I’ve lost count with the negative sputum results I’ve been receiving lately. Things are looking rather promising; surely I’m close to the finishing line.
The past few weeks in the mountains have been hectic. Due to increased fighting in the region, more and more IDPs [internally displaced people] have been coming into the areas we work in. Due to increased overcrowding and a risk of a measles epidemic, we started organizing a Measles Vaccination Campaign in collaboration with the Ministry of Health. The target group of a campaign consists of children aged six months to 15 years. In order to provide sufficient herd immunity, a coverage of 100% is required ie: all children need to be vaccinated. In reality, a result of 75% coverage is acceptable. A vaccination campaign is a huge logistical exercise.
Our patient from the other day first presented to an outside clinic, where there is no surgeon, when he still felt too weak to stand several days after being beaten with fists and sticks. He was admitted to the clinic with a swollen, distended abdomen and increasing pain, given intravenous fluids, evaluated with an X-ray and a blood count, suggesting blood loss, followed by a phone call to our project chief and a discussion with me about transfer. At home this patient would have had a CT scan to identify whether he had an injury to the spleen and/or liver, plus checked for signs of other injuries that would suggest he needed surgery. With a stable liver or spleen injury, he would be placed at bed rest to minimize the chance of recurrent bleeding. Here in the Central African Republic the choice was to risk leaving him at a facility that had no capability for an operation or transfer him to Paoua by LandRover with the risk of making any potential bleeding worse, as the trip is slightly less jarring than playing a game of rugby. We told them to send him over as soon as they could. Due to a combination of vehicle availability, road conditions and security issues, it was a full 24 hours before he arrived in Paoua, now almost six days from his initial injury.
Sleeping on the ground in day-old, fishy, muddy, sweaty clothes isn’t my idea of a great night out, but still it gave me time and reason to reflect and understand the people I’m working with better. Not the staff, though yes them too somewhat, but the patients. The oldies that come with general body pains that we send away with no medication, telling them its normal to have body pains after working in the fields cultivating, carrying 20kg drums of water for miles on their heads, cutting and carrying wood for miles just in order to live.
Kate Chapman is a nurse working with MSF in Matter, Ethiopia. Kate and her team have an unexpected camping adventure and gain further understanding of how local people live when they get stuck in the middle of nowhere.
It’s a kind of medical utilitarianism: the patients’ needs come before everything. And people appreciate it: at a checkpoint, a man always gave us bananas because we saved his leg. They show us their babies in the street, and they remind us that the birth was difficult but that they’re still there.
Anna Halford, returning from a four-month mission as a project coordinator in DRC, reflects on the work MSF does to help people enduring daily violence.
Despite a volatile security situation, MSF continues to provide free health care in four reference hospitals, 12 health centers, and four health posts in North Kivu, as well as in four reference hospitals, 19 health centers, and five health posts in the province of South Kivu. There are also a number of cholera treatment centers (CTCs), mobile clinics, and emergency response activities.
At the project in Masisi, MSF performed 105,681 medical consultations in 2011. In the Masisi hospital, 7,226 inpatients were admitted for hospital care and 3,947 women gave birth for free.
This is…what we’re here for: responding to the most urgent and immediate medical needs. It is incredible what we have been able to achieve, but it’s not enough. There is always something more that can be done, and we have to fight to make sure these people have what they need, not just to survive, but to give them dignity, give them quality of life, make sure that they can maintain the spirit that they have.
Helen Ottens-Patterson, from the United Kingdom, is a nurse and Doctors Without Borders medical coordinator in Upper Nile State’s Maban County, South Sudan.