BAPTISM BY FIRE

We often say that some of our qualities surface when we are facing great challenges. It happened to me…Let me explain.

When I returned from my trip in France, the nurse who held the position of Medical Team Leader (MTL) was leaving for her vacation. The MTL is my immediate supervisor in the field. At that time, I took on some of her responsibilities temporarily.  But, as Murphy’s Law would have it, an incident prevented her to return to the project and I am still wearing her hat on top of mine.

For the last five weeks, I have taken under my wing the TB/HIV (Tuberculosis and AIDS), maternity, laboratory, and pharmacy departments. I also had to facilitate transfers and discussions about our patients between our doctors and others from Bangui (the capital) and Paoua (MSF-France). In addition, we are getting ready to send our international medical order, which will have a great impact on our care delivery in the spring of 2014.  Finally, our new expat doctor has just arrived and I have to help her integrate into our team and the project and figure out what her duties are – quite the challenge since we have not had an expat physician with us since June!

I have to admit that all these accumulating challenges allowed me to shine somewhat. My qualities of leader and coordinator have been well demonstrated. I love to do this kind of thing and the more I have, the better I perform.

I think the trick, for me, is to just take one item at the time – there is only one of me to accomplish all these tasks and I can’t divide myself in two or four in order to do it all. I was clear with the new PC – I will give it 100% but it might not be as quick as she might wish. All she told me was: “Do what you have to, do it right and all will be good.”

So I used all my assets – my team! All the supervisors (IPD, Maternity, TB/HIV), the new doctor, the other supervisors from the pharmacy, hygienists and laboratory and we hit it head on. And we succeeded in all of the tasks.

We were able to provide good care to our patients and we tackled the small daily issues brilliantly. The war wounded arrived, were taken care of and left all in good health. The orders were done and sent each week and we did not run out of anything (nor did our patients!) The international order was completed with the help of the doctor (Thanks Elisa!), our fin/admin (Thank you Roberta!) and me. We were even the first of the country to submit our orders – both medical and logistics (Bravo Boguila!)

And just when I thought that I could breathe easier…Our MTL must now go to Bossangoa, town located about 100km from here, without coming to Boguila. Bossangoa has seen a number of armed confrontations in the last little while and they are without expat nurses, which is why we are lending them one of ours while they wait for the assigned one to arrive. Life must go on!

But wait! I am now asked to replace the x-ray technician who has just resigned and we do need our patients suffering from respiratory infections and the TB/HIV patients to have chest x-rays.

I am telling you: with MSF, you are never bored and you learn constantly! Bring it on! I am ready for anything!

Janique

NEUTRALITY. IMPARTIALITY. INDEPENDENCE.

The hostilities have started. 

We are at the ready in Boguila because another rebel group – we call them the ‘Groupe d’Auto-Défense’ (AD) – is attacking the Seleka from Boguila. We have already received gunshot wounded; some gravely injured, others, less so. 

It is interesting to see the reactions from the hospital staff – it is easy to say that MSF is neutral and independent but practically, when emotions ride high, it is another story altogether. Here is what happened…

This past Monday, we were planning to transfer one of our patients to the hospital of MSF-France in Paoua (approximately 60-70 km from Boguila). All was well and we were just about to depart when we got the news that there was an armed confrontation between the AD and the Seleka on the road to Paoua. Needless to say that our transfer was cancelled for security reasons and that we stayed put.

A few hours later, a truck from the Seleka arrived at the hospital and the soldiers brought us two injured, both with gunshot wounds – one in worst shape than the other. The team from IPD was ready: our ‘Salle de pansements’ had been filled at capacity with dressings and IVs and the personnel had seen worst. 

The first injured only had a few superficial wounds that just needed a good cleaning and disinfection as well as dressings and a good follow-up.

However, the second one sustained gunshot wounds to the abdomen, and on both the legs and arms.  He was losing a lot of blood and was showing signs of shock. We quickly started to intravenous lines and covered the wounds before bringing him to the operating theatre. The OR team ran to get dressed with the OR clothes and get the room ready. In the meantime, we had to control the flow of soldiers wanting news from their colleagues. They only speak Arabic so we asked one of our nurse supervisors to translate for us. He calmly explained to them that we are doing all we can and that they have to respect our instructions – one of the soldiers had made his way into the OR while we were preparing the injured for the surgery!!! In order to help with this problem, we stationed an expat nurse outside the door of the OR – they seem to be a bit more respectful of the rules if a ‘white’ person is there versus a coloured one. Thankfully, they quickly understand that not everybody can circulate in the hospital.

The surgery starts and we find out that the injured had gunshot wounds – pellets – in the abdomen, the right leg and the right arm. We succeeded in removing the superficial fragments from the leg and the arm. The others that are slightly deeper will have to migrate by themselves to be removed later. We now open the abdomen – what are we going to find? Usually, this type of injury can cause lots of damage as the abdomen protects many vital organs – liver, spleen, intestines, kidneys, etc. We could also find a hemorrhage or a septic infection if the bowel has been touched. We can’t believe it! No organs have been injured! The bullets only penetrated muscle deep. This man is so lucky! In the end, we still remove two or three 9mm bullets… 

We finish the surgery and bring the patient back to the Soins Intensifs/Urgence pavilion where he will stay for a few days.

It is only after the surgery that we find out our patient is in fact the commander of the Seleka group stationed in Boguila. There are already many visitors – militaries, family, etc. – and they all want any news about him. We have to be careful of who enters the hospital and who does not. What are we going to do if civilian wounded start arriving? How many wounded can we expect?

We discuss with the national staff (secourists and nurses): it is important to remain neutral and to watch what we are saying when we work at the hospital. They have to remember and respect the MSF principles. We are not only treating the injured here, we have their families in the hospital and they can hear everything that is said. Our staff responds to these reminders in an exemplary fashion…When new patients arrive, the civilians will be placed on the pediatric side so that they are at opposite sides with the military, thus minimizing any altercations between them. And everyone completely understands the consequences a bad comment in the presence of any of the groups would bring. They can all wear their MSF ID badge with pride.

In the following days, as expected, injured civilian patients, from the older man to the fifteen-year-old girl: all were working in their fields and they were the unfortunate recipients of the retaliation of the rebels on the civilians. These little people work in their fields in order to gather some money that will help them eat and a lot of them become the unknown victims of the rebellion and its repercussions.

When will the international community intervene in order to stop such violent events on the inhabitants of this country that only ask to survive: survive the war, the malaria, the hard life.

Janique