- © 2008 Canadian Medical Association
I recently returned from eastern Democratic Republic of Congo, where I was working for Médecins Sans Frontières. And everyone asks, what was it like?
It's hard to describe the experience properly. I was 1 of 6 doctors (the other 5 were Congolese) in a community “reference” hospital. It's in an isolated town in hot, humid jungle. We provided general medical and surgical care under basic conditions: no x-ray, no biochemistry, basic bloodwork and microscopy. Living conditions were also basic: no running water, minimal electricity. There were a total of about 10 foreigners in town (we constituted half). Strangely, cellphone service has recently been installed.
I could tell a thousand stories. There are a few victories, occasional comedy, many tragedies. And, also, moral lessons, personal discoveries, political drama.
Aviva was 18 months old, struggling to breathe. Respiratory rate: 50–60, pronounced indrawing. We put her on ampicillin and gentamycin. I worried that she would die that night. I told the nurse on duty to keep a close eye on her, although there was little to be done if her condition did deteriorate. Our hospital had no oxygen.
Aviva looked marginally better the next day, and quite a bit better after that. She smiled at me when I rounded. Her mother helped her shake my hand as I said, “Jambo!” (Hello.) The rest of our interaction was in French–Swahili translation. Her fever had resolved, but she still had some fearsome indrawing and an elevated respiratory rate. After her first course of antibiotics, I started her on ceftriaxone but suspected tuberculosis (TB).
Diagnosing TB in kids is hard; we use the (not well-validated) Keith-Edwards score. Aviva was transferred to the Malnutrition/TB/HIV Pediatrics ward, and over the following weeks, she gained weight, completed the intensive phase of TB treatment, and was discharged.
I thought it a story of victory. But I later learned from local nurses that Aviva had failed to attend ambulatory TB treatment after being discharged. A week after leaving hospital, she was dead, of causes unknown. I was surprised and all the more saddened.
Footnotes
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CMAJ invites contributions to Dispatches from the medical front, in which physicians and other health care providers offer eyewitness glimpses of medical frontiers, whether defined by location or intervention. The frequency of the section will be conditional on submissions, which must run a maximum 350 words or be subject to our ruthless editorial pencils. Forward submissions to: wayne.kondro{at}cma.ca