It has been almost a month since I left home. I think I’m into a groove. I have mastered straining coffee through a handkerchief without making too big a mess. I’ve also got a vocabulary in the local language M’Bai of about 35 words. Although I always use a translator with the patients, being able to directly communicate for a few moments with patients and families is one of the small joys and priorities in MSF work. Nothing builds a therapeutic relationship than greeting someone in their own language and genuinely telling them they have a beautiful child.
In my first mission I learned that it takes about 1/3 of the mission time to completely learn how things work, 1/3 of your mission to really get into the work, and 1/3 of the mission to make some improvements. All said and done, you’re working hard from the day you set foot in the project to the day you leave. As in my last mission there is also a steep learning curve in an MSF mission. Now, on my second MSF project, it’s a bit different than the last. I’ve tried to not make too many changes, but with the cooperation of the team, we have made some immediate changes to our sleeping sickness program.
One change we have made is to try not to make the diagnosis of sleeping sickness and then leave the patient on a ‘waiting list’ for too long. When that happens, the patient can convert from stage I of the disease to stage II of the disease. This transition represents the migration of the trypanosome parasite to the brain and central nervous system, and can eventually lead to complications and neurological problems. It is very easy to land in this situation however because to screen and stage for the disease takes only a few hours. The initial screening test was use to establish the diagnosis of sleeping sickness takes only 5 minutes itself. In contrast, the treatment takes 14 days and requires regular nursing and physician supervision. It’s easy to make the diagnosis and it’s more challenging to treat the disease.
Many other urgent cases are admitted regularly to our HAT (human African trypanosomiasis) camp. A 2-year old girl named Louise presented with severe second degree burns of her entire left arm and face and after 14 days of dressing changes and medical care, she made a good recovery and left home today. For some of her dressing changes that would predictably cause pain, we sedated her with ketamine. Burn dressings are notoriously painful and nothing is worse that painful burn dressings in a child. I try at all times to avoid that occurring.
Another recent case was Severin, a 1 year old boy who presented with severe dehydration and gastroenteritis – one of the leading causes of death among African children. When he presented to hospital he was unconscious and could not drink. The nurses and I could not insert an intravenous line in his arm, hand or scalp veins. His veins were just “too flat” due to the dehyrdration. So instead, I inserted an intraosseous needle into his right leg tibial bone. Through that intraosseous line we hydrated Severin and now he’s made a full recovery. I hope to discharge him home soon – likely tomorrow.
Ngoh came back today from the village of Daga. He is a very cute infant who came back today to be reweighed. He presented with severe malnutrition and I discharged him home one week ago with a plan to re-feed him on an ambulatory basis. With the help of one of our national staff who is a nutritional assistant, I advised his mother to come back and see us in one week to be reweighed. Using Plumpy Nut which is a tasty peanut-butter-like ready to use therapeutic food, he’s made good progress with ambulatory re-feeding. When he entered our program he weighed just 4.3 kg but now he weighs 5.8 kg. The goal for Ngoh to exit our ambulatory program will be 6 kg. Although he peed all over me when I held him today (I could not resist, he is so cute) – we will welcome him and his mother back in one week to be reweighed and reassessed. Until then I will continue to give him Plumpy Nut on an ambulatory basis. Maybe next week he will not pee on me, but as I learned in Burundi on my last mission, when a baby pees on you it is a sign of good luck.
Warm wishes from the Central African Republic,