Our hospital in Mweso in the D.R. Congo is in its variety of challenges comparable to my Amberg hospital: The most visited departments are obstetrics and family planning, internal medicine (where infectious diseases are also treated) and pediatrics with the sad focus on malnutrition.
Long waiting times are often pre-programmed with the anamnesis...
The "Bloc-OP" takes care of all patients who require surgical treatment. Surgical interventions are often necessary after household accidents (often burns), after traffic accidents or as a consequence of the violence. Especially with complicated inguinal hernias and intestinal ruptures, rapid action is required, even more so when children are affected (which is usually caused by typhoid fever). For German colleagues it may be hard to imagine that we perform anesthesia without intubation and muscle relaxant. The hospital does not have equipment for intubation and ventilation and the team lacks the practical experience, instead successfully using ketamine for most anesthesia.
This is standard of care in most rural Congolese referral hospitals, but is less than ideal as we hope to be able to provide a higher level of care if possible. In a more stable environment, such as Mweso, intubation may be an option and therefore, one of my tasks here is to evaluate possibilities for adding general anesthesia to the available anesthesia options. In any case, we are all relieved and happy when the little problem children wake up and want to drink and eat again the next day or day after.
To the limits of exhaustion
The project in Mweso also includes a large outpatient clinic with over 100 visitors per day and a network of many health centers in the surroundings of the hospital. One can imagine them as simple outpatient clinics without a doctor. According to well-proven statistics, almost 400,000 people are treated every year in this network of Health Centers and Health Posts by very committed local "Infirmiér(e)s", like nursing staff. Seriously ill people are admitted to the hospital.
The well-being of the patients at first priority - the Congolese nursing staff do a great job.
At the hospital, 13,000 stationary admissions per year often bring the team to the limit of exhaustion. The most common diagnosis is a complicated form of malaria. Tuberculosis, which is unfortunately a typical disease of people under the simplest living conditions, is also frequent in the Health Zone; it always causes diagnostic problems in its complexity and many forms. Cholera is sporadic, due to sub-optimal hygiene, lack of quality water sources and widespread population movements caused by insecurity. Because the vaccination against measles is often incomplete here too due to the poorly functioning public health systems, we unfortunately see severe progressions again and again.
Never ending stories
Well, so much - or so little - about the work that keeps our brain and our conversations busy until the evening. All the more important is the evening after work: we have agreed above all on a ban on continuing to talk about work. Everyone has their own strategy to calm down: For me it is sometimes an hour of yoga, sometimes playing the saxophone (yes, I have an alto sax with me!) and always: reading.
Yoga calms me down - especially important for switching off after work.
Important for most of us here is the get-togethers in the evening: We eat together, play cards or (Google-based) Trivial Pursuit. We listen to music together and listen to stories from the lives of others. With the typical colorful composition of the Doctors Without Borders family, these are never ending stories!
And no matter how beautiful the idea of an endless story may be, the next time I'll tell you already about the return trip of my exciting journey.