Opening the Ward

It's the start of the rainy season in Moïssala, and for the MSF team that means one thing: malaria.

The MSF project here in Moissala is a malaria project. It's the start of the rainy season, which means it's the start of the malaria season as well. We manage a ward for infants with severe malaria in the district hospital. We're scheduled to open June 1st, as a guideline in our agreement with the Ministry of Health, but with a long list of indicators to be followed, with the exact date of opening to be determined as the situation dictates.

June 1st is a Sunday, so we'll open on Monday, June 2nd. The rate of positivity for the rapid malaria tests has more than doubled, the references to the pediatric ward have increased, and the rural health centers are conducting more consultations. The pediatric ward has expanded into one of the unused buildings for the malaria ward, due to high patient volume. It's time.

I have four days between getting back from vacation and Monday, June 2nd. Luckily, the logistics department has been busy. We've been repainting, repairing beds, ordering in blankets, soap and mosquito nets for donation to all patients, and arranging the furniture in the wards. We're halfway through the rehabilitation of the hospital's waste area, but it has remained operational throughout.

I have four days to prioritize and shuffle resources around, and to get ready for a provisional opening of 30 of our eventual 80 beds. There are plenty of trainings and deliveries to be done before opening, plus the usual activity of setting everything up. The hospital buzzes all weekend with logistical and medical teams moving everything into place, checking equipment, photocopying forms, hanging mosquito nets.

Monday morning at 8am is the hour set for opening. After our all-staff meeting at 7:30am, the medics head to the ward. I tie up some loose ends at the office (we still have a full range of external activities, including constructing waste areas at several rural health centers), then head over to the hospital. The team has done an incredible job with the preparations. 25 crisp beds line the walls of our three rooms. The admissions room is ordered and stocked. I greet the several nurses, hygienists and doctors who are there. We take time to discuss any needs or requests, and then move on to entomology of our respective names.

We have no patients.

Well, all of our indicators were strong, so we know there's the need to have our ward open, but as the hours stretch by and we don't receive a single patient, we start to wonder. Did we tell the health centers that we're open? Yes. Do the patients know how to find us at the hospital? Yes. Weird.

Five days later, we've opened two new rooms of 10 beds, and I'll head over today to make sure the 18 beds of a third building are installed.

We're full. Every bed is occupied with a small child with malaria, with the mother curled up beside them (most of our patients are under three years old). The patients started coming Monday night and haven't stopped arriving. The nurses and doctors move through the ward with an efficient air, setting IV drip rates and taking vital signs. It's busy but controlled. The admissions room is more hectic, since it's the place for the first examination and medical intervention by our medical team. Crying children and distraught mothers are received here, then admitted into the busy calm of our ward.

The communication between the medical team and the logistic team is strong, with repairs, equipment requests, room openings and medical waste management all happening smoothly. The systems are in place, and we can continue to grow to our capacity. The kitchen is preparing and distributing meals consistently and reliably. I can turn my attention back to the waste area and latrines that are still under construction.

I'm hoping to finish the construction within the week, because a rain shelter for all the mothers needs to be built, and we're less than a month away from our first distribution of malaria prophylaxis to the population throughout the district.

And the patients keep coming.

Top image is an archive photograph of the hospital in Moïssala, 2011.