Ann Sellberg has worked with MSF since March 2014, focusing on HIV (adults, kids, treatment failure and cervical cancer screening) and is currently part of the project in Chipinge, Zimbabwe, which deals with HIV. She blogs about a house call that may have saved a life...
Little chicken running over my black leather, moderately heeled shoes.
Shoes are important for African doctors - that much I’ve learned after three years on the continent.
Although my shoes (that I polish every morning), were getting dusty from navigating around orange sand and stones.
Little chicken squeaking around my feet.
I was sitting on a white plastic bucket, the patient lying on a blanket, on top of a straw mattress, surrounded by women and children of the house.
She was thin as a ghost; conjunctivae paper white, the liver extending down to her belly button.
We were outside the huts, under a straw shelter; the patient, her relatives, the MSF nurse-mentor, a Ministry of Health nurse and I.
A family that can't afford medication
I was impressed by the Ministry of Health nurse. It was a busy day and she hadn’t even taken her lunch, and yet she came with us for this home visit.
She was talking to the patient in a soft voice, almost tender, taking time to explain to her that her medication for HIV most probably wasn’t working anymore. The patient would need to switch to second line regimen.
The patient was slow in her speech and understanding, as though her entire brain was on low speed.
I checked through her patient file. Hemoglobin of 5.
"Can they afford to pay for a blood transfusion at the local hospital?" I asked the nurse.
“They can’t even afford the iron tablets.”
The relatives had been able to raise enough money to pay for hospital admission and investigations, but not any of the treatments.
So we needed to change her medication - but first we needed some basic investigations.
We discussed whether to take her to the clinic, but as she was so sick we decided to draw blood from her on the spot.
The Ministry of Health nurse knelt by the patient, put on a tourniquet, and flicked the skin to extend the vessels. Nothing appeared.
“Too little blood,” she said, frowning.
She wanted the MSF nurse mentor to do it, “You’re the guru”
The MSF nurse mentor wanted her to do it, “You’re the midwife,”
They both wanted me to do it, “I’m from Sweden. In Sweden the nurses do the bleeding.”
But in the end the midwife succeeded. Succeeded after both her and the MSF nurse had been penetrating the skin of the patient countless times, the needle probing all the dried up vessels.
“I don’t like admitting defeat,” the Ministry of Health nurse said.
We provided them with some iron tablets and antibiotics and explained how to take them.
The patient was too tired to show any response, but the relatives thanked us, their eyes shining with gratitude.
They knew we were her only chance.
A life in our hands
We went back in the car along the dusty road, the sun setting over the mountains.
The medical team leader was annoyed as we arrived at the clinic where the other team was waiting.
“What took you so long?”
I explained about the patient, the home visit, and how sick she was.
“So you’ve saved a life,” he said, his voice much softer.
“At least we’ve improved her chances.”