I am the only non-African on this MSF Mission
in Jahun– the others are from Kenya,
Sierra Leone, Ivory Coast, Congo, Malawi, Ethiopia and Burkina Faso The MSF
compound where we all live is walled,
and there is razor wire along the top of it. From my room next to the wall I can easily
hear the sounds of sheep goats chooks and people in the side street and from the house in the next compound, of kids mostly, of their early
morning recitations from the Koran, of their crying and grizzling, playing,
shouting…and often at night a generator is tuned on that drowns out everything.
Last night welcome heavy rain drowned even that noise out, and cooled
everything down.
Big steel gates open to let the vehicles in
and out, and there is a watchman on duty all the time, but there are no guns.
Inside, there are several buildings close together, basic offices, an eating
and kitchen area, an aircondtiotned lounge room with soft chairs, and old books
and a satellite TV, and we each have a room of our own with shared bathrooms. Theres no hot water. Our lunches and dinners
are cooked every day by a local woman who serves it in large plastic containers with lids supposed to keep it
warm, and we serve ourselves whenever we
can. Typically we have rice, potato or sweet potato, or noodles or
couscous, with chicken or a meat casserole, some spinach, chopped up cabbage
and carrot , and various spicy tomato sauces. Once she served up some sort
of local dish that was so slimy and
gelatinous it reminded me of mucus with peas and mince swimming in it – just
couldn’t bring myself to even try it but the Africans all scooped it up! Today
there are nine of us resident, but last weekend we had a few extra guests who
came up from Head Office for meetings..
My daily routine is more or less unvaried –
I am either eating, resting in my room, sleeping or busy at the hospital. Occasionally
I watch the news on TV and have a choice between CNN, Sky, Al-Jazeera and BBC
World, but its all Ukraine, or ISIS and Syria and nothing much else. The
Business reports don’t interest me but the sport sometimes does and I found I could watch live
Rugby if only it didn’t coincide with the need to be at work. So I managed to
see the first Wallabies-All Black match, the one that was a draw, but unfortunately
missed the next one , the one where the Wallabies got hammered! It would have been great to watch that!
To get to the hospital I walk to the front
of the building where the Security guys are and they drive me in – I could walk
there in five but we are not allowed to.
In addition to myself there are five young
Nigerian doctors and a Nigerian Specialist who rotates from a nearby major
center for six days at a time, to share
the Specialist Call with the MSF Specialist. So, if he has been on Call for the
night, I go in for the morning, he covers the afternoon and the night is mine.
All of these Doctors have taught me an
enormous amount – the volume, the
severity and the complexity of the cases
that we see here are beyond – way beyond – anything I have had to deal with before, even in South Sudan
and Ethiopia – and we have had to deal with these women with more or less
complete absence of any sort of Laboratory tests or other back-up to help. The very fundamentals of Medicine, which is
history taking, basic observations, careful examination, clinical judgement and
experience is all we have to go on – and fortunately for me, these guys have
seen it all before, many times, and usually can work out what to do.
So, at 8am each day we do a round of
the Intensive Care Ward There are eight
beds, the room is airconditioned but the
resemblance to a real ICU is slight – its really just a place where we can more
closely monitor the vital signs – ie
Blood pressure, Pulse, Temperature, Respiratory rate and urine output of critically
ill women – there are no fancy machines of any kind and no access to any tests
other than of haemoglobin and no X ray.
All the postoperative patients go there
initially and once stable get sent to the “Annexe” a huge open ward like a shed, recently built by MSF
for the postnatal patients, designed I believe for 40 but often crammed with 60
or 80, along with their family supports, many on the concrete floor. It is so
big, and there are so many patients that the few nurses working there take for
ever to get to see everyone, and several times while I have been here, the
nurses or the Doctors have simply stumbled across people “in extremis” who have
been quietly deteriorating, unnoticed in
the crowding and noise and bedlam of the place.
After ICU we go to the PreDelivery Ward, the
place where all the frantic action and obstetric calamities are unfolding, also often full,
there may be women on matresses on the floor or even sharing a bed for a short
time. Once we have seen everyone and sorted them out, I remain in the PDW at
the desk, and as new work arrives, help out as I can.
Now, I apologize to the non-medical reader in advance for what follows, but it is a list
of the actual patients we saw on the PDW round the other morning, a snap-shot of
a typical caseload - you will notice a number of women with "Eclampsia" - it is such a rare condition that in all my years of practice in Australia and New Zealand I saw three cases - seeing three in a DAY here is not unusual:
Bed One : Eclampsia : 18 year old woman,
second pregnancy, brought in because she had been fitting at home ( having
convulsions ) She was so restless and confused she was tied to the bed, Labour
to be induced. Eclampsia is the MOST feared pregnancy complication : it kills mothers and babies
Bed Two : Eclampsia and Malaria, and by
the Coca-Cola colour of her scant urine
has HELLP syndrome as well ( dangerous complication of an already dangerous
disease) . Also confused, semiconscious
and tied to the bed
Bed Three:
Eclampsia and Malaria in a 15
year old, in Labour. BP 180/100
Bed Four : Heart failure 2 weeks after home delivery. 25 years old.
Responding to diuretic therapy. Cause of heart failure unknown and unknowable
out here. The woman is just sitting there breathing fast and looking weak and
near collapse but theres little more we can do.
Bed Five: Eclampsia : 17 years old Admitted
for Observation of high BP, 1st pregnancy, then began fitting. We
have to induce her labour and deliver the baby in the next 12 hours.
Bed Six : two women on one mattress on the
floor ; one had a normal birth of a live baby, the other is half way through
her sixth pregnancy but the baby has died. We don’t know why the baby is dead.
We hardly ever know why. We have to induce her labour.
Bed Seven : Eclampsia : 1st
Pregnancy, began fitting in labour at
home. Tied to bed. Baby alive.
Bed Eight :
Placenta Praevia at eight months – previous Caesarean ( this woman has
dangerous bleeding from the placenta)
Bed Nine : Severe anaemia (Hb 4.3) and malaria in pregnancy ; For blood
transfusions.
Bed Ten : polyydramnios ( a hugely
distended pregnant abdomen becauase of excessive fluid around the baby which is
abnormal)
Bed Eleven : She came in with lots of bleeding
during labour. The baby is out and they are both OK.