Day 29 - the things you remember

She wrapped her arms round my neck and I never wanted to let go. This little girl, as light as a feather, dressed in her best frock.

She wrapped her arms round my neck and I never wanted to let go. This little girl, as light as a feather, dressed in her best frock.

It’s my last day. I have been bumped off countless flights but tomorrow I will be on a flight out of here. And it seems apt that I’m working in Pudurubel, the village where we started the mortality surveillance 4 weeks ago. I’ve come full circle.

I’m working with Team 4. Benjamin the carpenter, Asha the nurse, Amna the cleaner and Daniel the dispute resolver! Sandra has been chatting to each of the outreach workers individually to find out more about their skills and experience and what they would like to do. We want to ensure we are maximising their skills and capacity-building as much as possible. So Asha and all the former nurses will be talking to Sheik, our medical team leader, tomorrow. Amna will talk to Laura, our Irish nurse, who is also managing the hospital. Benjamin will hopefully join Richard or Robin, our construction logisticians, and cheeky Daniel will stay with us, his skills best suited to working in the community.

The staff strike is over. At the same time as asking them to work incredibly hard for us during this refugee crisis, we suddenly stopped the staff shuttles that brought them from Jamam Town to work, about an hour’s walk. We simply didn’t have enough cars and it was impacting on our activities. So they walked out. After a couple of days, the situation was resolved and we agreed to morning and evening shuttles but would no longer do the lunchtime shuttles. That was a tough couple of days for our teams, especially the hospital staff, but many of our local staff had actually started trickling back anyway, realising that the shuttles didn’t affect them.

So now we could restart the MUAC surveillance. And we are finding so many children in Pudurubel with red MUAC plus an infection. We need to get them to the hospital. Why is it that even when you are telling a mother that her child is seriously unwell, she still has to spend ages getting ready? This is a trip out of the village and they need to look their best. One woman decides to have her hair braided, another gives her little boy a bath and the final one needs to find a pretty dress for both her little girl and her new baby. We often see children become malnourished when a new baby comes long, the mother’s attention being focussed on the new arrival. Hence this little girl, standing in her pretty dress, severely malnourished with a fever. I scoop her into my arms and she rests her head on my shoulder, two mud stains on my thighs where her little shoes gently tap them. But other patients are presenting themselves to us. The old lady with probable malaria, the young teenager with vomiting and diarrhoea and the little boy with jaundice. We will have to do two trips.

And it’s such a fantastic feeling to find the little girl later, gobbling up a packet of plumpynut, the peanut-based high-calorie food supplement that we give to malnourished children. Children with red MUACs have often lost their appetite and we have to try more drastic means to re-nourish them. But this little girl is sticking her finger into the packet, trying to pull out every last dreg. I want to give her a big hug, relieved that she’s going to be OK, as long as she stays in the programme.

Girl with Plumpy Nut, the peanut-based high-calorie food supplement that  MSF give to malnourished children. Photo © Ruby Siddiqui/MSF

We pile everyone back in the car to drive them home, all of them diagnosed and receiving the appropriate treatment. I notice the little boy with red MUAC was supposed to receive a bednet. We give bednets to all pregnant women and children under the age of five that attend OPD as they are more likely to suffer the severe consequences of malaria. But his medical card says we’re out of stock. I remember I’d requested a new bednet after breaking mine. I’d actually fixed it (in a lopsided fashion) so I rushed back to find the spare bednet. The mother looked surprised and grateful that I’d gone to such effort.

Field work is exhausting, tensions can rise in such a large team trying to share tents, bathroom facilities and the internet. I can’t remember the last time I had fruit or vegetables and I’d do anything for a bottle of coke.

But you never remember that stuff. You remember days like this, days when your surveillance has picked up sick people, days when you might have saved a life. Its days like these that give you the biggest high.