The work and the play

Day 30

Day 30

One month. Exactly one month since I left home. 30 Days. And the staff meeting tonight was as frustrating as is possible to be. Just like staff meetings at home. Over 2 hours of meeting and a totally unsatisfactory outcome for all the players. I am in a tug of war with a hospital clinician over procedures there and am wishing so hard that things would settle and I could go to Pagil, where I am originally contracted to be. I should be working in a small clinic with a small team in the middle of nowhere with no bureaucracy to deal with. But no… the security issues are not settled and I am living in a large town/city, full of mud and chaos and soldiers with torrents of rain, but no water in the taps, in a house designed for far fewer people than are here, in a room shared with two or three others, depending on who is passing through (MSF does say that whenever possible, you will have your own room). The market has nothing but onions and the security here means you can’t go out alone, you must always have a radio, and you cannot go out after dark (6:30pm) except in the car and you must be home, but not necessarily tucked into bed, by 9:30 pm.

Well, that was certainly a rant, but it does feel good to get it out and off my chest. MSF tells you that you need a way to relieve ‘stress in the field’. They suggest perhaps yoga or exercise or meditation. I prefer drinking beer, or blogging, it seems

The good things are that we have music and we sometimes have cold beer and we seem to have dancing most Saturday nights and we have a team here that works well together, despite the challenges. I think that perhaps MSF should include dancing, really really dancing, as a way to relieve stress. We have an awesome sound system and music, fantastic African music, courtesy of the African expats, the people who now work for MSF as international staff (like me) but who started out as National Staff, working for MSF for years in their home counties.

They come from every part of Africa, (Congo, Kenya, Cote D’Ivoire, Sierra Leone, Ethiopia, Eritrea) and bring an incredible amount of experience with them. I really had no idea how much MSF promotes education and development of skills among their staff, but more of this later. Our Saturday night parties are energizing, and people from the other NGO’s (Non-Governmental Organisations) in town always come because they have later curfews than we do.

One of the things they stress in the PPD (remember, if you are following along on this journey, Primary Pre Departure) week long session, is just exactly who it is ok to have any kind of ‘relations’ with (aka Bill Clinton, Past President of the US of A) while on your mission. It seems that other NGO staff are ok, (thank goodness, I haven’t broken any rules yet), MSF expats are ok, (but beware the challenges when you break up and you still have to work in close quarters in the middle of nowhere with guns firing all around for 6 more months), but National Staff (the amazing South Sudanese employees of MSF) and the local population and our patients are definitely not ok.

There are many good reasons for all these rules that concern the same things that make it not ok to be involved with someone inappropriately at home (you are their boss, their teacher, their professor, their employer, their doctor, or have an unequal power relationship) but when the ……… well, you know.


there is work for me here and the reason I joined MSF was to work where I was needed and so, now, back to the non-stress relieving activities of my day. Let me tell you about…..

My patients…

who often arrive critically ill, after a boat trip on the Nile that may have taken days. I am only starting to feel that I am ok, that it feels right to be here, that I have the ability and the knowledge and the tools to do a good job, and then today happens. A woman arrived on our doorstep, folded up in a blanket, carried by her husband for 2 days, having left four children at home to care for each other. The oldest was 12. The last born, as they say in Africa, was 4. The rest had already died or lived somewhere else or could not be contacted.

We think she was about 46 years old (ages are generally unknown here) and she weighed 48 lbs or 22 kilos. Yes. 22kg. Her BMI (Body Mass Index) was 8. I had seen hungry and sick people before in Malawi and Zimbabwe, treating HIV/AIDS, but…

We had to measure her height the way we measure a baby; lying down because she is unable to stand. Her husband had to hold her and we had to subtract their combined weight from his to get her weight. We included the weight of the blanket.

Body Mass Index is a way of judging how close to normal a person’s weight is. This is needed to correctly calculate the dose of medication we should prescribe. Normal is between 18 and 24. My BMI was 24 when I left home, and even now, with the weight I have already lost here, I am over 100 lbs /45 kg more than my patient. I am about the same height. I have to step back and take a big breath before I can start to examine the form wrapped up in the blanket. And when I did, she opened her eyes, looked up at me, and she smiled. She smiled at me. I did cry.

A BMI of 8 means that when I tried to listen to her chest, to see if she had pneumonia or perhaps tuberculosis, I couldn’t get a seal on my stethoscope so I could not hear her heart sounds or her breathing. Imagine the ribs of a skeleton you have seen in the museum, and try to place a stethoscope and listen. I finally figured out how to angle the chestpiece of the stethoscope so I could sort of fit it between 2 ribs.

It’s hard not to look too shocked, not to be certain that I will be unable to offer her the medical care she needs. But I have seen people with AIDS gain 30 lbs/13kg in just one month on ART (Anti-Retroviral Treatment) and come back to the clinic looking healthy and well. Perhaps, since Kala Azar is a disease similar to HIV/AIDS, in that it attacks the body’s immune system, the medicine we have for KA will work that well for my patient. Today, I can only start the IV lines and the rehydration and the antibiotics and the food supplement and the investigations into her illnesses, and wish and hope. And move on to the next patient.

Last week I had a patient with a HB or HgB (Hemoglobin) of 2.7. The previous lowest HB I had ever seen in a conscious person was 4. Every time I think I will never see illness more unmanageable, a patient with a more astounding problem comes in the door of the clinic. And sometimes they are even walking! And have been walking for days to come to the MSF clinic to get help. Normal HB should be above 10 or 11 in women, and up to 16 in men. Hemoglobin carries the body’s oxygen. How a person can walk for days with their circulatory system working on such overdrive, already sick with a disease I haven’t yet diagnosed, overwhelms me. Sometimes, the end of the day can’t come too soon, and I can go home to the team, the people that make my work possible.