Shamwanesqueries, shamwanoddities

Shamwanesqueries

Resteront gravées, pour la postérité...

Les nuages sur les collines au petit matin, lorsque je cours sur la piste d’atterrissage, et le brouillard qui se lève.

Toutes les petites filles qui pilent du manioc. La femme congolaise de brousse travaille de l’aube au soir, et tient tout de la bête de somme aux yeux des hommes.

Les orages-moussons presque prévisibles en saison des pluies, la pluie tambourinant sur notre toit de tôle.

Les absurdités de Shamsterdam. Conséquences de nos désastres logistiques dûs à la bureaucratie de la capitale: le fait qu’on ait à racheter à la population locale la farine de maïs distribuée gratuitement par Concern (via le Programme d’Alimentation Mondiale de l’ONU) pour... nourrir les patients à l’hôpital suite à nos ruptures de stock. Le fait que la majorité de notre staff national, les urbains de Lubumbashi, ne consomment pas le manioc local et donc aussi rachètent la farine de maïs (il y en a même qui se mettaient en ligne chez Concern à la distribution, alors qu’ils constituent clairement la haute bourgeoisie de Shamwana).

Vue du nouvel hôpital, vers la salle d’op



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Shamwanoddities

This is pretty much my last mass e-mail from out here as I am now flying out of Shamwana on March 6th - it keeps on being preponed! And who knows if I’ll ever get to meet my replacement as the flights are as unpredictable as ever – and more out of incomprehensible coordination problems, not weather issues.

The last week was a busy one. I thought that I would commit it to staff evaluations and end-of-month and end-of-mission reports... but instead, it was time to go back to the operation theater!

After a few months of normal deliveries, we’ve had a string of obstetrical disasters again. Our deliveries in hospital have increased to about 30 a month from less than 10 when I first arrived in August. Last week, a woman was sent from Kisele, one of our peripheral villages, with a dead baby and a roaring infection of her uterus. Our midwife had to use the vacuum to pull it out and, I’m told, the stench was palpable. The patient now has a vesiculo-vaginal fistula, to be expected, that is, a permanent connection of scar tissue between her bladder and her vagina. It means that she is now incontinent of urine. Fortunately, the fistula surgeon will be back in Dubie sometime this summer so she might be eligible for surgical correction.

Then last Thursday, our new Congolese midwife (who used to be a mental health counsellor), called us urgently to the delivery room. A woman no taller than 1m40 was on the table, visibly diaphoretic and talking. Upon taking the vitals signs, her blood pressure was... absent. I verified by checking her radial pulse... absent as well. True shock, and yet, there she was, still talking and crying! She had been in labor at home for one or two days, and was finally transferred to Shamwana on a bicycle as usual. Her contractions had stopped; her cervix was fully dilated, but there was no fetal heart. This kind of scenario spells a disaster: a probable full uterine rupture. After crossmatch and an IV line, we went straight to surgery. The uterus was completely ruptured and attached to its lower third by a mess of organized clots and necrotic tissue circumferentially. The baby had been dead over a day – its skin was literally falling off and it was hard to grab it to take it out. Talk about stench and sight again! I assisted my Congolese colleague in performing a total hysterectomy; we couldn’t even salvage the adnexae or the ovaries. We were in there for a mere... four hours. I came out exhausted. But... she is alive, stuffed silly with antibiotics, and received almost two units of blood. Surely, she would have died of haemorrhage or overwhelming sepsis with a decomposing baby in there. Yikes.

Who said that green wasn’t a good colour for me??? :)


As well, we hadn’t used our blood bank for a while, and then we got a string of children sick with malaria causing severe anaemia. I encountered the lowest haemoglobin that I’ve ever met: 14. For comparison, my own haemoglobin probably hovers around 140. Again, the child was defying all medical knowledge: he was still breathing and crying, in spite of having 10% of one’s normal oxygen-carrying capacity. Unfortunately he did not survive in spite of the transfusion that we gave him – he could not compensate any further. Human resilience does not cease to amaze me, and few of these disastrous cases ever make it to the literature. Nobody teaches you this in medical school!

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More Shamwana pictures around the hospital

Seriously cute kids!




J, our burn patient, the one who had seized. He’s now into his third month at the hospital but is getting so much better. We actually discharged him earlier today




Our last set of twins – Kyungu (=oldest twin) was the sick one, whereas Kabange (=younger twin) was the fat one at 2 kg.



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Sur ce, je vous souhaite une bonne continuation. Je vais rouler ma bosse sur le continent avant de rentrer pole pole à la maison quelque part en avril. Je serais sur des plages tanzaniennes, sur le Kilimanjaro, et à Amsterdam chez une certaine psychologue. Portez-vous bien et on se revoit à mon retour!

Pour Damien Lehalle

Official MSF press release about the tragedy: three MSF-Holland workers killed in bombing in Kismayo, Somalia, Jan 28 2008

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Le monde humanitaire et plus particulièrement, les travailleurs MSF, sommes tous sous le choc face aux décès de nos collègues expatriés Damien Lehalle, logisticien de France et Victor Okumu, chirurgien du Kenya, lors d'une attaque contre une Land Cruiser de MSF-Hollande à Kismayo, en Somalie, lundi dernier le 28 janvier 2008.

Damien était le logisticien de Dubié en août 2007 lorsque je suis arrivée au Katanga. Je l'ai rencontré brièvement lors de la réunion médicale d'août qui s'est tenue à Dubié. C'était un mec joyeux de vingt-sept ans, souriant, au sens de l'humour clownesque, et qu'on n'oubliait pas facilement. Il se promenait avec ses pantalons en pagne et un grand sourire brillant. Tout le monde de la mission l'adorait. Lors de notre réunion médicale, il y avait trop de visiteurs à Dubié, et donc il avait prêté sa chambre. Il dormait paisiblement à la belle étoile sous un moustiquaire sur le terrain de volleyball. Dubié a été sa première mission pendant quatorze mois et il était au premier mois de sa deuxième mission à Kismayo lorqu'il a été tué. Lorsqu'il a quitté Dubié en octobre, il a dit ses adieux à toute la mission sur la radio HF; comme j'étais moi-même en route pour Kishale dans une Land Cruiser, je lui ai souhaité un bon voyage et une bonne continuation. A Dubié, on l'aimait tellement que tout le village est venu à sa fête d'au-revoir (arrosée de fruits de la passion, m'a-t-on relaté), et le staff national l'a transporté physiquement jusqu'à l'avion le jour de son départ. Sa vie a été brutalement interrompue; ses parents ont perdu leur fils unique. Nous sommes tous en deuil.

De tels évènements nous rappellent que malgré toutes les meilleures intentions du monde, la violence est constante et imprévisible dans le monde humanitaire. Tout travailleur MSF est bien mis au courant des risques possibles d'une mission. Mais nos personnalités fortes nous font croire à une certaine invincibilité. On tente de gérer le risque en choisissant un pays moins armé qu'un autre, mais le chaos et le danger sont toujours possibles là où MSF choisit de travailler. Que l'âme de Damien repose en paix. Nous, qui avons croisé son chemin, avons été chanceux. Nous accompagnons tous en pensée sa famille et ses proches durant ces moments difficiles.


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The humanitarian world in general and MSF workers in particular are devastated by the deaths of Damien Lehalle, French logistician and Victor Okumu, Kenyan surgeon, in a MSF-Holland Land Cruiser that was bombed in Kismayo, Somalia last week.

Damien was the logistician in Dubie in August when I arrived, and I met him shortly during the Katanga medical meeting. He was a fun-loving, energetic, popular, tongue-in-cheek, joyful 27 year-old guy, and was well loved by everybody in the mission. I remember his twinkling eyes and beautiful smile. When we held our medical meeting in Dubie, we were out of tukuls for all the visitors, so he had parked a bedcamp and a mosquito net under a tree next to the volleyball court and slept there happily under the stars. His first mission had been Dubie, for fourteen months, and he had been for only one month in Kismayo for his second mission when he was killed. When he left Dubie in October, he said his goodbyes on the radio to everybody in the Katanga mission; as I was en route for Kishale in one of the Land Cruisers, I wished him good luck and a good continuation. He was so loved that all of Dubie attended his goodbye party and the national staff carried him to the plane on his day of departure. His young life has been cut short; his parents in France have lost their only son. We are in mourning.

It is a harsh reminder that no matter how good our intentions are, it's a hard world out here. MSF workers are fully warned of the risks of leaving on mission, but I believe that we somewhat sin in invincibility in a way or another. Of course, risk can be to some extent managed by picking a less gun-prone country vs. another, but the risk of chaos is present in most places that MSF chooses to work. May Damien's soul rest in peace. Those of us who have had the luck of crossing his path were all blessed to have known him. May his family and loved ones bide well during this hard time.