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| 9651km from home (Ottawa,ON) |
Another
week gone by. Time has gone a lot faster these last few days. I am busy with my
various tasks and my adaptation to the climate, the people, and the project.
This remains a positive experience. I don’t regret my decision to participate
in a MSF project – I can finally see what kind of impact the organisation can
have on the population.
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| Entrance to Boguila Hospital |
I work at
the Boguila hospital as the manager of the Intensive Care Unit (ICU), the
emergency department and the In-Patient Department (IPD) – pediatric ward, and
medicine/surgery ward. This is quite the
challenge for me! I don’t think I ever had that many responsibilities in my
nursing career. But I feel ready and motivated. The team of nurses and
“secouristes” works well and the mood is good despite the difficulties present
in the country and the area. This is encouraging because the rainy season will
arrive very soon and this is our busiest time of the year – malaria season or
the « Peak Palu » as it is called here.
Already,
our Out-Patient Department (OPD) has seen the number of cases increase
daily. And most of our admitted patients
– with a great number of children under five years – suffer from the severe
form of the illness.
Malaria (or
« paludisme » in French), a parasitic infection, is transmitted to
humans by the bite of a mosquito. Most of the infections are due to four
species: P.Falciparum, P.Vivax, P.Ovale and P.Malariae. In our region, we
mainly see infections caused by the first species – Plasmodium Falciparum. Unfortunately, this species often causes
complications, thus the name Severe Malaria.
The
clinical signs of uncomplicated malaria include a fever associated with chills,
sweating, headache, muscle pain, a lack of appetite and nausea. In children,
these symptoms also include abdominal pain, diarrhoea and vomiting. Children and pregnant women can also often
suffer from anaemia. If it is unfortunately a severe malaria case, the patient
can present with changes in his level of consciousness (delirium, coma), convulsions,
extreme weakness, respiratory distress, shock, renal failure.
After our
clinical assessment, we quickly confirm our suspicion of malaria with a Rapid
Diagnostic Test (RDT) called ParaCheck. A few drops of blood are required for
this quick test. Of note, in the event we do not have the RDT, the treatment of
a suspect malaria case should not be delayed because an individual suffering
from uncomplicated malaria can rapidly progress to severe malaria, which can
cause death within a few hours if untreated.
No time to lose!
Treatment
is relatively simple – artemisinin-based tablets for three days. A coformulation
(2 antimalarials in one tablet) is preferred as treatment. In hour hospital, we
are using the coformulation Artemether/Lumefantrine (CoArtem). In the event of
vomiting which prevents an oral treatment, we can also use an intravenous
intramuscular treatment - Artesunate. As for the other symptoms such as anaemia,
fever or hypoglycaemia, we treat them individually, as they present.
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| Village House |
We try to
encourage the population to protect themselves during the rainy season with
mosquito bed nets. All of our admitted patients, regardless of their
diagnostic, are given a mosquito bed net for the duration of their stay in the
hospital. All admitted children leave the hospital with their own mosquito bed
net. Despite our efforts, the population does not use the bed nets on a daily
basis, complaining that the combination of the heat and the bed net during the
night prevents them from sleeping well. In addition, the lack of money and
resources, and big families limit the purchase of bed nets for all the members
of the same family. This explains the high rate of malaria in children – the
parents keep the bed net for themselves or for a baby sleeping with them.
The last
month having left its mark in CAR with a successful military coup and
increasing insecurity amongst the population, we see many people staying in the
bush with their family. A large number have not yet returned to their village
for fear of retaliation, looting or injuries.
So they continue to live in the forest, without food, without drinking
water and without protection. One of the consequences of this exile will be an
increased number of malaria cases, and an even greater number of death due to
the illness as the population has no immediate means to health care. When they
decide to come to the hospital, it might be too late to receive treatment in
time. All we can hope for now is to pass on the message through discharged
patients that we are present and that we offer free health care.
Until next
week…
Janique.
