My first week of working, and it has been hard to switch off. I think it is always like this, when you first come to understand the scale of a challenge you are facing. In this case it is the number of patients and the severity of their illnesses, the limited resources, the clinical uncertainty and the proximity of death. It is hard to walk away from the hospital as you know that children will die in the night, and you think to yourself that, just maybe, you could save them. Yet it is grandiose to think like this, to think of ourselves as indispensable. The death of children is a reality that Nigeriens accept gracefully. The world has always been thus, and people survive through the strength of religion and community; and well-intentioned NGOs and individuals come and go like the tides. Working as we do, it sometimes feels that we are striving in stubborn opposition against the force of reality. And yet, in my more peaceful moments, it feels as if we are all drifting along together, trying to touch each other’s lives beneficently.
The project here consists of three elements – a food distribution program for under 5s, a number of mobile and fixed therapeutic feeding sites (offering nutritional and medical support), and a 350 bed hospital-like unit for the severest cases – which is where I am working. Officially I am the medical supervisor of the hospital, but since this is a new role, and since it was working pretty well without me it’s not immediately apparent what I can offer. Nevertheless, I have worked this week in a role that I am more or less familiar with – that of a doctor and a trainer – and as time goes by I’m sure it will become clear what the problems are that need to be resolved, and in which direction the service should evolve.
It’s sunday evening, and I am writing in order to switch off (which obviously never works!) Faces from the week flit in front of my eyes. One face in particular – I don’t know his name – whose eyes I found myself staring into yesterday afternoon, as if beseeching him to tell me what was happening to him. He was gasping for breath – of course he was anaemic, and had pneumonia, and was dehydrated from diarrhea – and I had tried everything I could think of (albeit conservatively, as the weakened metabolism of malnourished children cannot withstand many aggressive treatments) – and yet he would just stare, unable to tell me how to help him. And yet when I left the hospital that afternoon, I had the hunch that he might just make it through the weekend. I guess I’ll find out tomorrow morning. The charts for the newly deceased children get left in a pile on my desk for me to review. What a way to start the week!