It’s May 2019 and already past the end of the working day.
I want to go home after a heavy day in the sweltering heat of the Sahel, a semiarid region of western and north-central Africa that extends from Senegal to Sudan.
It’s 45 degrees Celsius in the shade; there are some ceiling fans to move the air around and that's it.
The Phase 1B tent, where I’ve been assigned for the last month, is filled to capacity – 30 children, all suffering from severe malnutrition.
I’ve been circulating, moving from bed to bed, examining each child, asking each mother the same questions:
“Did he/she have diarrhoea at home? Yes? Since when?
“Did he/she vomit? Have a fever? Convulsions?”
In Magaria, time can quickly become our enemy, so we must act swiftly. You have to see all the patients.
It’s almost 6pm when I reach the bed of a child of two years, three at most.
Aisha (not her real name) has been diagnosed with acute febrile gastroenteritis and profound dehydration, as well as severe malnutrition.
I have seen hundreds of patients with this diagnosis during my six-month mission in Niger.
It can be too easy to fall into automatic responses, repeating the same diagnoses, the same prescriptions.
But no, my medical training taught me the rigour and professional ethics that makes me, I believe, a good doctor today.
Every child has their own peculiarities, is a unique life that counts as much as any other.
Preparing for the worst
I lean over little Aisha’s bed and see her lying there in her loincloth, so weakened.
She does not open her eyes. She cannot talk or sit up.
Her mother tells me that she was doing very well five days ago. We try to rehydrate her using an IV drip.
Two hours pass and Aisha’s condition hasn’t improved.
In Magaria, time can quickly become our enemy, so we must act swiftly.
Her heart is beating too softly, too slowly. I tell myself that we might lose her.
“Hang in there,” I whisper to her. “It will be fine.”
Aisha gets the most energy that her five kilograms of body weight can absorb.
Before leaving the ward, I advise the nurses to keep renewing her drip until morning. We have catching-up to do.
I go home. I eat. I talk a little with friends and I go to bed.
In my dreams, I see the fuzzy face of a very thin little Aisha, her features drawn back like those of an old man at the end of his life.
The next morning, I return to my post in the 1B tent.
To my dismay, Aisha's bed is empty. My first thought is "She’s dead”.
There is no mat, no loincloth, no mother, no child; only a white mattress shining from the cleaning product that our hospital hygienist has taken the time to apply, knowing the next patient will soon arrive.
I immediately ask the nurse what happened. She tells me, “I do not know. When I arrived this morning, the bed was empty.”
One of the greatest fears for a doctor is to make a medical mistake, to have given the wrong treatment or missed something.
We get angry at the idea that we could not do everything to save someone's life. That's what I feel in this moment.
A glimmer of hope
Luckily, with the help of an interpreter, I talk with the mother of the child in the next bed. She tells me, no, little Aisha did not die last night.
But in the quiet hours of the morning her condition worsened and she was transferred to the intensive care unit. I say to myself, “Not dead then, but it looks bad”.
I continue my day in the Phase 1B tent.
When dusk arrives and the ambient temperature has cooled slightly – it’s 35 degrees maybe – I take the time to go for a quick visit to the intensive care unit.
There are just over 20 patients in the unit. I'm desperately looking for Aisha.
Did she survive her day? Which bed is she in? I can’t find her. Anguish and sadness rise in me.
The white bed
And then, I see her. Hidden behind the panels of the “white bed”. In Magaria, this is the name we’ve given to the resuscitation table, quite simply because it is white.
Aisha is here. She breathes laboriously. When she looks at me, her eyes are empty, without expression.
But she’s still with us. She’s fighting with all her strength, and it shows.
If a child ends up on the white bed, it is usually because they had a cardiac arrest and we had to resuscitate them.
According to the duty nurse, Aisha had stopped breathing and returned to her after brief manoeuvres.
That night, I arrive home late, still thinking of Aisha and feeling guilty.
Is there anything I could have done differently during her first day in tent 1B? Should I have rehydrated her more aggressively?
I sleep badly. I dream of Aisha inert, carried in the arms of her mother. I have lost hope.
Days follow without me hearing any updates on Aisha.
A chronic emergency
Before the seasonal peak of malnutrition and malaria, the paediatric unit of the Magaria District Hospital cares for an average of 200 patients each day.
Many of these are transferred from one ward to another until they are eventually healthy enough to leave the hospital (most of them) or do not recover (a minimum proportion of the hospitalised children).
It is impossible for me to stop and search for information on the progress of each patient that I no longer see.
Two weeks pass. We receive a visit from the MSF communications manager in Niger.
I show her the different services: intensive care, Phase 1, Phase T.
We call it Phase T for “Transition”. This is the final step before a child can be discharged from the hospital.
Their acute medical conditions have been treated and the focus now is on diet and weight recovery or stability.
The majority of that follow-up will be done externally, in the ambulatory therapeutic feeding centre.
That's when I suddenly see a woman with a big smile on her face, dancing happily with her child in her arms.
She looks familiar to me. It is when I see the face of little Aisha that I understand where that sensation of déjà vu came from.
She is there, alive, in the arms of her mother, her big eyes watching me.
I feel a lump in my throat and tears in my eyes. Does she recognise me?
I cannot believe it but her mother confirms that it’s her, the same child I had seen in Phase 1B tent. She is alive!
To all those who have worked here or who may one day go through Magaria: please, do not lose hope.
When death threatens, when we have really done everything in our power and used all our resources, there will be happy endings.
There will always be stories that deserve to be told. That push us not to give up.
You will often say, “Today, I made a difference”.
Making a difference
In 2018, nearly 18,000 children were successfully treated at the Magaria District Hospital thanks to the collaboration between MSF and the Ministry of Public Health.
Our teams “made a difference” nearly 18,000 times, for nearly 18,000 families.
I hope that with these words and results in mind, we will be determined to continue doing our best as long as there are lives to save.