Diagnostic cliffhanger

Kimberly describes how evenings are spent eating dinner in shifts, sharing news from their days and staying in contact with family back home.  As number skyrocket in the Therapeutic Feeding Center'she relates how one malnourished baby stood out from the rest.

Hello friends and family!

What?! It's basically June? Seriously?! How did that happen? It's been too long since my last update and have I ever heard about it from you guys. Well, listen here: Maybe I am in this elective quasi-prison, but we're a pretty busy crew here in Lashkar Gah. 

Our work week is Saturday through Wednesday (just a half day on Thursdays). We do Insanity or P90x workout DVD's immediately after work unless it's been THAT kind of day... then it's just chocolate from your private stash and crawling into bed with your computer and a movie. After the gym, most people have a quick shower and wander over to the kitchen. 

I keep hearing how our kitchen is amazing compared to most field kitchens, and for that I'm grateful. We have dinner prepared during the week by local cooks, but the meal quality can vary significantly day to day. If anyone from outside of the project has visited, they know good and well that they should bring us cheese and chocolate, so if we've had any recent visitors the chocolate bar will get passed around after dinner. If no recent visitors, then knock– off Nutella on bread it is. 

We eat dinner in shifts of sorts, maybe five or six of us at a time, coming and going. Some people may sneak away early if they have Skype date or there's a big WWF wrestling match on TV. We generally eat dinner outside on the "patio," which is really the top of our bunker. Now that the weather has warmed, we're more often choosing to keep the lights off while we eat even though it's dark out. When we turn the lights on we are quite quickly swarmed with a menagerie of bugs – little ones that bite you without you ever seeing them, small swarms of mosquitos who sneak away just as you slap at them, friendly beetles that truly look like they just came out of a Pixar movie, and then there are these ginormous mutant bouncing things that can only be described as suicide bombers in this context. Mostly we end the evening chatting until slowly everyone has turned to their smartphones or tablets to message with friends and family back home. 

Then we start hearing snippets from each other about dramas going on outside our compound. The stories I hear about the friends and family of my team members (and those which I share about you) beat any reality television show at home, no question. And when the best story of the evening has won, slowly we each drift back to our rooms and tuck away until morning when we meet again over the cereal bowls. Our day off, Friday, is just a longer version of that, with an hour public address system islamic teaching around 1pm.

MSF Afghanistan

Work in the PICU and NICU has had some seasonal changes since my last note. The first round of presidential elections came and went, just as opium harvesting season kicked in. We saw an ebb in our admission numbers during that time, especially NICU admissions. That's not to say Helmand had less babies born or that the babies were healthier – only that the workers in the fields were too busy to bring their pregnant wife in for delivery or the premature or sick baby if he was born at home. 

It also meant that the malnourished children had to wait a couple weeks longer before anyone brought them in with concerns about their health. Consequently, once opium harvesting season was over, our Inpatient Therapeutic Feeding Center's numbers have skyrocketed, and in my gross analysis, they seem quite a bit sicker than the usual crop. Of note, we had both a curious spike in opiate poisonings and head trauma's after road traffic accidents in that season as well.

One malnourished baby stood out from the rest. He was just over a month old when he was admitted to our In-patient Theraputic Feeding Centre (ITFC) program. Often, the parent tells a history of difficulty feeding the child –  either mother didn't have breast milk or the family chose to feed tea or some other age– inappropriate feeding regimen. With this baby, the mother was successfully breastfeeding, but within one hour of feeding he was vomiting. 

His weight loss occurred over a couple weeks, at which point mother brought him to the ER and he was admitted to our inpatient program. My counterpart who supervises the ITFC and General Pediatric Wards was on his holiday, so the doctors called me for second opinion. We started the diagnostic tests and watched him over the course of four days. Our x–ray machine is working again (had been down for ~1 month previously), but the best studies to determine a congenital or early acquired intestinal obstruction aren't really feasible here. I brought the case to my medical managers as there was no surgical solution available here for the patient. For many reasons, our hospital doesn't have transfer agreements for pediatrics with any other hospitals so referrals are quite exceptional when they are done. 

After a good deal of coordination, we were able to fly the patient to Kabul where he had surgery the next day. I was anxious to see the family when they returned to town. The father has stunning light colored eyes and and exceptionally kind face, such that it takes you a moment to realize he's leaning on a cane because he is missing the lower half of his left leg. He begins and ends each statement with "Ta shakur," "thank you," and gives us his best rendition of their experience in Kabul. 

I know I should just be happy to see the infant already looking fuller, more energetic, more comfortable, but I'm disappointed to hear there's no summary paperwork from the hospital in Kabul, so my diagnostic cliffhanger is never truly resolved. The mother takes the baby in to be weighed on the scales and is gone much longer than necessary, most likely showing the nurses how well he is doing, thanking each one individually. I'm happy for the nurses to see a success story –  it's too often they see the patients default (leave against medical advice) because there is too much to do at home, they wife cannot be away from home so long, or other assorted reasons. The baby has a way to go, but the path seems much clearer now.

If it's almost June, then I am definitely in the last stretch of my mission here. While I miss you all and normal, day to day life at home desperately, I'm hoping for a fairly quick return to the mission field. My replacement for Boost hospital has already been found – excellent news! – and really, it's time for me to move on. However, I keep hearing stories from colleagues about other missions, the ups and downs of each situation, and I'm ready to see another project in another context. 

I've promised Mom no Ebola project, but otherwise it could be anywhere. I'll be sure to update you all when things are confirmed, hopefully much less delay than this last letter. PLEASE keep sending me the love notes and pictures of life from home – they truly are nourishing to me. I can see already how much I have grown, personally and professionally, from this experience, but one thing that hasn't changed is how much I love you all!