Fieldset
Il faut se debrouiller! (You’ll just have to muddle through!)

Kimbi Lulenge, South Kivu, DRC

Kimbi Lulenge, South Kivu, DRC

Our team arrived to start working at the Lulimba Hospital at the height of the malaria season. We barely had time to unpack our boxes because we were greeted with a crowd of sick children that have been arriving in ever greater numbers since. We found out very quickly then that Lulimba Hospital had only one thermometer.

When you lack most tests, being able to take a temperature in an area endemic for malaria and other tropical diseases is critical. So the staff spent the first days running between the outpatient clinic, maternity, paediatrics and internal medicine, chasing the small tube of glass and mercury to place under the arm of a hot, lethargic child. When the bottleneck was discovered, we found a further two thermometers when we raided MSF’s own medical kits, kept in our vehicles.

While we waited to fully unpack, set up our supplies and for a rush order of additional resources to deal with the unexpected numbers of sick people, I was carefully guarding the paediatric department’s one thermometer after it found its way out again to outpatient consultations, bringing the ward round to a grinding halt.

The lack of thermometers is only one of many shortages that beset the hospital, which is now trying to cope with a surge in patient numbers since health care was declared free with the arrival of the MSF team.

There are plans to build a new hospital.

But what do we do now? We are roaring through our first tonne of medications, especially antimalarials and paracetamol. The numbers of children are growing, with two or three children to a mattress, along with their mothers and often their siblings. And the hospital staff is overworked, handling the white water ride of this start-up with patience and humour.

When I asked one mother after seeing her child if there was anything else I could do to help, her reply in Swahili prompted musical laughter from the other mothers. The nurse on duty, Silele, grinned and translated for me: “She was asking if you could sort out the problems between her and her husband but I think we have enough to do already.’’

The shortages, particularly in terms of nursing staff, impede our work at every turn. At the start, we lacked a rapid test for malaria (there’s apparently a shortage of these tests across the globe) and the large numbers of children presenting with fever overwhelmed the tiny lab, a dusty little room where the one microscope is placed carefully in front of a pokey window to capture enough light in the search for the parasites that plague our hospital population. The lab technicians use a torch at night to bounce off the microscope’s mirror.

In the operating theatre, the patient is anaesthetised with ketamine and a small wisp of cotton wool is placed over one nostril. If it moves up and down, the operating team knows the patient is breathing.

The wisp of cotton wool in place of winking, bleeping machines found at the anaesthetic end of operating tables at home is the perfect example of a phrase in French that is on everybody’s lips – Il faut se debrouiller!

Building a hospital takes time but with the flood of patients, we’ve had to improvise quickly. We’ve moved the internal medicine and paediatric services out of their overcrowded, dark rooms into four large tents while we wait for the new hospital. This has also created space for other services.

We now have bed nets against mosquitoes for each patient in a bid to prevent the mosquito vector from spreading malaria from one patient to another. Each service now has buckets with chlorinated water for drinking water and hand washing to help prevent cross infection.

The operating theatre now has a light and the instruments are sterilised in a proper autoclave in place of the pressure cookers placed on charcoal braziers when we arrived. We now have a generator which we can use to provide oxygen to patients with breathing problems. We simply treated all feverish kids for malaria until the rapid tests arrived (when we subsequently started collecting data from these tests, 85% of them were positive for the potentially deadly P. falciparum form of malaria).

I was woken this morning by a crack of thunder and the pummelling of heavy rain on the tin roof. The rains threaten more malaria, more patients and the already parlous dirt roads and airstrip that we rely on for the delivery of drugs and equipment that this isolated hospital so desperately needs.


This post was first published by the Guardian Online