So it’s been a week here of not doing outreach but doing other stuff
instead. I’ve been covering the holidays of other expat staff, which has put
me in charge of an inpatient department. In Europe the first question anyone
would ask is ‘how many beds is it?’ Well here we don’t have beds, a grain
sack on the floor is the nearest thing to it. Furthermore in terms of
admissions if we have more patients than there is space we just put up
another tent. To say we have been putting up more tents this week gives an
indication of how the week has progessed.
The days have been punctuated with many different patients, all with a
unique story and outcome. The first patient I saw was on Saturday. He was
four and weighed the average weight for an 8-month child in Europe (7kg), I
make no exaggeration when I say it was lucky mum and dad decided to come to
the clinic in the morning because by the afternoon there would have been
little point. There were many furrowed brows, tutting and desperate attempts
to get the child going with some fluids. Not an easy task. His skin was
paper-thin and trying to get an IV line was akin to trying to stuff the
machine that dug the Channel Tunnel down a trouser leg!
Eventually 24 attempts, and a lot of huffing and puffing later, we sited an
IV line. Death delayed for a few hours but still very much on the agenda.
Man cannot live by IV fluids alone (though it’s a very good start). The
painstaking process of feeding begun, the parents were magnificent, cajoling
and coercing for hours on end. The child by this stage had reached a point
past hunger and he simply wasn’t interested. This morning, he walked out of
the clinic having reached his target weight in less than a week, leaving a
team of grinning health centre staff with a lovely warm glow inside.
At the other end of the spectrum are those who don’t want to hear what you
are telling them. We have had an eight-year-old boy with us for a nearly two
weeks, he has TB and as a result is malnourished. Culturally here it is very
difficult to convince people their children need IV drips (I still haven’t
got to the bottom of quite why this is!) so this patients parents refused
point blank. Then they refused the special food we gave the child (I think
they may even have been giving it to the sibling and selling it on the
market) Consequently their child got sicker, and so they became angrier. The
final straw occurred two days ago when then accused us of trying to kill
their son.
I walked back to the expat living area with steam gently rising from my
ears, went and threw a Frisbee round the place and played Risk. Felt a
little better after this, and decided that a change of tactics was needed,
bring forth the man with the sticks!!!!!
No dear reader, I didn’t pay a man with sticks to attack the couple in
question, though for a few moments I considered it. The man with sticks was
a TB patient who had presented months ago unable to move and feed himself,
and now after a bucket full of TB drugs and equally important food he was
able to walk ala cross country skier with two sticks. He lived in the TB
camp
This is a large area of more than seventy patients who are all at various
stages of TB treatment. Treatment for TB can take six months or longer and
so they live in a little community of tents and huts whilst they complete
the arduous course of medication. Caretakers and Improving patients care for
the sicker patients. The mood is always buoyant; there is always a game of
something going on. It is a place of laughter (followed by bouts heavy
coughing!) and millions of children running in all directions. I wish I
could spend more time there.
I took the parents to see the place we intended to bring their child once he
was improving and we sat in a small circle whilst the old man with sticks
recounted his TB experience and how the process had been long, painful but
ultimately successful. Things then took a bit of an unexpected turn, as the
topic of our discussion became public knowledge in the camp. Soon there was
no stopping them! A large crowd of people gathered all with stories about
their own TB crisis and the importance of nutrition and taking the medicine
as prescribed. Our poor translator nearly had a stroke trying to translate
the quick fire conversation that followed, In the end he just gave up and
gave us the topics been discussed. The plan could not have worked better, I’
ve just seen the child in question now and things are picking up. No more
arguments about the treatment, my life is less stressful and their child is
better. Everyone’s a winner!
Of course there are those who arrive too late. I won’t pretend that good
news outweighs bad. Four people passed away last week including an eight
year old boy and a mother who left a thirteen year old girl and four year
old boy to fend for themselves (the father died last year). Tragedy is a
constant companion, however I have never felt that I have made such a
difference as I do here.
I’ve passed my first two months, in many ways it has flown by, but then
again London seems an awfully long time ago. And two months means a break,
so I fly out on Monday for a few days R&R. The sea is calling I think.
Though I think I’ll have a bath first.
