Successes and failures

“You have to meet this girl,” Dr. Clement Toussaint from France ran ahead a few paces to catch up to a young refugee from north of Yida.

“You have to meet this girl,” Dr. Clement Toussaint from France ran ahead a few paces to catch up to a young refugee from north of Yida. The girl smiled shyly at Clement, her teeth brilliant against her shiny dark face, while her mother stood beside her, swathed in a billowing piece of pink cloth.

“Hawa* was with us for two months,” Clement explained. “She arrived with tetanus, her body jerking in spasms, and I can’t believe that she has recovered fully!” Clement and Hawa shook hands. “Today she is going home!”

Clement is taciturn, making each English word count. For him, this was a long speech, but through the laughter that he and the girl shared, I could tell how much he delighted in her recovery. We waved as Hawa and her mother stepped through the doorway out of the MSF compound in Yida, South Sudan, and out of Clement’s life.

We continued our morning rounds, entering our 'suspected TB' tent, where three infants were being cuddled. A chubby boy of about five years of age reached out his hand to high-five Clement. “He speaks French,” Clement boasted. “Comment ça va?”

“Comment ça va?” the boy happily echoed back, cupping his hand to catch a tattered tennis ball that Clement tossed him, oblivious to his torn and stained clothing.

“He was skin and bone when he arrived,” Clement commented, scanning the chart. “Now his is normal weight. He will go home soon when he's finished the first two months of intensive tuberculosis treatment.”

I reflected on the scourge of consumption, that dreaded disease that has been found in prehistoric skeletons as far back as four thousand years ago. My father had spent the better part of the Second World War in a sanatorium in Ontario, taking the prescribed fresh air rests twice daily, but his story seemed quaint and romantic, a far cry from the vitality sapping disease before me, as I witnessed the three small children still laboring to breathe. I look forward in hope to the next two months of the four antibiotic combined treatment working its magic on these malnourished little bodies.

I was on call later that night, jerked from my mosquito tent cocoon by the squawk of the radio handset imploring me come to the measles tent. We were in the midst of an outbreak, with two tents set aside to segregate the measles patients. They were mostly children who had missed their vaccines while hiding out in the Nuba Mountains.

A small crowd huddled outside a funerary white mosquito net. Inside, the pulse oximeter tolled an unpleasant beep, announcing a low oxygen level. The oxygen concentrator hummed at maximum capacity, just not enough for those little wet infected lungs. I called for several puffs of salbutamol to open up his lungs, with some effect, but the nine-month old boy sucked in air with an ominous honking stridor.

We’d been supporting this boy with oxygen, antibiotics for secondary infection, fluids, nutrition, salbutamol and a desperate attempt with steroids but he continued to deteriorate, just not able to rally against the scourge of the overwhelming viral measles infection. The brave little one soldiered on for another day before succumbing, cuddled in his mother’s arms for every second of the end of his short life.

As I reflect on my first two weeks in the MSF hospital at Yida refugee camp, I think of the great joy of sharing in the recovery of so many little kids that would not have survived tetanus, measles, pneumonia, acute watery diarrhea, had we not been here.

Clement is preparing to leave us. It will be bitter-sweet for him to wrap up his mission and head back to his life as an emergency room physician in France.

I suspect he will be back. It is the joy of those recoveries that bring us all back to the field. It is the memories of all the losses and sorrows that we carry home.

* a fictious name to mask her identity 

Written 25th January 2015