So…a bit more about our tent city--the Paediatric Malnutrition Intensive Care Unit, or ICU. We work in three massive tents set up in the yard of the Red Crescent. There is a gravel path and outhouses. We can do bedside glucose and haemoglobin and provide oxygen up to 5 L/min. We’ve got lots of antibiotics and naso-gastric tubes and IVs and blood transfusions as long as we send two blood donors to the blood bank for every transfusion we request. In exceptional circumstances we can refer a child for an X-ray or ultrasound at a private hospital nearby, or ask for a consult regarding potential TB and HIV, but for the most part, those are our tools.
Of course, kids are no different in Canada than they are in Djibouti. ICU here, ICU there - we take care of the same little ones.
The thing that saves us, and the kids, is not sexy. This thing is…..The Protocol. (My capitals. Out of respect). The Protocol is clearly the labour of love of a very dedicated and extremely nerdy team of infectious disease and paediatric experts and is a comprehensive document which attempts, by working with the law of averages, to give you a way to care for most of these kids, most of the time, under field conditions. (It is 212 pages long. I am currently trying to memorise it. I have suddenly discovered a very enjoyable novel set in turn-of-the 19th century England that is hampering this goal. I am working on my self-discipline). It sets out what to do in pretty much every clinical situation, and backs up its recommendations with stats and evidence. Having expected to end up doing pretty sloppy medicine once I understood our technical limitations, I am actually extremely impressed with the rational way we can function with The Protocol as guide.