Night shift in Chad: Hot off the ward

UK doctor Sarah Wookey blogs about a long hot night in the MSF hospital in Am Timan, Chad...


It's hot. Very hot. So hot that I have to wait for the water in the shower (which is stored on the roof) to cool down before I can step in. Chocolate reaches melting point in about 30 seconds. The other day I decided to measure how much I drank in 24 hours. Six litres. I keep having to put my iPad in the freezer in order turn off that annoying message telling me it feels too hot to work today. "How do you think I bloody feel!" I want to shout at it.

I'm beginning to understand why camels have such insufferably smug expressions. They can concentrate their urine down to the consistency of syrup; they can drink 25% of their body weight in one go and not drink  for another 10 days. They can drink anything, including seawater. When it's hot they get hot; they don't bother to waste energy and water in sweating; they just wait until it cools down in the evening. The fat in the hump can be metabolised into water and energy (I know, I had to look this up as well because I didn't believe it at first either). They have special joints in their legs which means that they don't do that annoying thing that we do of sinking the front bit of the foot down into the sand with each step. They can shut their nostrils during sandstorms. And their penises point backwards. So how do they...?
All of the above ruminations are, of course, escapism from my main job of working as a doctor in Am Timan hospital, south-eastern Chad.
Sarah Wookey wears the MSF waistcoat as she directs a woman in a headscarf in Am Timan Chad
Sarah at work. Photo: Sara Creta / MSF. 
I've just arrived at the hospital to start the overnight shift. We have 70 children in the acute malnutrition centre (entry criteria - significantly underweight plus another complication such as gastroenteritis or pneumonia). "Evil white woman!" I hear in Arabic as I pass the kitchen where the specially formulated therapeutic milk feeds are prepared. Hapsita, one of the milk ladies, knows that one glance at my strange, pale face triggers howls of fear from many of the small patients. "Evil black woman" I reply instantly in Arabic, to gales of laughter from the assembled mums. We repeat this show most days. One day, I know, the wrong person is going to hear us and it's going to get me into huge trouble. To say that 50% of my Arabic relates to inappropriate content is putting it mildly.
I take a little wander around the wards to see what's going on. Infections that healthy, well-fed children would shake off at home can rapidly progress to become life-threatening here. We need, therefore, to make completely different clinical decisions. If a child coughs and breathes faster than usual at home in England we suggest paracetamol and plenty of drinks. Here? Seven days of heavy-duty antibiotics.

Infections that healthy, well-fed children would be able to shake off can rapidly become life-threatening here

A child comes in very ill with anaemia. He needs blood urgently. The only available donor is his father. Quick check on dad - HIV negative, hepatitis B negative but the malaria test comes back positive, indicating that he’s had malaria at some stage in the past three weeks. If we give his blood to the child we might well give him his dad’s malaria too, but if we do nothing he’ll die… Stuff it! I give him the blood with a slug of antimalarial medication and hope for the best.
Another child has a huge abscess on his leg. We inject him with painkiller and I make an opening in the wall of the abscess. A huge and weirdly satisfying quantity of pus cascades out. My daughter tells me that there are entire websites with video links catering to devotees of blackhead squeezers and boil lancers. Am I now a weirdo?
Twins are born, very prematurely. Each of them weighs less than 1 kg. We know that, with the facilities we have here, the chances that they will survive are minimal. We offer their mum the choice between taking them home or caring for them here. She understands that her babies are not going to survive and says she'd prefer to stay with them in the hospital. I discuss them with the neonatology nurse and we agree to prescribe warmth, expressed breast milk, close physical contact with mum, and a total ban on anything sharp or painful - like needles.
We prescribe warmth, expressed breast milk and close physical contact with mum
A severely malnourished child with pneumonia arrives. His blood sugar levels are dangerously low. The nurse who sees him initially has given him a sugar drink, sited an intravenous catheter (into a vein I can barely see), checked him for malaria, measured not only his height and weight but oxygen levels, heart rate, breathing rate and temperature.  For good measure he’s also got out the appropriate antibiotic and is ready to give the first shot as soon as I arrive. 
Morning. I hand over a list of the night’s events to my colleagues and crawl back to breakfast, shower and bed. 
We've run out of Marmite, but that's another story….