First impressions

So this will be my first ever blog entry. I wrote this as an email to a few family members and friends when I first arrived to describe my new home, new job, and my initial thoughts. And my very first thought: "What did I just get myself into?" 

So this will be my first ever blog entry. I wrote this as an email to a few family members and friends when I first arrived to describe my new home, new job, and my initial thoughts. And my very first thought: "What did I just get myself into?" 

I am currently stationed in Aweil, South Sudan. It is in Northern Bahr el Ghazal. This region avoided conflict during the fighting last December.

Upon arrival to Aweil, I was introduced to the team, the hospital and my new home for the next months of my life. I live in a small tukul (a hut with concrete walls and a thatched roof). I have a cot, a "dresser" and a plastic chair and table. We have showers (cold only) and sinks with running water, so I was happy to see that! All the facilities are in an outhouse. I’m getting used to the bugs. Really big ones fill the sink every am. I turn the water on and run while they scramble to get out. The toilets are my least favorite, basically a concrete port-a-potty, no running water. 

We have an outdoor common area with a large picnic table for eating. A sitting area for reading, but the cats also use our sitting area, so with my allergies I stick to the plastic chairs. We have a screen and projector for movies. No cable or TV, but I'm fine with that. 

There is a small kitchen and people make our food everyday. Very simple meals. Lots of potatoes, rice, beef, and a variety of veggies: eggplant, tomato, ocra, cucumber, spinach. We also have some canned veggies and canned fruit. The main fresh fruits are banana and occasional watermelon due to cost. Once a week we get whole chicken. I eat alot of pb&j. 

There is a "park" nearby where the kids play soccer and we can run around the perimeter. We go as a group two day a week and then I am trying two days a week to do a crossfit style workout: push ups, jump rope, step ups, squats, and my fancy concrete barbell.  

The hospital has been the hard part for me. We have very few non-clinical diagnostic capabilities. We can do some basic blood work; hemoglobin and a white blood count (infection marker). We have urine dipsticks. On CSF fluid from a lumbar puncture, we can get a gram stain (looks for bacteria), protein and white blood count. We have a rapid malaria test and we can do a blood smear for malaria. We can check glucose levels. It's rumored we can do liver function tests, but we have not been able to since I have been here. We can get ova and parasite tests on stool. 

We have limited drugs, but they cover most needs, just no MRSA coverage (resistant staph coverage).

No jaundice treatment for neonates. No surgical treatment other than an Obstetrician for the pregnant women and we can do some small procedures (mostly drain abscesses and dressing changes for wounds and burns). A few surgical cases we can transfer to another region for surgery. There is very little blood for transfusions (families are responsible for donating for their children). We are working on a blood drive to try and increase blood supply for malaria season. We can get basic x-rays, but we are responsible for interpreting our own films.

Most of the time we rely on clinical judgment and treat the best we can, our testing abilities and treatment supplies cover our most common pathology seen which includes tetanus, malaria, neonatal sepsis, asthma and respiratory infections, malnutrition, diarrhea and dehydration.

For me, the most difficult cases are the children who come in so sick with an unknown diagnosis and the ones not responding to treatment. We try everything we have, but it still feels limited and there are so few diagnostic tests. 

Also there are days the system is so overwhelmed that its difficult to treat every child with the attention they need. It will get worse as malaria season is picking up and a lot of children are presenting in a coma. 

The medical staff that is local has very little training as they come from a region that has experienced decades of conflict. Very few people have had a chance to go to school and get a proper education. They follow MSF protocols well and a major part of my role with MSF is to teach them medicine as they are very eager to learn.

It has also been really hard on me when a child suffers and I know there is nothing I can do (bone infections, cardiac babies, stomach or intestinal bleeds). My goal is to make them as comfortable as possible.

The days are up and down, I read a lot to try and expand my differential, as tropical medicine is not something I have a lot of experience with. 

All of the MSF expat team are great, I have a super supportive team!! I am very lucky and grateful to have such a strong group with me!

I am told it takes time to adjust and life does get easier so I'm looking forward to that!