At certain moments it feels as if we are walking a tightrope, struggling to retain our equilibrium in the face of a constant barrage of destablising events. Each day poses new challenges for the transfer of activities – a threatened strike by the nurses at the general hospital, the discovery of bats in one of the buildings we wish to use, confusion amongst the public about the new setup (requiring further radio-broadcasts and announcements in the churches). The biggest problem at present is our capacity – we have built a new 42 bed paediatric block in the general hospital, which, in combination with the old 45 bed paediatric building should meet the needs of the population. However, we did not bank on the old building still being ‘under reconstruction’ 2 years later. So we have accomplished the first part of the transfer strategy – the opening of the new block (which filled up in three days) – but yesterday we had 46 children, and only 42 beds.
So, the solutions – we’ve put up tents, only to find that they are immediately filled with surgical patients, soldiers, families of patients. We could use the observation beds in the nearest health centre (300 m away), but would be unable to assure the quality of surveillance of the patients. We can (and do) meet with the corporation responsible for the reconstruction to try to find a solution, so far with little success. And of course (as many suggest) we could just put two patients per bed – to which I am strongly opposed, having seen the potential consequences of this elsewhere.
So we just manage to hang in there. Fortunately work in the surgical ward finished yesterday, enabling us to move the surgical patients out and the bedless children in today. But as soon as there is a further influx of patients we will be back to juggling beds again. There is no slack in the system, no extra space to put up more tents; if a child now comes in with measles or any other contagious disease, we will have to reorganise things again to create an isolation area. And the stakes are high – the lives of the children, and the credibility of the hospital (and MSF) – which determines whether parents will continue bringing their children to the hospital when they are ill.
At times it all seems formidable – we are trying to keep so many plates spinning, all at different speeds, and the tightrope is wobbling – and disaster looms in all directions. But then at times this vertiginous sensation is followed by a wave of serenity, as I recall the comforting words of whoever it was that wrote that book on chaos theory – that there is order within chaos, or that chaos gives birth to order, or something of the sort – and suddenly I am sure that everything will turn out alright.