The outpatient department is a tukul divided into several individual consultation rooms. The 'waiting room' is a large piece of ground covered with plastic sheeting and sheltered from the sun by a thatched canopy. Good triage in the waiting area saves lives. Children and their caretakers, usually their mothers, form a line to the left, adults form a line to the right; at least this is the way it is supposed to work in theory. In practice there is much shuffling back and forth between the lines, people coming and going to the lab, people socializing, organized chaos. All children have their temperatures taken. Those with a fever get screened for malaria; those under five years old get screened even if they only have a history of fever. Children between 6 months and 5 years are screened for malnutrition using a MUAC or mid-upper arm circumference. If they are deemed to be malnourished by the MUAC, they are measured and weighed using a sling and a scale that hangs from a nearby tree. The children are generally not happy with the sling, but a good cry is a good sound. All pregnant women and adults with fever are also screened for malaria.
The mothers cover their children with blankets or carry them in baskets. We have to be careful to find all the children who are hidden in the lines or risk missing a seriously ill child. Most of the children have diarrhea, upper respiratory infection, pneumonia or malaria, sometimes meningitis.
A child, semi-conscious and in shock, is identified quickly by the vigilance of one of the staff. The child is rushed to the inpatient area where three people try to establish an intravenous line. The hands, arms, feet, and scalp are all tried. The child does not even flinch. Finally someone succeeds with a scalp vein. A small victory.