A doctor in DRC: Barefoot medicine

Ludvig has recently completed an assignment as part of MSF's emergency team in the Democratic Republic of the Congo. This post was written six weeks after arriving in Bolomba, a remote area where Ludvig and the team have been fighting an outbreak of measles - one of the leading causes of death in children globally.

Ludvig Bolinder and members of the MSF team

Days are added to weeks and time passes, without you even realising it. 

Today, the first team has left for Itotela - the area to the south where we'll be extending our work. Myself and Doctor Mamie have been covering it, but now there will be 10 people who will establish the base, build a hospital building (in wood, with plastic ceilings), train the staff and then roll out the full-scale treatment of patients in three days.
Dr Mamie will be going with them, which leaves me in sole charge of our hospital here and for staff santé. That means dealing with any health problems among the 70 MSF staff here in Bolomba. And there are a lot: for example, around half the team has already been treated for malaria since we arrived, and virtually everyone (myself included) has done a de-parasite treatment at least once.
Doing rounds with 40 patients, discharging a dozen and receiving as many new ones is a rather busy day's work. In a hospital in Sweden it would be impossible, but that doesn't mean it can't be done. "Fever? Vomiting? Poo? Urine? Cough? Eating?" Clear.
There are three possible lab analyses I can order: haemoglobin, blood sugar and a malaria test. No x-rays to base a decision around. No long journals to read. Barefoot medicine, we call it. In the short term, very liberating; in the long run, however, enormously frustrating to never really be able to find out the cause of the patient's symptoms. You're forced to use a degree of trial and error.
Whilst some things are less difficult here than back home in Sweden, others are complicated. Take for example oxygen treatment.
In Sweden:
1) Take an oxygen mask from the shelf on the wall.
2) Connect the hose to the oxygen outlet on the wall by the patient's bed.
3) Place mask on patient.
4) Press the button on the oxygen outlet.
Time: about 15 seconds.
In Bolomba:
1) Call the logistician via radio and wait for them to answer.
2) Ask the logistician to start the diesel generator.
3) Take down the oxygen concentrator and connect it to the generator with a giant extension cord.
4) Get an oxygen mask at the small hospital pharmacy.
5) Place mask on patient.
6) Press the button on the oxygen concentrator.
Time: about 15 minutes.
Two new international team mates have arrived during the week. And gone again. The Belgian pharmacist Sara will be in Itotela. The other, a French logistician named François, will devote himself to constructing vaccination sites for the vaccinations that start tomorrow.
500-1000 children are vaccinated every day by a single team of 10 people, one of whom is a nurse and holds the syringe. François goes round putting up and taking down vaccination sites all day long. In 45 minutes, he designs a fenced-off path using bamboo poles and plastic tape. This directs the queue of people. He then constructs a kind of tent that provides shade for the people in the queue.
Dinner's ready. Let me guess. Rice with foufou and the last of the goat we have been eating for a few days now. Yesterday it was the intestines and a hind leg, I think. Logically, there should be at least one leg left. How is the meat kept in anticipation of ingestion? Don't ask.
Also, don't ask which animal species the meat belongs to, if there is no goat, pig or chicken available. I've obviously eaten antelope, possibly a monkey and some unidentified predators. Don't ask, as I said.
After the food (yes – it was goat with rice) François comes with a surprise. A jar of NUTELLA!!! My friends, I tell you, I think the kingdom of heaven is eating Nutella with a spoon straight out of the jar after 1.5 months in Bolomba.