I am now in the 4th and last month of my mission in Maitikoulou. Certain truths have unfolded. The MSF Land Cruiser side-door mirrors are the best to shave with. There is little point in trying to sleep once the sun starts to rise around 5:30 AM, unless you go to bed too late. I'm always going to be sick.
Other truths to me include that the living conditions here at this HAT camp will always be to my personal disliking. There is little space for personal privacy. I can rarely stop being a doctor or an MSF volunteer.
At home in Toronto, Canada - when I am done work at the hospital, I can easily be absorbed by the crowd on the street when I exit the hospital. I cannot do that here. You're always a bit of a novelty here. Going for a walk after work is like being an animal in a zoo - on display. And lastly, the strong will survive - this is Darwin's domain. The weak can maybe survive - but the odds are largely stacked against their survival. But there are exceptions. Exceptions are important - they are a window for a different future for the weak and poor in my opinion.
As a case in point for this last observation I would like to tell you about Remarko. Remarko is a crippled man. Both his legs are atrophied and almost useless. This is likely due to polio when he was a child.
Remarko is indeed true to his name - he is remarkable. He moves himself all around using only his arms to carry his body. When the distance he must cover is a longer one, he holds onto one leg (which he can straighten) and then rolls from his front to his back. His progress is slow but it seems determined. His blue and red soccer jersey is covered in dirt most of the time, and he does not travel too far. His life is tough but he still has a shy smile and certain resigned happiness to his personality.
The other crippled man who also carries himself by his hands is a well-known person around Maitikoulou village. We sat beside each other once in the Protestant Church where I go to enjoy the singing. I don't know this man's name but he also always smiles widely and waves hello. He seems to still be engaged in life despite his obvious serious disability. Neither of these men ever ask me for anything.
I always give the patients the plastic empty bottles that once had medications. In addition to empty boxes and empty bottles that once held peanuts, the patients love these as they are clean and they can put water or other things in them. People are very poor here - everything is recycled. I'm not worried about the bottles being laced with medication as the medications are put in a bag before being placed in the bottles. When empty containers appear, I usually evenly distribute them, tent by tent.
This time, I gave two big and one small medication containers to Remarko. He seems surprised but happy. He kept them on his bed.
Remarko has no guarde de malade - no one is there to take care of him. This is odd, since a guarde de malade is the rule here. No one - really, no one - comes to hospital without someone else there to help feed, tend, bathe and advocate for the patient. This is markedly different than medicine in Canada were I frequently attended to patients who are alone.
I think being crippled and with no guarde de malade is why the other villagers in Remarko's tent took his 2 large bottles and left him the one small one. When I asked those in his tent where his bottles went, two strong healthy-looking men also being treated for sleeping sickness pulled them from their bags. I scolded them. But this is Darwin's domain - the strong survive. But there are exceptions.
After this incident, I decided to make a little care package for Remarko - in private. I have been secretly keeping some boxes and bottles I know him and his sleeping-sickness affected family will be happy to use for this and that. But I keep it in our medical office as I know the strong will take from the weak. When Remarko returns home in the MSF Land Cruiser I will make sure these little things go with him.
Remarko's life has been hard lately. His mother also had sleeping sickness and was treated here. She is quite old and is in failing health. I recently brought her by Land Cruiser to the hospital for some tests and additional treatment. There is honestly not much I can do for her chronic ailments here - other than treating her severe arthritis and testing her for parasites and malaria - we have little other diagnostic capabilities here. Stating he was worried about his mother, Remarko initially did not want to come to hospital to be treated for sleeping sickness. A long talk with him with the help of his village chief, changed his mind. As well, his village chief agreed to come and be Remarko's guarde de malade for a day. That must have helped as well.
As an MSF medical doctor in this community, I believe I enjoy a position of earned respect. I am aware that how I talk, how I treat people (including even the most simple interactions), and how I conduct myself can set the tone for the team around me, for good or for ill. I am hopeful that if I try to protect the weak, show genuine empathy and compassion for as many as I can, and act fairly and justly I can positively influence those around me. I think this is an important part of being an MSF volunteer and of being a medical doctor.
Warm wishes from the Central African Republic,