Death & Life in Don Bosco

Sadly, miracles don’t happen that often. Which is why, of course, they are miracles. We really wanted one yesterday, for another tiny baby. Just two months old, her mother brought her in with respiratory distress, her tiny chest expanding with the effort of breathing. And every few minutes she would start this dry, barking cough, which would continue, excruciatingly, for minutes.

“It’s whooping cough,” said our new doctor, Ana. She’d seen it before, which I never had. We gave little Merline all the treatment she needed, and kept the oxygen concentrator going; managed to clear a small ward so that she could be isolated; and then just prayed, as we left for the night.

This morning she was dead. It just brought home to me the importance of the vaccination campaign we’re running at the clinic, on behalf of the Ministry of Health. So far, in just over a week, the small team has vaccinated over 1500 children from birth to two years. Whooping cough is included in the eleven vaccines we’re giving.

As I’m supervising the vaccinations, it was one of my biggest challenges to start with: learning what VAA, PCV and DTC meant, what the vials looked like and how many doses were in each different vial, so that I could get out the required number from the cold chain quickly enough, under the eagle eye of our scary pharmacist, for the temperature to stay within the required limits.

I should explain that since my last blog I’ve moved to another position. Now that the conflict is decreasing here in Bangui – still with sporadic daily gunfire and news of shootings, but with fewer admissions to our emergency centre – we’ve handed the hospital back to the Ministry of Health to run, with the help of another humanitarian aid agency.

And our efforts will go to areas in the interior, and the clinic in one of the refugee camps here in the north of Bangui. It’s a refugee camp – or rather, an IDP (internally displaced people) camp that was started in December in the grounds of a school run by Salesian priests. Some 40-50,000 people from the surrounding area sought safety here, displaced by the ongoing conflict between the Seleka and anti-Balaka militia. Many have now returned home, but about 20,000 remain, fearing for their security in an area that is still a zone of conflict.

 

So, having just got to grips with one job, it’s a new job for me as from last week. The nurse has just left, and we had two days together for me to learn the ropes.

The first day was chaotic. I arrived on the day of the feeding programme for moderately malnourished children – which meant an influx of some 200 children under five. And on top of that, it was the first day of the vaccination campaign: another 250 babies and infants trickling in. Getting a new team of vaccinators into action, organising a logical flow of the mass of patients – and at the same time trying to learn how the feeding programme worked before I could actually supervise it – was quite a challenge.

In between all that, Mila – the nurse I was taking over from – managed to show me round the rest of the clinic. It had grown a lot from the provisional clinic opened last December, and as well as an outpatients department, providing about 200 consultations a day, there are nine or so inpatient beds, an ever-expanding maternity department (mothers seem to come from far and wide to deliver here) and a small section for emergency admissions. Oh – and don’t forget the pharmacy, the unloved province of MSF nurses. They are often fairly disorganised and always very busy, and it’s difficult to keep an accurate track of consumption and therefore ordering. This one looks like no exception, and one of my first tasks will be to get to grips with it.

As well as learning how many doses in VAA and PCV and DTC, and how many we need to order each day.

I was slightly anxious about my move to this clinic, because of the security risk. A week or so ago, there had been an incident in the surrounding area that resulted in nine people being admitted at once with gunshot wounds. And all car movements had been stopped in and out of the area. Would the staff have to spend an uncomfortable night in the clinic? Luckily things calmed down before curfew time, so they were able to return to our base.

All new challenges; let’s see how I rise to them. The expat doctor who has been running the clinic – very experienced, very calm – has just left, so we’re a new medical team. And I’ve taken over as what is called Medical Focal Point – which basically means I have to be a problem solver. I’ll let you know how it all goes!

Meanwhile, we have another baby to worry about. Little Mbetimale was born twenty days ago prematurely to an HIV positive mother. The mother has since died, and the father sleeps in the clinic with the baby. Mbetimale weighs a bit more than a bag of sugar, and it seems another miracle that she has survived this long. It didn’t seem possible – but she’s a fighter. I hope she manages to keep on fighting.

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