"There's this child . . . he's breathing so weird"
This World Humanitarian Day, nurse Barbara blogs about her first posting with MSF, to Colombia, where she met her first pneumonia patient, and saw the difference that vaccinations can make to children's lives...


In our work, we see so many children with respiratory infections. After several missions with MSF, it's very common to see - kids either come in because of diarrhea, malaria, pneumonia, or some kind of combination of these three.

When I think about it, I actually remember the first baby I ever saw with pneumonia was on my first mission with MSF. We were in Colombia setting up mobile clinics in remote areas, which would take around six to eight hours by canoe to reach. Our national staff - doctors and nurses - would do the medical consultations, and the expatriate staff were there to help. I was there to triage, so I assessed the patients as they came in and give a quick diagnosis of each case.

I remember this baby on our second-to-last day of the mobile clinic. There was this mother with her baby, and I thought the baby was very small, maybe eight months old.  He had the classic chest in-drawing, but at that time in my life, I was not so used to seeing it. I didn't know immediately what it was.

This baby had such a difficult time breathing; gasping for air, the chest draws very deeply inwards. You really can see the ribs contract, because his body and lungs were trying to get as much oxygen as they could. The baby was completely dazed, not crying...

I had never seen any child with that kind of sickness before.

I went to the doctor and said, "There's this child... he's breathing so weird." And the doctor said to bring him to her immediately. I told the mother to come, and I stayed to observe, because I saw how worried the doctor was. The doctor had worked her whole career in this context - helping underserved people - and to see her so concerned was alarming.

It took me a while before I understood that the baby had pneumonia. And I really felt bad afterwards, because I didn't think the baby was in as bad of a condition as he was. I had never seen any child with that kind of sickness before. In Italy, where I’m from, most of the kids are vaccinated against pneumonia. And if they do get sick with respiratory illnesses, the access to healthcare is pretty good and we can treat the child early.

Really the biggest difference between a paediatric ward in Italy and one in an MSF setting is that there's no crying in the MSF paediatric wards. There is no sound. Maybe just the normal sounds of a clinic, like the nurse walking or maybe the sound of a mother. It is not a pediatric ward as you imagine.  When kids are very sick, they don't really cry. 

It is very striking, because one of the serious signs for how sick a kid is, is when they don't cry. Or when they cry without tears. 

Once the baby in Colombia was with the doctor, we ran several tests.

We were worried because he was so listless. After that, it was clear that the baby needed to be referred to the hospital which was six hours by canoe and then another four by car. We kept the baby under observation overnight. Luckily we had a small oxygen tank with us and we could keep the baby oxygenated, I am telling you not an easy task to safely transport oxygen tank in a mobile clinic. So this story went very well, because we were also leaving the next day. The mother and baby came with us and we travelled in the canoe for five to six hours.

When they don't cry, that's a sign a child is seriously ill

When we reached the village called La Gabarra, from there we had our MSF cars.

Everyone jumped in the car and we brought the mother and baby to our base in Tibu, which was four hours (in good weather conditions) by car from La Gabarra. Once we arrived in Tibu, the ambulance was waiting for us to bring the baby to the state capital hospital, another four hours by the road. That went very smoothly and the baby was fine. We did these mobile clinics every two weeks, so afterwards we were able to follow up and check up on him.

We were very lucky, because he must have been very sick for at least a week before he came into our clinic, but the family wasn't able to seek healthcare sooner. I say this completely without judgment, because you have to understand the setting. It's not easy to reach healthcare in these areas. Like I said, it takes hours to travel by canoe and car to reach the nearest hospital. And you need money to pay for the transportation, to pay for the canoe, then the car, and journey back. It's not easy. 


For more than six years, Doctors Without Borders/Médecins Sans Frontières (MSF) has tried to negotiate a lower price for the pneumonia vaccine with its only two producers, Pfizer and GlaxoSmithKline (GSK), in order to be able to protect children in developing countries, including countries in crisis, from pneumonia. So far, both pharmaceutical corporations have refused to reduce the price and there remains no solution in sight for populations living in crisis.

Help us make a difference by tweeting at @Pfizer and @GSK to lower the price of their pneumonia vaccine to $5/child for all developing countries and humanitarian organisations!