Our camp for sleeping sickness or Human African Trypanosomiasis (HAT) is bustling with activity. It is an MSF project which is scaling up and expanding rather than winding down or staying stable. Our logistical team is working flat out to build new housing for our staff, new inpatient facilities and new outpatient treatment facilities.
Operationally, we plan to treat all those who are sick with HAT on our waiting list. At the same time, we'll treat any other patient who is severely ill as well - regardless of their pathology. Even if there is a sleeping sickness epidemic here - there is also a tremendous burden of malaria, meningitis, malnutrition and emergencies related to pregnancy and child-birth. These urgencies require our attention as equally as sleeping sickness. We can't treat one disease and close our eyes to the problems here.
Next, we plan on finishing screening those areas which still have small pockets of untested patients. These villages lie to the east of our camp up here in northern CAR at the Chad border. Finally, we aim to move south and delve into untested villages where we suspect there is much more sleeping sickness to diagnose and treat. Ideally, we'll meet the Spanish section of MSF who are coming north in their efforts to eradicate this disease. As a new volunteer to this project, this all makes sense to me and is exciting that we are coordinating our efforts with another MSF operational section.
Here in the HAT camp a typical day means the arrival of a few serious cases, often first identified by our busy outpatient clinic (OPD) which sees about 120 patients per day. Yesterday, this included a four month old child with meningitis and severe malnutrition. The child presented also severely dehydrated. She had not been breastfeeding due to convulsions for a few days at least.
Like in the Canadian emergency departments where I have worked in the past, within minutes of the arrival of this sick child, we had established intravenous access through a scalp vein, administered antibiotics, next completed the lumbar puncture to collect cerebrospinal fluid and commenced intravenous rehydration. The child after 24 hours is improving, and slowly starting to breastfeed. Yet I fear this child will suffer neurological consequences from the delay in presentation to our hospital. Really, only time will tell. I'll keep you updated.
At the same time, we are issuing new invitations to nearby villages to come and be treated for sleeping sickness. The "system" for bring these patients to the hospital is simple yet fairly reliable. We write a letter to the village chief requesting those positive for sleeping sickness to come to our camp. This letter is given to our out-patient nurses. They in turn identify a patient who is from that village during the day's consultations. This "letter carrier" "then takes the invitation for treatment to their village chief and in a few days the patients start to trickle in for treatment. Sometimes 15 patients will show up at time and all need to be examined, admitted and treated. The system is not perfect, but given there is no electricity or running water in this austere and jarringly poor part of CAR, it is the best we have got and we will make it work.
OK - time for the morning rounds. I've got to go. Over and out for now from the Central African Republic,