alexander Nyman / MSF

Jeconnais is suffering from Monkeypox, a transmissible but rare virus that exists mostly in Central Africa. The virus itself if self-limiting, which means it normally gets better with or without treatment, but all its complications are dangerous. The boy now gets the support of painkillers, anti-biotics and good nursing, as well as strong support from his parents. The isolation is a must, and so far no one else has been infected. Hopefully he'll be feeling better soon.

The newborn girl from last week's breech birth was named Martine. After just two days she was already doing well, and we were able to discharge her after a week.

You can read Alexander's post in the original Swedish here.