Nursing in Pakistan: The Tiny Babies and the Elephant Foot Bread

Annke blogs at the end of a tough day on the ward in Pakistan

The Emergency Room (ER) in the DHQ hospital in Timergara has a dedicated corner for babies younger than 28 days in the Red Room - the room where we treat the most critical cases.
Six baby cots with overhead warmers to keep the tiny ones warm while we treat them. Families bring their small babies into the ER for medical emergencies or just for healthy baby check-ups, as many babies are born at home in this area. 
The newborns usually come to the ER very well wrapped up against the cold, because there is snow on the mountains. The team very quickly learnt to take a look at the face of the baby to see whether he or she needs immediate help as soon as the attendants enter the Red Room, or if the attendant could take her time to undress the baby before the little one gets weighed and we give the medical attention needed.
Sometimes those 30 seconds can make all the difference!
Mountains in Pakistan
Snow on the mountains around the projectPhoto: Annke Yssel / MSF.
The small space used for the Neonatal Corner is a bit of a challenge. I jokingly call it the ‘Neonatal Shuffle’ when the national staff, the international staff doctor and myself respectfully side-step each other around the cots to give all the proper care to the babies. If you are really tall, you can reach almost everything while standing in one spot!
Many babies in this area are born at home, or they might be born too early and suffer from complications during birth like breathing problems. The family then rush to the ER for help.
Once a baby who is seriously unwell arrives in our Triage Room, they are rushed to the Red Room where we immediately start life-saving procedures to try to revive him or her.
One late January afternoon after a very busy morning, we received a newborn baby that we just could not save. Sometimes our best efforts are not successful and after this family was counselled, the female attendant came to receive the baby.
I knew that she was standing next to me with her arms open as I carefully removed the intravenous cannula and wrapped the tiny body up. I turned to face her. When I looked into her eyes, she had tears rolling down her cheeks. She was crying without making a sound. 
All the emotion of this posting and of that particularly tough day caught up with me in that moment. I could not hold back my own tears, and they slipped over my cheeks. I so badly wanted to say something comforting to her, but I could not speak.
I just carefully placed the baby in her arms and at the end of the day I went home with heaviness in my heart. 
The next morning I was up early and I was in the kitchen baking bread. It has always been one of my trusted coping mechanisms. When I bake something, I feel better (and my housemates eat well).
That morning I made 'elephant foot bread': so-called because you can make one very large, flat bread – just like an elephant foot. Comfort food!
I boiled the potatoes, mashed them, added the yeast, sugar, salt and flour and worked my emotions into that dough. Twice.
The bread was crispy on the outside and very soft on the inside. After more than one cup of strong tea (Pakistani tea, of course) and warm bread, I really felt better. I decided that as a humanitarian fieldworker I would always try to remain like elephant foot bread: a bit tough and crispy on the outside, but always soft on the inside. 
MSF nurses Annke and Ashfaq attend a baby
Annke and nurse Ashfaq attending to a newborn baby. Photo: MSF