Good-bye dear Maitikoulou

Dear Maitikoulou,

Dear Maitikoulou,

It is good to have been with you. After 4 months serving with MSF in your small village, I leave with a deep sense of satisfaction. There were sure tough times. I fell sick a lot which is unlike me. The isolation was challenging to cope with as well – I live in Toronto which has about 4 million people – that is the population of the entire country of CAR.

In Maitikoulou, since it is a start-up project still stabilizing itself, the living and working conditions were rough. We all felt under a lot of stress, but we still had fun like some nights when we had a “Maitikoulou dance party” and all danced together to our favorite music. The team and I, we did our best. By no means was our work perfect. But we gave it our all and we definitely advanced you Maitikoulou from a start-up project to a functioning project.

There is still a lot more work in Maitikoulou for MSF to do. We need to finish building our in-patient ward, and we need to improve hygiene in the wards (which is critical for our malnourished patients in particular). We also need to screen more villages for sleeping sickness and put in place a computer system for managing the data of our patients who are screened and treated for sleeping sickness. This is just the tip of the iceberg. This will be the work of future MSF teams to come.

Dear Maitikoulou, despite all the challenges, we did save a lot of lives and we did alleviate much suffering. I recently wrote about Angela, Abasse, and Rahmana. I am so happy to tell you that Angela can breathe properly again - we have almost cured her severe pneumonia. She's a bit of a miracle my national staff colleague Dr. Placide and I agreed. The two malnourished children Abasse and Rahmana are also now stabilized and both are gaining weight - I no longer fear for their lives being lost. They're little miracles too. But with the cure of these patients, as always, come other sick patients. Treasure is a little boy just admitted with 20% second degree burns to his body after falling in hot oil. We can only do his dressing changes after sedating him with ketamine. His father fainted the first day we sedated Treasure and took off the bandages his family has applied 2 days before. I felt faint too. The sight, smell and heat that day was hard to bear. I leaned up against a bed to prop myself up as four of us worked on Treasure, hoping I too would not have to leave the room or lie down on the ground.

As is often the case, the hospital tents in Maitikoulou are full - we took out the last mattresses from the logistical stock on Nov. 1 in order to give patients a place to lie down. Malaria, infections, sleeping sickness, malnutrition and many other pathologies fill our wards. And this, dear Maitikoulou is only the end of the rainy season. When the dry season hits us, and the rivers go down, so many more Centraafricans and Chadians will present to our facility that I am not sure where the patients will go. But we'll figure it out. The new in patient ward will hopefully be done by then and dear Maitikoulou, you will be a well-oiled MSF machine ready to ramp up our patient numbers.

Maitikoulou, take good care of those I have left behind to work in the sub-base. Take care of all the national staff and expats. Especially take care of the new doctor from Austria who arrived on Nov. 1 to replace me and the American nurse-practitioner that I worked with side-by-side, everyday, 7 days a week.

Yesterday, we did a long hospital patient round and my replacement, over a 24 hour hand-over, got a crash course on the challenges and opportunities of being an MSF volunteer in Maitikoulou. What a great feeling is to know that whereas my mission served a few specific purposes - to stabilize the medical program and advance the sleeping sickness effort - my successor’s strengths which are different than mine, will take you, Maitikoulou, in a yet more improved direction.

Maitikoulou, you took a toll on me. Sometimes, you made me wonder if I was tough enough to be an MSF doctor and volunteer. You shook me, physically, emotionally and psychologically. You lead me to do things

I don't usually do. I said many a prayer when I felt things seemed out of my control and I even had a few cigarettes when I looked for ways to chill out and calm down. After a weekend of being really sick I told our expat nurse I wouldn’t smoke anymore if somehow I could regain my health. Maitikoulou, you made me so sick sometimes I wished I had never left Canada. And also, you made me feel so good when we cured children like Angela, Abasse, and Rahmana that would have died otherwise. So many mixed feelings. So MSF.

In the end, the best feeling is when the MSF car pulled out of the compound yesterday and we drove to Markounda, our base station. Dr. Tanja who replaced me and Dr. Martins, my medical coordinator asked me

how I felt. I said I was not happy to go, and I was not sad either. Rather, I was satisfied. Satisfied that MSF was here, and satisfied that I could be part of our work in Maitikoulou.

Dear Maitikoulou, thanks for the memories and the sense of profound satisfaction I will carry with me always.

Warm wishes from the Central African Republic,

Raghu Venugopal