Day - 6

The hospital remains calm. The number of patients who arrive at the doors dwindles steadily day by day. Today, the total number of patients in the building this morning (inpatients plus those awaiting assessment) was nine.

The hospital remains calm. The number of patients who arrive at the doors dwindles steadily day by day. Today, the total number of patients in the building this morning (inpatients plus those awaiting assessment) was nine.

The patient who was short of breath yesterday looked better today. Yesterday, we rounded on her — it was a ward round of one patient — and concluded that she had an infected hematoma at the site of the operative wound, as well as a lot of risk factors for pulmonary embolism. So, opened some of the skin stitches (they dehisc'd on their own), continued antibiotic coverage, encouraged mobilization. During yesterday's discussion, the team had a good chuckle, because the

patient's sister told us that she is half the size she used to be... and she is still morbidly obese.

Problems arose simultaneously today: I stopped by the operating block to see what there was, and noticed that the recovery room looked as well stocked as usual. This is not a good sign, because half of it was supposed to be packed yesterday, so that once in the new hospital, we can open one operating room, and one recovery room bed. The nurses said they had not received any instructions on the recovery room. And no one seemed really sure that what had been put in boxes yesterday

was sufficient material to open one functional OR. Unfortunately also, it is unclear if there are any packing lists for those boxes, which makes it all difficult to verify.

OK: I have learned my lesson about packing lists and packing instructions. It is easy but not necessarily obvious, especially for medical personnel who do not usually pack things. The next services to pack will get more specific instructions.

At the same time as this became evident, we also got news of a major medication recall. Part of the team went to the pharmacy to see what we had in stock that might be affected. As it turns out, it is a significant number of essential drugs that we use. Some of them, we have been able to borrow from another source. But I have also made some difficult decisions about withdrawing some from our formulary entirely, but leaving others still available because they are life-saving when needed. They will be replaced as soon as other stock is procured, but we cannot be entirely without them.

I suppose it could be considered a good time, since we have so few patients that our consumption is extremely low. It's just that we're a little busy with this move.

And, will the hospital be ready on time' The electricity part of the logistics team was finishing installing extra fluorescent tubes in the OR today. The outlets are functional, and the wall tiles pretty much done. We're still working on the scrub sink — it got tiled today — and the double-hinged swinging doors are also in progress.

I'm also worried about the lab because we have to move the hematology machine tomorrow. It's the only day that the technician is available to help move it and service it. But there is still more logistical work to be done there: finish tiling, finish painting, finish electrical circuits, install the air conditioner. We are trying to protect the machine as much as possible; it will involve a lot of plastic sheeting.

This afternoon, then, I asked the medical team to meet. The overall plan is continually evolving, something ahead of schedule, some behind, and I wanted to be sure that we didn't overlook any crucial elements when advancing some activities while others were delayed. The chief of gynecology is eager to collate our patients into one mixed inpatient service. The team agreed that this is feasible, and that we still have enough extra capacity if our patient numbers creep up. We'll see if we can move pediatrics down to our mixed service also. This would entirely liberate the second floor.

The last meeting of the day was in the car on the way home. We are having a daily meeting of both logisticians, the project coordinator, and me (medical team leader), to discuss problems and progress. It ended at the dining table at home, interrupted by learning when we arrived home that the generator would not turn on. (Logistics jump-started it from the car battery.)

The most difficult moment of the day was mid-morning. After hearing that the packing of the OR might not have been as smooth as I'd originally thought, and that we had this major drug recall to deal with, I received a message from headquarters commemorating the one-year anniversary of the deaths in Kismayo, Somalia. Three MSF field workers were killed by a roadside bomb. One, Damien LeHalle, was a friend from the 'primary departure' course we took before our first mission. In the middle of stress and frustration, I needed to grieve.