The ‘real’ MSF experience is trickling in slowly. Most days consist on rounding on a shrinking ward: 16 patients now, down from the 29 inherited. My bipolar karma is behaving - ah, but just wait till all hell breaks loose. We had an exciting case earlier this week. The expat midwife and the outreach team went to Kisele, one of our villages, to do some health assessments. They found a woman actively seizing while in labour, kept in a hut for the last eight hours or so. So we organized a ‘kiss’, that is, one Land Cruiser leaving from Shamwana with medical supplies whilst the other car was driving back from Kisele. We met halfway through. The patient was unconscious. Her firstborn baby was lifeless and stuck in the birth canal. This is the Congo: no oxygen tank, let alone an ambu-bag so all we had was... an oral airway. We transferred her into our car and injected her with some intravenous magnesium sulphate. I was picturing the same scenario back home, on an airplane med-evac up North, and was ridiculously praying for an endotracheal tube, a laryngoscope, an IV pump, a monitor and an oxygen tank to magically appear. A long hour on the bumpy road punctuated by two stops while she was seizing: diazepam pushed in. Finally, we got back to the hospital. In the delivery room, our excellent Congolese doctor extracted the fetus with a ventouse. I treated her eclamptic hypertension, seizures and fever. The midwife thought that she wouldn’t make it. I replied: “You’d be surprised, she is young, humans are resilient.” I thought, if she survives the first day, she’ll be out of the woods. We continued aggressive fluid resuscitation, antibiotics and magnesium sulphate. The diligent nurses watched her closely, checking her vitals every hour. Two more convulsions overnight. No labs so no need to treat her likely numerous metabolic abnormalities - I am fairly sure that she has a touch of rhabdomyolysis. Four days later, this morning, she is talking and requesting food. She did make it. I can only imagine, had we had a case like that back home, what a commotion... The whole hospital would know about it, all the services would be consulted, the residents would talk about it at lunch, rounds and case presentations would be held about her.
The lady with the Bible uterus will be discharged this week-end. She is now making jokes with us at rounds and is walking around the hospital helping out the other patients. Apolline left for Lubumbashi; we hope that she comes back looking like a supermodel.
On the ward, there are three babies (a pair of twins and a singleton who lost his other twin) about a month of age and under 1.5 kg of weight. They play tricks on us, gaining weight one day and losing the next, playful one day and listless the next. It’s the yoyo of life. I’ve elected to treat them for their mild lethargy without any labs. I just couldn’t get myself to perform lumbar punctures on little patients the size of kittens – it would have been an academic consideration since the only result the cerebrospinal fluid would yield would be macroscopic, that is, using my eyes in plain daylight. They are back on the upgoing trend today. I hope that the antibiotics work their magic. And I can’t wait to have a functioning laboratory. And internet, and ice-cream, and sushi – might as well dream in Technicolor while I can :).
The main tent, pardon, ward.
Kitten-size singleton and his mommy
The future operation theater and bricks being laid for the next medical ward.
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