Fieldset
Baby, it’s cold outside!

Kimberly deals with the freezing winter temperatures with adopting the local of approach of layering of clothes.  Locals and the hospital also prepared for winter  with heaters installed, but an unfortunate side effect is the rise in the number of burns victims.  Tragically a space heater explodes in the hospital causing injuries.

Hello friends and family!

Winter is definitely here in southern Afghanistan. I may have thought it arrived earlier, but I underestimated what was coming. It is generally ~30F/-1C in the morning and evenings, gets a little warmer during the day. I’m not quite used to these temps anymore, so I find myself layering under my MSF vest and appreciating the head scarf I have to wear.

We have very nice heaters in our rooms on the compound, kind of a modified window unit, but if I have to use the restroom in the middle of the night it’s a serious internal debate – is it worth bulking up and braving the cold? The generator stays on until 1am then they turn it off until 6am. My strategy to deal with this is to get the room toasty when I first fall asleep so the heat will keep until I wake. Generally works fairly well, but it doesn’t make it any easier to get up in the mornings.

The locals have made an art of dressing for the weather. The children have one or two shirts on under their salwar kameez (long shirts). Then a jacket or sweater over that, finally bundled in a random assortment of blankets that likely double as diapers at some point.

My favorites though are the hats. I have seen every variety of head gear you can imagine on these kids. Most of them have a bit of a cone shape, often with sequins or appliqued flowers. Even the sickest child can look quite festive when they first arrive to the PICU (paediatric intensive care unit).

The men stylishly speed through chaotic traffic on motorbikes, brisk wind slapping their faces. They have their heads wrapped up in 6-8 feet of fabric with a heavier blanket material draped around their shoulders. If they are not too fast, you can notice the 4-year-old perched just in front of them on the seat of the motorbike, eyes wide in half glee, half terror, sometimes a woman behind in a burka.

Various head gear on the children in winter MSF Afghanistan

Our logistics team dutifully worked hard to winterize the hospital. This involved putting more mud down on the roof to be sure it will be thick enough to endure the coming rain/snow. An inventory of heaters was also done as there is no central heat source or duct work for the hospital. This is true for most buildings in the area and families use “buccari’s”, or gas powered space heaters.

Various head gear on the children in winter MSF Afghanistan

As the temperatures have dropped, our census of burn victims has risen, often due to these space heaters or other warming methods. Two new burn units (one for men, one for women) were quickly put together in the beginning of December and help to keep these vulnerable patients as protected from infection as possible. Our expat surgeon has altered her teaching priorities to perfect our burn protocols with the surgeons and nurses.

Last week we had a family of six all brought in with serious burns, the father and some of the children died. Yesterday I was asked to come help with an eight-month-old with over 60% third degree burns, mostly on his face and chest, although only one foot was a possible site for IV placement. As we looked for a way to give him relief, I was overwhelmed with the smell of burnt hair and skin. The baby had an needle inserted into his tibia and he received morphine and IV fluids until he finally died about 12 hours later.

We currently have to use these space heaters in the hospital. The generator we have now cannot support electric heaters throughout the hospital, so many rooms have these propane tank space heaters. After a busy day of trying to prepare the NICU (neonatal intensive care unit) so the electricians could turn off the power for maintenance, I was happy to head home and calm down over dinner yesterday.

I became suspicious something was up when our logistician got up mid-conversation to answer the phone and never returned. About half an hour later we were informed one of the space heaters had been leaking gas in a room and there was an explosion – a fireball that melted the mattresses through the beds, plastic off the light switches, broke the windows and charred the walls. There were three to four patients and caregivers present (differing reports) with minimal burns considering the state of the room.

The staff present in the hospital at the time quickly extinguished the fire and evacuated the hospital until the acrid smoke cleared. This morning the maintenance staff was already at work when I went to marvel at the scene. It’s just another example of the daily reality people here experience – even just trying to stay warm can be risky.

Various head gear on the children in winter MSF Afghanistan

I may look back on these winter days fondly once summer surfaces, but for now I count this simple duvet and hooded sweatshirt as blessings. I’m grateful for a warm cup of tea before bed and the chance to go back tomorrow and see what the night brought us.