Audio diary: Politics, cheese and resilience

In my first audio diary I describe the Médecins Sans Frontières/Doctors Without Borders (MSF) project where I work and then talk you through a night shift.


Hello my name is Ed, I am a doctor working in the Central African Republic for MSF.

Central African Republic is as you’d expect: a country in the middle of Africa, a landlocked country with a relatively small population. We are working in a hospital in the north of country which has about 120 beds.

The vast majority of which are for paediatric cases, and we deal with a significant population of malaria patients. About two thirds of all our admissions involve malaria in one form or another, whether that be with a sepsis on top as well.

So we work here and try and provide ongoing longer term medical services as well as an emergency service where anybody can pitch up and get free, at the point of care, healthcare.

The project itself has been going about eight years with MSF. It's relatively busy seeing about 30 or so cases a day, of which 20 or so will be children.

I’ve been working here for just over two months now. My days and weeks involve time split between either working in emergency services and seeing patients as they come in or doing ward rounds on the paediatric ward and then night shifts where we cover the whole hospital as a single doctor.

As I was saying, the vast majority of the project involves the prevention and treatment of malaria and its complications.

Being a French project there's obviously a lot of politics and cigarette-smoking during the evenings, sitting around at the compound.

And if we are lucky and someone is visiting from France we might even get some cheese.

Night Shift

So it’s about 3:30 in the morning here in Paoua, as it is in London.

I am in the middle of the night shift where I spend the evening in the hospital waiting for the cases to come in.

The rain is coming down pretty hard. We are in the middle of our rainy season here. The rain is definitely our enemy, it leads to lots of standing water meaning we get a huge amount of mosquito reproduction leading to what they call Paoua peak year.

Man speaks in French in the background

Oui, J’arrive

Gotta go.

So that was a pretty typical case, a little two-year-old who came in with a profound anaemia. Effectively what happens is the parasites multiply, and the red blood cells lead them to burst, giving you a severe lack of red blood cells meaning you can't carry enough oxygen.

He came in looking pretty unwell and we managed to stabilise him with a bit of fluids and will try and treat the malaria as well as giving him a blood transfusion of which we get through about 20 or 30 a week here and hopefully have the right blood groups. If we don't we ask the family to donate and that's pretty consistent. 

I have just walked to the paediatric ward with him, it is about 100 meters away, under an umbrella.

He'll start his transfusion which will take about three hours and I’ll go check on him in the next little while.

Hopefully, within that time the anti-malaria medications will also start helping decrease the number of parasites.

We should start seeing an improvement in his well-being within about six to 12 hours. And often, even with the severe anaemia, these kids can turn round really, really quick. That’s the great thing about these kids, they are pretty resilient. 

There is no one waiting to be seen at the moment. So I am going to go and catch 30 minutes shut-eye.