Finally Sunday has arrived…. It has been months since I have written a blog post. Not that there hasn’t been anything noteworthy to write about, but there have been so many horrible events in CAR that everything else seems utterly insignificant. I can’t seem to bring myself to write about the ongoing violence against the population, complete lack of respect for humanitarian aid and medical facilities as neutral spaces. So I simply have not managed to write anything at all. Maybe it’s a coping mechanism.
Life and work does continue on. And sick patients are always there, so you have to pull it together the best you can and just get it done.
Friday’s mobile clinic was most certainly not my best day here in Bossangoa. Other than feeling a bit unwell with a cold, it started out nicely, with this sweet baby boy I was greeted with when I got to Ouham Bac for mobile clinic. He was born at 4am, several hours before we arrived. He was beautiful.
He was thoroughly upset after being undressed to be weighed, and unfortunately I would continue to share his sentiment he is displaying in this photo for the rest of the day.
It all started with two patients who were presented to me, very sick, by one of the nurses on the outreach team. One, a baby who had malaria, was severely anemic and had been having seizures and a decreased level of consciousness and the other, a patient with tuberculosis, off medications for six months also anemic and edematous with very low blood pressure. Then another nurse came to me with another two severely anemic children with malaria as well.
Our car this day was really full already, and an extra car movement takes time to arrange, so I thought I would try and send right away the anemic children on motorbikes to the hospital. So I called back to the base to see if I was allowed to send all three babies on motorbikes, as I decided the adult could wait until we drove back in the afternoon. For some reason, the signal for the satellite phone was not cooperating so I was running back and forth between the clinic, the phone, and the radio in the car to arrange whether we send motorbikes or arrange a car movement, since there were so many patients already that needed to go. While I was running back and forth, again one of the nurses grabs me to look at yet another patient (this makes five) - a baby with SEVERE respiratory distress. I said, “okay, motorbikes, and go quick, NOW”. Meanwhile, one of the nurses was testing what we can test for blood grouping, to send the best family member for a possible match, as we of course have no blood bank. The rest of the pale babies were ready, so I send off four motorbikes right then.
In the meantime, there were probably close to fifteen different chiefs and notable village leaders waiting for me to make a speech to them, as we had planned to hand over our health care activites in this village to other actors. At the same time, there is a complicated situation involving a man who has been held hostage in this village - who I check on when we are there - who was waiting to see me, as we have been lobbying other actors to help him be escorted out of this village safely. Oh, and never mind that the staff also found me another three patients I would have to transfer to the hospital. One of them was a complicated case that I needed help with deciding how to manage from the physician in the project, more fun with the radio and satellite phone. Shit.
As I was just looking at this complicated patient, I heard a motorbike pull up, only maybe one hour after I sent the four transfers. I doubted there were many more motorbikes to be found in the village, so I knew it was a transfer returning. I ran around the corner and there was the Mom holding her baby I sent with the respiratory distress desperately trying to close his eyes and mouth. Double shit. He had died before he got even ten kilometers down the road. I tried to suck back the tears, but I couldn’t. One of our outreach nurses tried to console me. I had a lot more things to arrange, so I quickly wiped my face and got back on the phone to see what to do with the complicated, probably immunocompromised patient while she waited for transfer to the hospital.
So eventually I got that done, then I took a few minutes with the man who had been taken hostage and was now trapped there as he politely and gently asked for help, thanking me profusely, though I had yet been able to get any results for him with other actors. Then I spoke with the village chiefs, the mayor, and other key community members to explain the handover, which thankfully was received with applause and a big thanks to MSF. The entire speech I felt like I had made a mistake in thinking we could hand over the site, as I have never had so many transfers from one place in one day like that. We might just be continuing there after all.
Then at last, we had seen all the patients and there we no more emergencies. We crammed all our patients and ourselves in our Land cruisers and off we headed for home… We made it 13km.
At 13km from Ouham Bac, I see parents running out toward the road holding a limp baby. Triple shit. We stopped the car and looked at this baby. His uvula had been cut off, a traditional practice that is often done here; with vomiting, diarrhea and severely dehydrated, going into shock. We had no possible way of fitting more patients in the car, so I kicked one of the more stable children out, sent them on a motorbike and we threw the new kid in the car, stared an intravenous line, gave some glucose and ringer lactate and off we went again…. For another 20km.
Then I see a motorbike broken down on the side of the road. There next to it was one of our severely anemic children from the morning in his Mom’s lap. Quadruple shit sounds weird, so let’s just imagine another swear word. At that point, it was too late and difficult to find another motorbike so we crammed up a bit more and fit the anemic baby in the car too.
We FINALLY made it to the hospital, and thankfully my colleagues were there quickly to greet me and receive all the presents I brought them.
It’s a good lesson for me. Even though the conflict is relentless, the population is continuously a victim and help seems very far away, there is a lot we can do right now to save lives. At least some of them.