Rollercoaster ward rounds

My first couple of weeks in my new project were oddly exhausting. Not because of the workload, or the living conditions, or the heat or anything like that at all.

My first couple of weeks in my new project were oddly exhausting. Not because of the workload, or the living conditions, or the heat or anything like that at all. In fact the workload appears pleasantly manageable, the living conditions are several notches up the scale from my last mission, and temperatures are hovering between a balmy 25 and 35 degrees Celsius – thanks in part to both the slight elevation of the  Zemio region, and the recent advent of the rainy season.

No, the brain strain is simply due to my freaking imbecile level of French. Every meeting/conversation/doctors’ round/greeting is fraught with un-navigable syntax, tenses and words, and requires a constant level of concentration and furrowed brow interpretation on my part. And for that matter, on the part of my staff too. In the medium of the English language I am something of a perfectionist - one of those irritating apostrophe pedants - and for whom hearing bad grammar is on a par with physical pain. Well, it is an enlightening and humbling experience to rerun my own stumbling attempts at sentences back through my mind and realise that my day was littered with frequent episodes of the French version of “I have maked” and “I didn’t understood”, and messing up my name and gender pronunciation badly enough that I am turning every equivalent of George into Georgina and vice versa, albeit totally naively.

But anyway progress continues to be “maked” and most of the national staff here are gracious enough to interpret my enquiries or instructions generously, and now that they are more comfortable with me are even proffering shy corrections as I flounder around lost in tenses, or help me rummage through my dictionary for an elusive word.

The Zemio hospital is small – only 30 inpatient beds, a moderate sized pharmacy and an outpatients department that has around 500 consultations a week. Currently I am inexpertly floor managing the lot as we have a bit of a gap before our next expat Dr arrives. The maternity service is run by three fabulously matriarchal MSF inpat midwives, the HIV/TB programme is headed by Lesly another expat nurse, and five health-posts ranging from an hour to a day’s drive away are supervised by the expat outreach nurse Julie. As in many of its projects, MSF is here collaborating and supporting the existing Ministry of Health structure known locally as the Corges (pronounced cor-JESS. I think.)  and although the bulk of staff numbers belong with them, it is medical and logistical resources, a smattering of  more highly skilled staff and most crucially side by side training that MSF is able to bring.

It follows then that patient ward rounds are an education for all concerned – me in terms of my vocabulary expansion, and the staff in terms of following protocols better or learning of hitherto unknown side effects of drugs they are using. What I lack for in vocabulary I make up for in charades some days. The most common diseases here are the same as all developing countries – severe malaria, dehydration related to diarrhoea, and various infectious diseases make up the bulk of our patient load. The background HIV rate here is estimated at 14% - a depressingly high disease burden for a country that has little of its own infrastructure to treat it. A tour of our patients’ files is like a little emotional rollercoaster full of alternating feelings from near tears to quiet elation.

Bed 1: Four-year-old boy, initially comatose with malaria, now sat up and taking food for the first time in two days after IV treatment. Feeling: a definite high.

Bed 2: Two-year-old girl-malnourished – third time on the feeding programme in six months. We suspect a congenital disease like spina bifida, or a chromosomal problem is contributing to her failure to thrive. We can offer nothing other than the food and medication we have here. Feeling: Low.

Bed 5: Five-year-old  malaria again – haemoglobin levels dangerously low on admission at 29g/dl, blood transfusion from an uncle in progress now. Feeling: Cautiously optimistic.

Bed 7: 32-year-old man recovering well post operatively following a bowel obstruction. Feeling: Win.

Bed 9: 38-year-old lady with very late stage AIDS, and a host of opportunistic infections. Pneumonia, oral thrush, skin rashes, diarrhoea. HIV is a cruel cruel thing. It’s a hard thing to be in the same room as so much suffering sometimes. And to top it all off, she is a Congolese refugee here with no family left. Feeling: Impotent despair.

The ward staff are reluctant to give personal care – unlike the UK where nurses will feed and wash and dress patients (unless you read the Mail, in which case we are paid merely to starve and neglect them) here that aspect of care is left to a spouse or adolescent child. Unless there isn’t one.

It takes me a few days to work out that this woman has no one to care for her, and although she is initially feebly mobile, a week later the staff need constant prompting to help her turn or use the toilet. One day we heat a bucket of water and move her onto a stretcher and I encourage two of them to help me bed bath her. It’s clearly an uncomfortable experience for us all; the male staff awkward and ungentle, the lady sweat soaked, naked and barely conscious, but in obvious distress at her emaciated frame being moved around. Her old blanket smells musty and sour and we toss it outside to be washed.

I hate how little I can do. In the absence of any clean clothes for her I guiltlessly pinch an old bed sheet and discarded t-shirt from the expat house and we are all relieved when she is clean, dry and covered back on her bed, and settles into a seeming deep sleep.

She dies that night.

Feelings: Complicated.

Mixed in with pity and sadness is anger - anger at the conflicts in this country and the neighbouring ones that killed her husband and children – maybe not with bullets, but with displacement and disease. A sort of hopelessness too – which I imagine a lot of people feel in the face of the many headed monster that is final ravages of AIDS, and for which as yet we can only offer a stay of execution from.  But also something like relief – relief that she is without pain, at peace, and no longer suffering the indignity of severe illness alone in a country where family is often the only comfort and security that you have.

Another woman died halfway across the world this week. Maya Angelou was a celebrated author, poet and civil rights activist, but grew up poor and marginalized and knew what suffering was. She once penned the words “I have learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

I can only hope somehow that for this patient, even through all the pain and delirium of the final days, that some comfort and rest permeated those last few hours, after we had washed away the staleness from her frail body.

Shalom ladies. I hope you are both dancing in heaven right now.