Fieldset
A girl who couldn't breathe and two starving boys

As I am about to complete my mission this weekend and this blog, I thought I would finish where it always should start and end - the situation and struggle of our patients. Three seriously ill patients in the in-patient service here in Maitikoulou are Abasse, Angela and Ramana.

As I am about to complete my mission this weekend and this blog, I thought I would finish where it always should start and end - the situation and struggle of our patients. Three seriously ill patients in the in-patient service here in Maitikoulou are Abasse, Angela and Ramana. Let me tell you

about the struggle for life of these three small children.

Ramana is a 1 year old boy from Chad, and slowly but surely, his life was saved by MSF. He arrived 32 days ago in a severely emaciated state. He was so weak and malnourished that he could not even cry. He could not sit up. He could barely feed so we initially fed him by nasogastric tube. I felt on

pins and needles, doing everything possible, to keep him alive and checking on him 4-5 times per day and carefully adjusting his medications and feedings.  To be honest, Ramana has not really gained too much weight here so far. But, his clinical condition has improved dramatically and slowly but surely he is consistently now gaining weight. He can now sit up, look me in the eye and put food in his mouth. Probably in 4 weeks he will reach a weight appropriate for his age. No rush. I will be handing his case over to the new doctor who arrives today. I am sure she will cure him.

Right across from Ramana is Abasse from southern Chad. Abasse also makes me feel on pins and needles. He is very sick, and so I am constantly nervous and worried about him. I check and re-check him all the time. I can't count the number of times I saw him today amidst getting our base ready for 5 expatriates who will arrive today. Just like Ramana, Abasse is severely malnrourished. He also presented with severe anemia due to malaria and when he arrived we had to perform an emergency blood transfusion in the middle of the night. Abasse is supposed to weight 8.6 kilograms but amazingly, only weighs 4.5 kilograms. His skin hangs on him in loose, dry folds. He can barely voice a protest when I look in his mouth infected by candida fungus and check his tearless, dry eyelids for signs of anemia. But finally, his diarrhea, vomiting and fevers have started to slow down today and he is wanting to eat. Dr. Placide - the other doctor here - and I have conferred many times on Abasse and we've given him everything we've got here in the middle of nowhere. We also both think Abasse is maybe going to live if we can get him through a few more rough days. I'm leaving here in 3 days and I think I'll know by then if Abasse will make it. It will be a busy weekend with handing-over to the new doctor, but Abasse will command my attention nonetheless.

Angela is a 1 year old female infant from CAR. She has the worst case of bilateral pneumonia I have seen here during my 4 month mission. Respiratory illnesses need to be taken seriously in this region with such a jarring lack of social services. Children do not routinely receive life-saving vaccines,

malnutrition robs their bodies of a competent immune system, and families who live far away from us wait-out illnesses such that they arrive often when a child is just about to die.

When Angela arrived yesterday, she was breathing somewhere between 60-70 times/minute - every muscle in her body was probably doing something to help her just breathe. Her lungs sounded just horrible. Dr. Placide and I both shook our heads in amazement and worry after we examined and resuscitated her together. Angela could not breast-feed and lay limp in her grand-mother's arms. We hit her with all medications we had here to treat her. I kept checking and re-checking her, and adjusting her fluids, inhaled medications and treating her with two potent antibiotics. Slowly, over the last 24 hours, Angela has started to turn the corner. She's getting better and not worse - she can now breast-feed - a good sign that the effort to breathe is not the only thing she can do at once. It is great to see. I'm very hopeful she will live, and I want to see her really turn the corner before I leave. We'll truly know in 3 days if she is on the road to recovery. My fingers are crossed and we will do our best.

Warm wishes from the Central African Republic,

Raghu Venugopal