From a Hot Weekend in Central African Republic: Ward rounds

Miriam is a supply logistician currently working in Central African Republic. 

Miriam is a supply logistician currently working in Central African Republic. 

Saturday morning I decided to do ward rounds with our charming Dutch doctor. She needed someone to film her at work for the communications team in Amsterdam. After making it clear [to the patients and caretakers] that being filmed was not obligatory, we proceeded first to the inpatient care wards (ICUs) for children, then adults, and then finally met with some special cases. As this still qualified as MSF work, I didn’t feel guilty abandoning my spreadsheets for a few hours.

As we started rounding in the first room, the guarde-malade, the carers of the children in the ward, began to tidy up the beds and themselves for the footage. I found it interesting that either for their own, or MSF’s, sake they saw this as important: the global reaction to a camera.

The doctor talked with the secouristes (national staff nurse assistants) about each patient.  Then, the secouristes moved between French and Sango to translate: "Has your child been feeding, been sick, any other changes?"- as they made additions to the checkered observation sheets that you see in wards across the world.

The only difference is that here the staff sometimes forget to fill the sheets out, or lose them, or don’t date them. While everything looks standard, you realise a lot of these systems are still new. For this reason collecting regular data in this environment is one of medical team's (and supply team's) constant challenges. We have to remember that outside of our small hospital there is no government, or other structure, its lawless and trust and long term planning are not primary concerns.

I film the room, the babies with malaria and parasites, the mothers who won’t smile at me but laugh amongst themselves and with the national staff when my iPhone camera moves away.

I try to remember everything I have ever been taught: film from different heights, looking up at the doctors as the child and mother are, looking down at the patients, close ups of hands examining swollen bodies, prodding feet, stethoscope on chest and back, wide open eyes.

Then I back out, taking in the scene as a whole: two mothers and babies per bed, the doctor sitting in her blue plastic chair scribbling information onto the A4 cards. The health assistants, standing listening, translating, laughing with the ladies in the room. I watch everyone watching the spectacle, the daily ritual, waiting for her blue plastic chair to move from bed to bed.

After the doctor's assessment, some mothers leave with their babies, whilst others stay for more observation, more treatment.

One baby needs to stay for a few more days to watch for sepsis. He had had his tonsils removed by a traditional healer, a common treatment for malaria.

Another child with sickle cell anemia is discharged with his mother and baby sister; he must have been about six himself. Whilst I had filmed the room, I had watched him playing with his baby sister out of the corner of my eyes, not wanting to disturb him. He made her giggle and her spider-leg hair braids bounced above her boggley baby eyes.

The boy leant over and kissed his sister on the cheek. Such a tender gesture, I knew that there must be love in his family. But for himself, he would not live long. Flow explained it to me, the sickle cells cause damage and blockages, and there was little they could do for him here.

In the adult wards we had a 60-year-old patient with a hernia that the surgeon tried to manually manipulate. I watched, but did not film, and the patient groaned in pain. Eventually, the surgeon gave up and said in his heavy Dutch accent: "Surgery". The man pulled up his trousers, for some decency through the pain, and we moved on.

Another man had been brought in by our mobile clinic a few days before following a motorcycle accident, and had awoken from his coma. The doctor was amazed; the man was sitting up and talking. All they had done was give him pain killers and IV fluid. Sometimes all we do is support the body healing itself here, she told me.

We chose to not film the morning’s last patient. It was a TB case, a skeletal body, low responses even though he was sitting up. He watched but didn’t otherwise move. Continued tests and drugs, and Flow made a note to pick him up some blowing bubbles from our base to let him play with.

Then we were done, my tour and her film.

I have now decided to join one of the medical teams every Saturday morning for ward rounds, either at the main ICU, or in maternity with my midwife roommate and the counsellor, or anyone who will have me and will remind me why I lose myself in the endless lists of stocks, codes and numbers that make my brain hurt in my world of Supply.

We haven’t had a camion [truck] since my arrival over a month ago, so we rely on a plane once a week to restock. The context here is not to be forgotten even if my enclave is calm. Supply in all directions is truly chaotic as the roads from the capital are risky. So I try to juggle urgent medical requests on a database, and fend off the less urgent, but still important, requests for things like pens.

This connection to the consequence of our work as logisticians is vital.