It's Sunday evening in Lankien again.
I've had a quiet day, catching up on my sleep and on my sock washing, reading a novel, and trying to convince my body that this 45 degree + heat isn't really so bad. I described it to someone recently as a little bit like living in a giant blow-drier (or at least what I imagine that might be like).
I was on 1st on call for the hospital last night. The report and the handover of keys happened at 5 pm yesterday and things didn't really stop until 1 am. As the MSF hospital in Lankien is really the first, last and only medical care in this region, people travel for hours and even days sometimes to reach us.
What that looks like on a Saturday night can get a little hectic.
Malaria continues to be a major problem.
Although it seems the numbers are slowly, slowly sliding down. Hard to see the improvement sometimes when there is a double row of parachecks (malaria rapid diagnostic tests) lined on the ER table and almost every one shows a positive result.
Even worse is to see so many tired little ones around, waiting for help. The diagnosis can come along with severe anemia, as a result of the malaria disease process. What that does to the body sometimes means a fatal outcome, particularly for young children. Blood transfusions are an important means to beat back this problem but gathering and delivering transfusions can be challenging.
Amongst other reasons, there is limited capacity for blood storage and in most cases donation is on-the-spot after family and friends are tested and matched. Once you've got a donor, attention to maintaining temperature control for donated blood is essential, but slightly tricky when it's over 40 degrees during the day and over 30 degrees even in the middle of the night!
Sometimes (as was the case last night) we have the good fortune to find a donor and the blood was prepared and delivered, only to find that the patient had developed a complication that had to be addressed before the transfusion could begin.
As in any hospital of course, there is never just one thing going on at a time.
Apart from malaria, people were arriving until the small hours of the morning for a wide variety of reasons including: snake bite, human bite (yes really) respiratory distress, mental distress, dehydration due to vomiting and diarrhea...and the list goes on.
An interesting twist came when a guard came to tell me (as I was trying to solve a few other problems) that he thought a lady was trying to give birth at the gate. I'm happy to report that she did not, and made it to the maternity team on time!
I got called out again a few hours later to check a patient in distress. As I was listening to this tiny human's breathing with my stethoscope, I caught site of a shape scurrying along the floor. Initially I thought it was a rat, but then I realized that it was a hedgehog.
In fact two hedgehogs were scooting around the inpatient malnutrition centre in the wee hours of the morning. I don't know why or how there are hedgehogs in South Sudan but they are here, and they are extremely cute. There are always some uniquely wonderful and weird moments as a nurse on night shifts, but this was my first involving hedgehogs.
"It's difficult to let the work go"
I find myself going back over situations and information, wondering if I made the right decisions, or if I could have missed something. I am fortunate to have amazing colleagues who I can call for help right away on the radio if in doubt, and also the national staff are the ones right there doing the care 24/7 (and indeed the ones who spotted the child in trouble at 4am and called me).
Once again my international and national staff colleagues gave me the gifts of their experience, patience, hard work and sense of humour, even when it was hard to see something to smile about.
I handed over the keys and the report to another of my colleagues at 7am. I walked back to our compound, had a shower and some breakfast and enjoyed the relatively easy temperatures of the early morning.
I thought about my night, about my frustrations and worries but also about small moments of beauty and grace that I had witnessed.
There was a national staff member who quietly sat and shared his dinner with the family member of a patient who had nothing at all to eat.
There was a group of big, strong, grown sons hovering around their frail elderly mother, just waiting to hear how we might help this lady. (They made me think of and miss my own brothers and mum.)
There was also, indeed, the patient who finally received the much-needed blood transfusion, and the last I heard was doing much better.
And so we continue.