sometime in march, near the beginning.

march 4. wow. yesterday was crazy. while trying to find some time to rest, just away from everything, a moment to myself the radio called me to the hospital. the ministry of health was touring and they wanted to see our measles program.

march 4. wow. yesterday was crazy. while trying to find some time to rest, just away from everything, a moment to myself the radio called me to the hospital. the ministry of health was touring and they wanted to see our measles program. i rushed to the hospital and showed them our wooden hut that stretched for a hundred yards, full of the miserable measled. i talked about coinfection, mortality, the ease of prevention. the audience was sympathetic.

as i was finishing, i got pulled aside. "could you see this woman who is bleeding? she is pregnant..." i did. she was miscarrying. as i was finishing, pulled aside. "could you see this boy? he is not breathing?" i did. they were right. high fever, poor respiratory effort, unconscious. he had fresh wounds on his chest from traditional treatment.

i am careful to not say to myself, or out loud, "in canada... ." but sometimes i do. in canada, in case you don't know, i can offer you the world. though we complain about the inefficiencies in our health system, our waiting lists and crises in rural care, when i walk into the room of a sick child i can say to the family, with confidence, "we will give your child the best care on the planet. the whole planet." In sudan, in abyei's tiny emergency room, i can only say "we will do what we can".

what can we do. the child needed to be on a ventilator, that was clear. his intercostal muscles and his diaphragm were too fatigued or acidotic to last. often, at home, i have a team of qualified nurses devoted to the care of these types of patients. in abyei, as well intentioned as they are, emergencies have a different meaning.

i asked the nurse to bag the child, to assist his breaths, and i went to the store room to find an oxygen concentrator that had arrived the day before. i set that up, wheeled it past a queue of curious and admiring inpatients, and gave the boy some oxygen. his saturation improved from a wincing 70% to close to 100%. but his breathing was erratic. too shallow. the question before me was to intubate him, to breathe for him through a tube in his trachea.

we have no ventilator. and we cannot travel the roads at night. if we could, i am not sure where we would go. the nearest hospital 3 hours away, and they have two ventilators, but perhaps they are in use. i couldn't know. what i have learned through experience is that .

luckily for me, my head of mission is visiting abyei to help prepare for our emergency measles campaign. i called him to the hospital. it was clear that if we did nothing, the child would die in hours. maybe minutes. we talked briefly.

it is so difficult in cases like this, to fight each battle. the war is going to be long, and the field littered. it is easy to say, "there is nothing we can do, we don't have the resources", and then work with resolve towards the day when we might. but i think, with msf, it seems we fight each battle when we can. we will try to convince each severely malnourished kid that we find on our measles campaign to get in the car, and to come and be fed until they are better. and we'll track down that patient with tuberculosis that left, frustrated, half way through his treatment and try to convince him to come back. even though the countryside is full of tuberculosis patients who we will never see, and one case will not tip the balance sheets of epidemiology towards a brighter TB-free future. to the world, it probably doesn't matter that much. until you remember that it means the world to the patient. one exact world. per patient.

so, i intubated the child. we called in an exhausted nurse from home, and she sat with him and pushed the ambu bag 12 times per minute for 12 hours. in the morning, she was spent. i removed the tube and for now, the child is breathing on his own. 12 hours later. at this point, as people here are fond of saying, insh'allah. it is in god's hands.

i would tell you about being pulled aside again, about a melee and the soldiers, or about the gunshot today, but i will save it. things are heating up, just in time for the hot season.

for the patients i spoke of before. the butterfly boy with the tube in his chest is improved. he is eating, and wants to go home. i will let him. while i was attending to the boy above, the baby who had been breastfeeding poorly, died. i watched the mother cover his face, then walk out. of the twins, the first one, the drama queen with her hand over her face, is alive. despite being so premature, she is feeding well. today she went home. her brother, sadly, was too new for the world.

one last thing. i have only this satellite to connect to the rest of you through. eventually, i get the comments you leave sent to me by msf. i read them all, and am so, so grateful for each. if i do not respond, it is because i haven't the resources. do keep them coming. so much better to have a dialogue. the work, as worthwhile as it is, can make one feel far away.

time for dinner. oh, for those who are considering sending me something, please cross peanut butter off the list. there is a 4 gallon pail in the kitchen. we go through them rather quickly. i am shocked to say that i may be losing my taste for the peanut.