Last night a woman with a previous caesarean section and prolonged labour kept me awake till she delivered at 6am. Why do they always come in the middle of the night? The call to maternity during the wee hours of the night takes me back to those days of protracted humiliation as a medical student, and those ghastly days of community service, and that shows me up again. For one, obstetrics always gets my knickers in a twist, I can’t seem to act quick enough, I panic deep down and (as usual) in the end you do just fine. But it makes me feel completely inadequate because you always feel like the life and death issue so much more urgent here. And it beats hands down the purity of fighting the social injustice when you do paediatrics. So after my doctor skills get called into action and question at 2am, my focalising eyes are also evaluating the electricity and the carpentry work and my heads spins as I walk away during the full mooned night not just a stress ball of emotions but also notes to self for logistics and pharmacy and more and more and more and more and my heads spins so I don’t sleep.
I fall asleep when I get called again to the ward for 2 babies who just arrived, both facing their first 6 months of life. The odds were against these babies. One had a bulging fontanelle, fever and was having seizures. I put on the works with heart numbing speed trying to halt the ticking hand and left eye but it was just a brief sojourn. My heart fell. The caretakers of the other Baba's sighed in unity. I refused to give up and eventually the seizures abated and I added the antibiotic and then rushed the other triaged with the poorest of prognoses. He, and I say this with a whimper in my voice, was gasping for something and air I suspect was not it. His gasp was his farewell words to his parents and his limp decrepit senile seen-it-all grandfather who had that look in his eyes, as he joins in the fight for his lineage that shows he himself has not yet plateaued. This little one too had the signs of severe complicated meningitis clinically and so I threw all in my arsenal right at him, dextrose, anticonvulsant, antibiotic, steroid and some analgesia. Pain is a killer too. In his case it had something to do with him being born in the vast stretch between here and the next health centre. Both too far outta reach. We need to go to him I guess. His parents assure me they tried everything to get him here, but in Darfur I'm doubtful the Donkey going to get you more than water from the water pump or a head injury, and a car that drives by is probably not going to stop for anything other than that - a drive by shooting! Our referral car has been shot at, the roads are not safe and the number of viable vehicles is not available for ambulances, even makeshift ones implored for by parents of a dying infant. So meningitis rears its ugly head again.
In MSF, in the meningitis belt from Ethiopia to Senegal across 20 countries I find myself inhabiting, it is not the isolated disease you isolate as you would in a Danish hospital. No. Here you get the cases, you spring into action. 700,000 people have succumbed in the last 10 years to it. No time to waste then. You check your stocks of drugs, you make sure your staff know the protocol, make a plan to get specimens to the nearest laboratory 3 hours away by plane, you track the cases and you evaluate the cold chain for vaccines in case of outbreak. Cold chain… Ha! In the desert with no electricity, no open road to get gas… Ha Ha! Some life saving force makes me hold my tongue and not laugh out loud. I just get to work. I check my darling of a person with meningitis who takes five days to smile and something deep within me resonates that there is indeed something precious to hope for sometimes and its this that dissolves away all angst and muddy reasoning.