Hard Hearted Woman

I am entering my second week here in Leer. The team found out they missed my birthday, and last night, we had a birthday cake, made from scratch in the homemade outdoor oven, and Happy Birthday songs and cool beer (there is no fridge in the compound, just ice packs and a cooler).

I am entering my second week here in Leer. The team found out they missed my birthday, and last night, we had a birthday cake, made from scratch in the homemade outdoor oven, and Happy Birthday songs and cool beer (there is no fridge in the compound, just ice packs and a cooler). It was a lovely evening, talking under the stars and sitting in the coolness of 32 degrees. It was a respite from the hard work for everyone, for a night. It was a chance to relax as a team, and get to know everyone a bit better. It was so nice.

I am really enjoying the challenge again, for sure. It is so good to have some success stories. Often, at home, people would ask me why in the world I was heading off to such a remote area, to volunteer for such a long time, to eat tinned food, to work such long hours and my answer, the easy answer, was I was looking for a new challenge.

Without trying to explain the intellectual and emotional intricacies behind the desire to volunteer in such a difficult environment, I would say simply that I was looking for a new challenge, something different from my day to day normal life. So, when the challenges threaten to take my breath away, I try to remember; this is why I came.

My favourite patient right now is little Joseph. Nuer children usually have 4 names, and it takes a while to get used to them all. Usually the first is a western name, then a Nuer name, then the name of the father and then the grandfather. For this blog,I have used Western pseudonyms, worried that I will get the Nuer names wrong, even as pseudonyms. It is a complex naming system.

Joseph is a severely malnourished child, previously treated in many places for many illnesses, and not getting well and recently transferred (meaning a note was written from the outlying clinic, and Joseph's mother was told to walk to Leer Hospital).

I was asked to see him in consultation on my 2nd day here. He had already received treatment for every disease it was thought he might have, and he was dying despite all the previous treatments. I looked at this shrunken child, his malnourished state, his obvious severe anemia, his swollen belly, and then I examined him.

He stayed so very still while I poked and prodded him. He did not acknowledge my presence. All his tests for Kala Azar (my specialty disease, remember, the disease I know so much about now) had come back negative, all the tests negative, done twice. But.... his clinical exam showed all the signs of having Kala Azar; fever, lymphadenopathy (enlarged lymph nodes), conjunctival pallor indicating anemia (low blood HB (hemoglobin) levels), peripheral edema (swollen legs and feet), and his abdomen contained a large liver and hugely swollen spleen.

Your spleen should barely be palpable under your ribs. His stretched all the way across his abdomen to his umbilicus and down to his pubic bone. I had worked with Kala Azar for the last 3 months. I knew, even if all the tests said no, that this child had Kala Azar.

I immediately transferred him from the Feeding Program to the ICU and started our most aggressive Kala Azar treatment. He was so sick. It was questionable if it was possible to bring him back from the brink. But slowly, and with a few terrifying setbacks, he sat up, he ate, he smiled and then he walked. Not far, but then he started to play with his sister. He was better. I was happy. I am enjoying this difficult job. It is what I wanted when I applied to MSF. I feel settled, finally.

Something I have learned, but haven't written much about yet, is just what kind of a team is needed to run MSF's medical programs. We, the Medics, the doctors, nurses, nutritionists, midwives, lab technicians, and pharmacists simply cannot do our job without the Team.

In 'the field', as a simple basic need, someone has to get the right medicine to the right place at the right time in the right amount in order for any medical work to happen. All the equipment and supplies that are needed to run a hospital or clinic need to arrive also.

And we must have a place to live and communication equipment and vehicles and computers that work and food for the team.......and in the city, there is a whole other crew of people, making sure that airplanes arrive on time, that medical evacuations are done when needed, that human resources are attended to, that finances are sorted.... so we can do the medical work that we do.

The non medical team members 'in the field' don't often get a close up look at the fruit of their labour. They are far too busy doing their job to be able to see the medical work on a day to day basis. And the MSF staff 'in the field' but who work in the capital city, who are in charge of the bigger picture, often don't get any chance to see the effect of their hard work I, personally, think this would be so difficult.

To work so hard for a medical humanitarian organization, and never really get to see the medical side of the work seems like it would be disheartening. But, perhaps, that is just the medical side of me coming out. Perhaps the FinCo (Financial Coordinator), and the electricians and mechanics really would rather be away from the more colourful (think blood and guts) side of MSF!

But, I would like to, formally and publicly, acknowledge and say thank you for the awesome work done behind the scenes so I can do medical work. Shukran, Gracias, Merci, Danke, Asante, Chezu ba, Dank je.

So, back to the job I am now doing, supported by all those folks.

Today, I think about how this job has changed me in a profound way, which I think is good, but I wonder. I pronounced 3 people 'passed' or deceased, in one day. The first was a baby, brought straight over to the ICU, referred from the OPD to the ED and immediately to me because she was so sick The charge nurse told me there was a new sick patient, and I went in to see.

A new mom, sitting with a bundle on her lap, sat on the bed, and I went over to examine the baby. I smiled at the Mom, she smiled back, and I unwrapped the baby. She was warm. But she was dead. There was no heartbeat. I listened and I listened and then I looked at her Mom, and said Malish, Malish Sorry Sorry. She died on the walk from the Emergency Department. It's about 150 feet, 50 meters. She died walking across the hospital compound, after walking so far to get to the hospital.

And then I got up and went to see my next patient. I worked for many hours that day, and pronounced 2 more people, one a young boy, trying to stay cool in the 40 degree weather, who drowned in a small brackish collection of water, left over from the rainy season.

The last one was a soldier, injured in a gun battle. We operated to repair the terrible damage that closely fired semi-automatic bullets do to a human body, but he died. His family was all there. The women screamed and ululated (an amazing sound like a musical instrument or a scream, depending on the context) and fell down and cried out, and the men stood to the side, quiet and stoic, and I, once again, moved on. I did all this, I looked after so many sick people and I went home to dinner and a beer, and wondered if I am getting too callous, or if this is what must happen to be able to continue in the work.

I don't know.

I discharged many well people that day also. We sent them home healthy again. I do know that our new treatment for malaria, introduced on my very first day here, seems to be working so well. Children that are deathly ill when admitted are sitting up the next day and smiling and on their way home the day after that.

MSF is instituting this new treatment in our hospital as one of the first sites, and there is paperwork to fill out and forms to complete so we can know, does it work better, are there worrisome problems with it, is it too difficult a treatment regime to be instituted in places that are more remote than we are here? It is good that we do this, but it is much more work for the nurses and the medical staff that I work with on the ward. But, it is good. Malaria is deadly. I like that I am a small cog in the wheel of research to see if this treatment is better.

What I don't like, but accept as part of the job here, is the fighting, the war, the seemingly senseless ongoing skirmishes that result in spear and gunshot trauma. I just want to be mad, to get upset and not to attend to the perpetrators of another seemingly senseless act of aggression But I don't know who the perpetrator is when a body is lying on the ground in front of me covered in blood. I cannot judge, and even if I could, I am here to provide medical care, to any and all who need it.

There are so many people simply caught in the crossfire, children who were in the wrong place at the wrong time, and I am here to work, and to witness and to accept that humanitarian care means providing assistance to all, regardless of the origin of or the reasons for the injury. I am working on this. I am growing into this job, I am learning in ways I never, ever imagined, what I am capable of.

I usually I like it very much, but not always. There are days of frustrating confusion and days of great accomplishment. Usually, I go to bed, in my tukul, (with my companions, the bats and the ants and the mosquitos and hopefully no snakes), with the feeling that this is the right place for me to be right now, and I look forward to the next day.