It all happened so fast; I froze. I certainly didn’t know what to do. The kid was completely shocked and confused. It could have gone either way for him, to laugh or to cry, but after the second wave stuck his feet and the little splashes hit his shins, it became obvious that he was going to begin crying. It was a matter of seconds until that got going and there was nothing that I could do. His older brother laying safely on a bed and laughing at him, the water sloshing up against his feet, his hand frozen holding a ball of fried dough halfway between the plastic bag and his mouth, he simply wasn’t able to understand what was going on. It was too much. The kid was just stupified. The tears did come, just after his face scrunched up and he started wailing.
What was she doing!? If you asked her, she was simply mopping. From my perspective though, her technique seemed a bit off. She pushed the water across the floor straight between the line of beds and the wall, ignoring the fact that a person was in the middle of that aisle. Then she pushed more water straight at the kid. As we know this now infamous ‘second wave’ pushed the boy over the edge. Becoming annoyed with the crying that she’d caused, she snatched him up by his little arm and plopped him onto the bed, next to his brother who was delighted because in addition to laughing at the crying he could now also get at the snacks at the end of his little brother’s now possibly sore arm.
What a stroke of good fortune for the older brother. What dismay and very guilty amusement for me. Ever since she’d started sloshing the water onto the feet of the boy who stood in her way, I’d wanted to do something but couldn’t. The distance, language barrier, and full hands prevented me from any action. I had a front row seat for this little episode but couldn’t help in avoiding tears. I didn’t even get one of those fried dough balls.
In a funny coincidence, one of the reasons that I was there in the ward was to ask nurses and clinical officers about what they thought the cleaners should be doing at different times during their shifts and what could be improved in their performance. So in a way, as I’m responsible for the cleaners and their work, this was just the kind of scene that I needed to witness.
To be fair I should say that kids are crying all of the time at the hospital, and usually for better reasons; getting a blood prick test, getting an injection, having an IV put in, though I saw one kid freaking out because he didn’t want to stand on a scale- his mother laughing at him. So this one crying about a little water? He was kind of being a baby; he’s a few months older than a baby.
To continue being fair, the cleaners are nice ladies. We speak through our Arabic translator of course, but there are smiles, attempts at hand gestures and some laughs in our meetings. They don’t make me cry. In our initial meetings they have been very open to the idea of participating in trainings, reorganizing their routines, and have given us good feedback about where they see needs for change. It’s not easy to come in and try to change the ways that people do things, but its necessary. Actually, last week was huge for us in the cleaning department. We reorganized the colors of the buckets used for different types of waste and cleaning activities in the wards. Yeah I know! Exciting! OK, not that exciting really. Organizing buckets isn’t the kind of thing that sounds that cool, but as I’ve prowled the wards these last few days and seen the right colors in the right places, I’ve been pretty chuffed (Ammar, I used chuffed!).
In our in-patient pediatric and maternity wards, we have a three-woman 24-hour rotation of cleaners, where at the outpatient ward and operating theater we have only daytime shifts. But despite the cleaners being on duty for 24 hours, the in-patient wards aren’t clean enough yet. There’s room for improvement, let’s say. We have guidelines for what needs to be cleaned, how often and with what kind of chlorine or cleaning solutions. These need to be retaught, made a part of the daily practice, and monitored.
One thing that has improved but isn’t perfect is the burning of charcoal in small metal boxes in the back hallway of the pediatric ward to heat milk for the kids. It sounds mad, but before MSF came here they were burning it daily inside of the buildings and might have done it next to the kids beds for all I know. Apparently we cracked down on this practice months ago, but I came across the little BBQ alight inside of the back door once. I brought this up with our hospital log(istician) and he shrugged his shoulders and said that it’s culturally unavoidable. He said that they cook inside their tukols (brick and grass huts) at home sometimes and so probably don’t see the big deal about a little smoke inside of the ward. Ugghhh. No, this activity will not stand. Local culture has to give way here.
The timing of cleaning activites seems to be a bit off too, like flooding and mopping the entire ward just after the medical rounds have started and when little boys that don’t like their bare feet getting wet are standing around ready to start crying. That’s not the best timing. So of the improvements that we’re working on with the cleaners, one of the most critical is a more organized routine that fits with the medical activities. This of course needs input from the medical side as well as some more direct observation by me. Also, it appears that a few tears are going to have to be shed along the way.