An obstetrician in CAR: “It doesn't take long to gain experience here.”

Four weeks into his assignment, Rennie blogs about daily life as an MSF obstetrician in Bangui, the capital of the Central African Republic.  

About the case of the woman who had the hysterectomy the evening of my arrival - well we both survived the night! She went home to her four kids a few days later. A life-saving hysterectomy was drastic – the result of an unsafe abortion. 
A woman arrives at the maternity hospital in Bangui

A woman arrives at the Castor Maternity Hospital in Bangui. Photo: Borja Ruiz Rodriguez / MSF

I am now four weeks into my posting. Seven to go. The first two were really tough. And I really wondered on a couple of occasions if I was going to make it through. 
A typical day involves getting up at 5:30. That's a great time of day. It is light and cool. I shower in cool water - there is no hot. Have given up shaving. Also given up with deodorant (that's French for under-arm scooty) - well what's the point when you are sweating from every pore by 8:30? I still clean my teeth. One has to have a red line where standards are concerned. 

Have given up with deodorant - what's the point when you are sweating from every pore by 8:30 am?

Then I drink my orange juice (from concentrate) and take my coffee (instant). At home I have freshly squeezed orange and a special blend of coffee from my express machine. I enjoy a bit of peace on the verandah. We are picked up at 6:45 and are at the hospital just after 7. 
I join the day staff for the handover from the night staff and we discuss the emergencies carried out and the admissions.  There is then another meeting where the different departments in the hospital take five mins each to inform the rest of the hospital what is going on in their departments and any problems they foresee for that day. This involves the labour ward, pharmacy, neonatology, post-partum ward , the lab etc.
At 8:30 the real work begins. We start les visites. This takes most of the morning. We see about 50 patients starting with those in labour then moving on to those women who have delivered. We check wounds, prescribe antibiotics where needed and stop them when they are not. 
the team, dressed in pink scrubs or colourful printed dresses, gather for a training session

A training session for staff at the Castors Maternity Hospital. Photo: Borja Ruiz Rodriguez / MSF.

The round is constantly interrupted with emergency admissions who need seeing and urgent calls to the labour ward to see women who are haemorrhaging or who require assisted delivery by Caesarean or ventouse (a forceps equivalent - a suction cap applied to the baby’s head and pulled on to speed up delivery - popular in Europe/Africa). 
We lunch at about 1:30 - then it's variable. There are busy days when you are in the operating block all day, and quiet afternoons when a bit of teaching / training goes on. The day team finish about 4:30. But we stay later if there is a lot happening. 

I was so tired I found myself eating cold ravioli out of a tin


The local docs are really experienced. It doesn't take long to gain experience here. I feel humbled that some of these guys have seen more complications in their short careers - due to the huge throughput and long hours they work - than I have. 
The hospital at Castors is also big on family-planning. While MSF doesn’t advise on how many children anyone should have, the team does give women access to contraceptives, putting them more in control of when they decide to get pregnant. That means no one goes home after having a baby without a stern talking to from the midwife and the option of a contraceptive plan in place.
I go home and another team covers overnight - but I can be called in for the bigger emergencies. This is a bit stressful as you can never really relax (i.e. drink much beer) but then I knew that when I signed up. I have lost weight - which may be because my liver has shrunk back to normal.
In the evening I read, keep in contact with family and friends, chat with housemates in French/English, eat. I hit a new low last week when I was so tired I found myself eating cold ravioli out of a tin. 
Sometimes we go out for pizza. At the weekend, we work Saturday am. We do our shopping for the week in the afternoon. Sunday, I like to go to the slightly over-enthusiastically named "Grand Cafe" for breakfast - they do a good croissant - then swimming. Usually abed by 2100.