Fieldset
A busy day in Maitikulu

Raghu blogs from the Central African Republic, where he's part of the team responding to high levels of sleeping sickness

It is a busy day in MSF’s Maitikulu sleeping sickness camp. At the beginning of the day the inpatient unit itself was full. There were no beds available to admit new patients either with sleeping sickness or other serious pathologies such as malaria or malnutrition. Although we aim to primarily treat sleeping sickness, the population will come with many other pathologies, and these cannot be ignored. We always make room to treat the sickest and most urgent cases and that sometimes means our more stable sleeping sickness patients need to wait to be treated. It’s a matter of triage.

The exact census of the hospital changes quickly, but we have about 100 patients. This poses an immediate problem that is solvable. Dr. Placide – our national staff doctor (who is from the Central African Republic himself) and I will have to discharge patients in order to make room. This problem is actually something which frequently occurs in Canada as well. When my hospital back home in Toronto is full that creates difficulty in the Emergency Department (as there is nowhere to admit patients) and so instead they end up in hallway gurneys. The same phenomenon happens here in rural Central African Republic except it becomes a mattress or mat on the ground. The situation is far from perfect, but the population knows we are doing are best under the circumstance. This is a “situation sans frontiers”.

The sleeping sickness program here is a careful balance of a few factors: first, we need to make the diagnosis by doing a series of blood tests, lymph node biopsies and a lumbar puncture (or spinal tap). Based on these tests we determine if the patient has a minor form of the illness (i.e. stage I) or more severe stage (i.e. stage II). Then, because of the volume of patients here with this illness they have to wait to be treated. So, the patients with a diagnosis of this illness have to go back to their villages in northern CAR or southern Chad and wait to be recalled to the HAT camp here to be treated. Ideally, once you make an important (eventually fatal) diagnosis like sleeping sickness (also known as HAT) you would treat it right away. But there is too much disease here to be able to do that. Overall, this situation of “waiting to be treated” we hope to change in the next few weeks. I’ll keep you posted on our progress.

Over and out from hot and humid CAR.

Raghu

Image shows blood samples being mixed with a solution that will determine if it they are positive for sleeping sickness.