We all knew that late in the dry season, malnutrition would peak. But this week it hit us hard. Our outreach teams had difficulty coping. The hospital was temporarily over-run. Dr. Johanna, our MSF doctor from Sweden, told me the hospital “looked like a refugee camp”. The team and myself surveyed the hospital grounds. Two patients shared a bed in some circumstances; the area we use for children’s play was covered with mattresses on the ground and patients ; and our tent used for epidemic infectious disease was filled with malnourished children … Quickly, we started making plans to deal with the increased numbers.
2am “Oncall, oncall for ICU – we have one child yes, they are convulsions…” I jolt into wakefulness and am out of my bed and running over to the hospital as fast as I can go telling the nurses to prepare IV diazepam down the radio as I go. This could be anything, but always think worst case scenario… I arrive on the ward and yes, this is actual convulsions, a four-year-old with cerebral malaria.
It’s just after midnight in Rutshuru. Tomorrow morning Dr. F, the French anesthetist who arrived here with me, and I leave for Goma. Unfortunately the schedule worked out with me on-call at the hospital and I missed tonight’s farewell party. This morning we had a fairly typical day in the OR, doing 12 procedures between 8am and 1pm including performing a skin graft, placing a traction pin in a patient with a fractured femur, draining a few abscesses, debriding a few wounds plus a handful of dressing changes including two children under the age of three with 2nd degree scald burns over roughly 30% of their bodies plus an eight-month-old who had her foot amputated for an infection two days earlier. I also admitted a 16 year old girl from the ER with chronic osteomyelitis [bone infection] who will need a fairly large operation in the next week or so to remove infected dead bone from her tibia. Chronic osteomyelitis in children is rare in the US but fairly common here in the DRC.
We first met Karim when he had sustained a severe head injury, he was comatose and from the start his survival was doubtful. Long story short: his family took him to a Neurosurgical centre in Pakistan when MSF could no longer help. Days later he returned but still needed some basic care and antibiotics, which MSF provided. He was discharged from MSF and walked out of the hospital with his family. I’m not saying that MSF saved his life nor that we can take full credit for the fortunate outcome; what I am saying is that it has been a privilege to be involved in his story. There are enough tragic stories in Kunduz, so when a case does turn out as well as Karim’s we are pleased (to say the least!)
It’s been awhile since I’ve treated someone with a gunshot wound though I saw my share during residency on the trauma service. There’s a significant difference between wounds from a handgun and a military rifle. The speed of a bullet as it leaves the barrel of a typical 9mm handgun is 300 meters/sec compared to 900 meters/sec for a military rifle. The force behind the bullet is in direct proportion to the speed of the bullet squared. This means that if a bullet from a Kalashnikov rifle is traveling 3 times faster than a bullet from a Glock 9mm handgun, it carries 9 times the impact. Compared to gunshot wounds at home, the ones in Rutshuru come with bigger holes and more tissue destruction.
There is one indisputable fact; bigger guns make bigger holes. If you ever get shot, hope it’s with a handgun and not an assault rifle.
I’ve done this job every day for so long that I have come to take it for granted that I will help the patients I see. So it is all the more difficult for me when I come across a patient that I can’t help at all.
When I sat on the bed across from Hissen, I just looked at him. His serious little face was angry. I fished out my mobile phone and offered it him. He took it carefully with his right hand and held onto it. I kept on giving him more things out of my pockets and he kept taking them only with his right hand. He would not use his left arm at all. After enough temporary gifts, Hissen agreed to shake my hand. Every move I made, he studied me as carefully as I was studying him.
Inspecting his left arm, we could see there was a swelling above his elbow. As gently as I could, I ran my fingers over it. Hissen did not like that. He immediately cried and I had to stop. Something was wrong.
I tell it to Gulzabira straight: if she continues sporadically taking non-DOTS treatment she will never ever be cured and her TB will kill her. But, if she joins our programme and sticks with it, there is a reasonable chance we will cure her. But there’s no guarantee. I tell her its time to close the door on tuberculosis and get on with her young life, but it will come at a cost: two years of handfuls of wretched tablets a day, plus injections, and she will hate me for it. To this last statement she shakes her head vigorously… but she ain’t tried what I’m offering her yet.
I have never seen burn patients like we have had here over the winter. Often the burn victims are, again, women and children, as the women prepare the meals over open flame stoves and the children play around their mothers. We often had multiple victims from the same families. While we do our best, we lost quite a few of the patients to infections or they were simply too badly burned to survive. All we can really do is provide sterile dressings, increased calorie foods, and hydration. It has been hard to watch, and I am glad this season is pretty much behind us.
Certainly, the most difficult part of this mission, for me, has been the child deaths. Of course, everyone dies, but I am not accustomed to so many pediatric deaths.
I leave with a strange feeling inside; this is something totally exceptional for me, to see a human body in this state [bones splintered, muscle crushed]. To understand the challenges faced by the surgeons and medical team with each case, to admire their skill, calmness and dedication to doing the best they possibly can for each and every patient. I take my hat off to them.
On this Earth, some children have access to life-saving medications, and others do not. This unfair imbalance means lives of equal value are treated unequally. Our MSF action seeks to make a dent in this injustice. It is unfair and tragic that children like Oumere die so early in their lives.
Well firstly we sat down and looked at what kinda attention DR-TB needs. For instance we talked about the urgent need to reduce the medication, 20+ tablets, those medications which makes you even more sick than you already are, and also to reduce them by making stronger drugs which we will be able to take not for 2 years or 3 years but only a month. This would be just fine so that we can continue with our lives. I hope the manifesto will be taken very seriously and land on the right hands so that something will be done with immediate effect.
And talking about side effects of the drugs, I noticed that I have not been very clear about the deafness part and very little people know that the medication makes you deaf… I did mention it a couple times before, well seems like not everyone is taking it seriously. For starters I for one have to start afresh if I want to study further again, I have to learn a new language which is signing, and from this point I have to adjust to the ‘’deaf world’’. It’s like learning something totally new, starting your life back on a very different planet