four days old

You always hear the children crying first and we usually start rounds in the
pediatric ward. Frankly we triage with a bias towards the children, because
it is often they who will succumb to malaria or other infections in this
place, in these times. 'Succumb' of course is a picturesque way of saying
"die". As we discuss events at the end of the day at the base I will sometimes
launch into my latest humor offensive, directed against these 'spoilt
children' who tend to demand all the attention. They get carried around on
people's backs all day long. They get fed a lot on demand. They occasionally
appear cute and playful(probably a ploy to trap us into liking them). They
inspire stupid smiling faces and gurgles from adults who should know
better(that's me). They often sneakily pretend to be helpless!
Beneath my dubious sense of humor lie other, quieter realities.
These are the beautiful old people who also arrive at our hospital
regularly. They are often stooped and crooked, sometimes dying, their
complaints as such perhaps not given the weight they might deserve. They
don't merit quite the same attention, they don't often squeal or cry. These
men and women arrive quietly and look at you with a calmness or a
resignation or a detachedness that seems to ask; "do I also matter, to you?"
Do they?
These are the survivors of a harsh life, walking or being carried in for
help. They have clouded eyes, pain, urinary retention, cancerous growths and
thin wrinkled skin. I sometimes ponder are they victims or victors?
Emergency medical organizations like ours are not ideally set up to handle
these old souls, in this place in these times.
The things these survivors could probably share with me. Those 'spoilt'
babies have no idea. I, have no idea.

An old man comes in with a distended abdomen; it looks like a small cantaloupe down there. It is his bladder, swollen and painful from urinary retention. We ask how long has this problem been going on? "about four days" he says. Maybe, but probably not I think. Swollen joints, end-stage
tuberculosis, HIV wasting, tumors, gangrene and festering wounds; when
asked, the patient will often tell you he or she has suffered from it for
"about four days".
And really, why think back any further?
I smile softly as these thoughts flow through my mind.
Everybody somebody's baby.
Four days old.
More later
John B Fiddler ANP

Rain

Patients wait outside the hospital ward- Zemio, Central African Republic 2011

The rainy season we think, has started finally. It is not like you imagine.
The earth is thirsty and greedy when it rains, initially there are torrents
of water rushing along the roads and gushing down the hills. But soon after
the deluge the earth becomes quiet and damp. Most of the water has been
swallowed below. Then the sun comes out.
A father has travelled 400 km to our hospital with his young daughter. She
has a huge tumor on the right side of her face, distorting the jaw and the
cheek. Eating and swallowing is difficult.
We think we know what it is, a type of lymphoma that is known to occur in
children in this part of the world. It has a suspected relationship with
repeated infections of falciparum malaria, the type of malaria we see in 96%
of the patients who are diagnosed here in the Central African Republic.
There is nothing much we can do right now for her, except send an email to
the capital medical team to see if there may be a chance of a chance to
treat her. You note how I word that sentence, I think the odds are not good.
The medical care in the capital, Bangui, is not much better than it is here.
I don't know what will happen to her. Frankly her future without state of
the art chemotherapy is dim. Another possibly dim future in a vindictive
land that is always thirsty for change.
But all is not so hopeless that you drown in perpetual frustration here.
Every day I tour the ward and see children pulled back from the brink. Most
of the sick children who arrive here with malaria, will stabilize and then
after a couple of days of treatment they will smile again, and you know that
a small battle is won. And almost every day children smile. As we tour the
small hospital we touch and hold hands. We try to impart what we can to
friends and relatives of the ill. We laugh, occasionally with a barely
submerged sadness. We try to accept the fact that we cannot change
everything and we continue in our own crazy, rural, isolated African
medical-centre in the rainy season way... to seek the courage and the wisdom
to change the things we can.

More later
John B Fiddler ANP