Focus on the positive

Kimberly takes a break from the stresses of work in Lashkar Gah.  Admissions had dropped recently, but burns patients reached an all-time high. With a new doctor arriving who specialises in malnutruition, she get to devote more time and energy to the ICU's (Intensive Care Unit) and do her best to maximize the potential of the resources and staff there.

Hello friends and family!

Sorry it's been so long. Yes, I'm healthy and happy and still in southern Afghanistan. I've thought about you all a lot lately, but struggle at times with what I want to share with you from here.

The last month has been mixed - hitting a mental and emotional exhaustion point just in time for a week holiday in Spain with friends. MSF and other NGO's make their field workers take breaks every 6 weeks or so (either a long weekend or a full week) trying to keep workers in a functional state by anticipating stress. I have seen the effects on colleagues that for one reason or another have to delay these breaks and often it causes more problems than it prevents.

"Pushing through" doesn't work as well as we all think it might and rarely do we have the insight to admit this to ourselves. My holiday was quite perfect - a time of restoration, renewal; a time to appreciate nurturing friendship, the art of food, wine, and the human potential for beauty - the list goes on.

At times I felt a bit frantic, wanting to satisfy every craving I've had the last few months, anticipating the seclusion to come. But I guess that's a personal lesson in first-world excess: what I used to consider standard is truly luxury, and I'm no worse off for that change.

The work has been good lately. Lashkar Gah had snow for the first time in 20 years (depending on who you ask), so most admissions dropped a bit - hard for the more rural people to get into town. However, burn patients have reached an all-time high.

Just before I left for holiday we received a second expat pediatrician. He's from Kenya and with experience in malnutrition, so he'll be supervising in the therapeutic feeding center and general pediatric wards. It's a huge relief for me because I realized that being spread so thin among the different wards I wasn't doing anything very well. Each place deserves a lot more attention and focus. Now I get to devote more time and energy to the ICU's (Intensive Care Unit) and do my best to maximize the potential of the resources and staff there. I have 6 more months here and I want to make the most of it.

We've had a number of memorable children lately. In the neonatal ICU (NICU) we had a mother who had given birth to triplets, making it to maybe 34 weeks gestation, with only two of the children surviving. These two were in the NICU for a couple weeks getting nasogastric tube feeds and struggling to gain weight. The mother was very excited about her children and would bring them up to me each day to make sure I appreciated their beauty. Her husband (and most likely her mother-in-law) was very anxious to have her come home - many duties in the home that only the wife can do - and so despite our pleading, the family went home when the children were still only 2lbs 13oz (1.3kg). We haven't seen them since, so I'm hoping for the best for them.

Tender Loving Care in the NICU.

Tender Loving Care in the NICU.

In the pediatric ICU (PICU) we've all bonded with Jaylani. He's a slight, feisty 8 year old who developed pneumothorax, a complication of pneumonia, and needed a chest tube. When I first met him he could barely speak because he was so exhausted just from breathing. I imagine laying flat with a heavy piece of furniture sitting on my chest, making it hard to fully open my lungs - that's what it must have felt like.

For a number of reasons he was in this condition for about 5 days and I wonder how much longer he could have hung in there. His father was with him, watching me closely, scared about why his son was sick and wanting him to drink more water. After the chest tube was placed, Jaylani spent the first night in the general ICU (adult) because the pediatric ICU was just too full. The adult ICU does not allow caretakers, so that was probably the first night in his life Jaylani had ever been without his family.

I knew he was improving when I came to see him first thing in the morning and the doctors asked me to transfer him out as quickly as possible because he was bossing them around, crying for water and food. He wasn't in pain anymore, he could breathe much easier, but he was fed up with our hospital!

This last week he has been in the PICU and everyday he is stronger and more irritated with us. Mostly he missed his father; his grandmother had to come stay with him as only female caretakers are allowed in the PICU. This was a rollercoaster week in the PICU and I wonder what a bizarre torture it must be to an 8 year old to witness this scene 24 hours a day for the last 7 days, especially considering he's likely only been to an outpatient clinic once or twice in his life, no television, no sense of the world beyond his rural Afghan home.

The nurses have bonded with him, bringing him special food, having him help with his own care - I think they liked having a patient they could interact with. Even though he may have been able to be transferred to a general ward two days ago, they never once asked for it. I can tell they are invested in his cure, want to watch him walk out of the hospital healthy and with a normal child's energy. I admit I'm anxious for that day as well.

We've had plenty of sad cases, frustrating cases, baffling cases, but I'm reminded of the importance of keeping focus on the positive, the triumphs in life. Hope you are all well and appreciating all your blessings! Sending lots of love your way.