Greetings from Bambari

  I recommend a holiday in Cambodia.  The kids do not like the Dead Kennedys song, but the country I think amazed us all.  The ancient temples, the agreeable people, the genocide memorials all warrant visit.  More bats roosting in trees, I guess this is a thing, who knew? not me. Cambodian silk, Central African tailoring, and behold.  The tailor was amazed at how soft the fabric was: I have another bolt different colors/pattern, I'll probably go for another of the same model. Back in Bambari, things have evolved.  My immediate supervisor is gone, here now a dynamic, motivated and intelligent replacement.  Can we get anywhere on meaningful improvement in my remaining 2 months?  Time will tell, odds not in our favor as hierarchical obstacles abound.  But at least we can try. I will repeat our "don't scold the patients and families" training, which featured role playing (by me as an over the top irate nurse) to much general amusement.  Here is the announcement, and a sam

 I am in Bangui on my way to second vacation in as many months - an accident of administrative oversight that serves me well.  Meantime, some only in Bangui scenes: A COVID PCR is required to leave the country.  Why?  Because.  Anyway, to get one within the 72 hours from departure requires a visit to Institut Pasteur.  Quick, my NGO picks up the bill, and I am documented COVID free to leave.  But, has anyone ever seen this, a bunch of bats roosting in trees in the middle of the city? Probably 20 trees are full of them (all those black things hanging from the branches), just settling in for the day as I arrive at 7am.  Is this a thing anywhere else?  No one I asked has seen it elsewhere in the country. Folks have mentioned the front page NY Times article on Wagner/Russian forces here in C.A.R.  It is an accurate portrayal as far as my experience goes.  The article does not capture the soft power that USA still wields here, souvenir of the long-gone Peace Corps and also Christian Mission

  After 4 months in Bambari - OMG Bangui looks like a massive bustling metropolis!  I am agape at the stocked shelves of the "Bangui Mall" which is a fancy department store featuring a well stocked supermarket on the first floor.  Prices are somewhat crazy but if you can find it at Safeway or Walgreens, you can find it at the Bangui Mall. I walk from one NGO residence to another which is allowed in daylight hours.  To my left, just 100 yards away - the Oubangi.   That's Democratic Republic of Congo on the other side of the river.  Nice to see it, even if the bustling part of the waterfront is elsewhere.  A few guys eating lunch next to their dugout canoe to my left (not pictured.)  My plane leaves for Richmond VA then NJ in three days, with me on it as long as I COVID PCR negative on Monday (why is a negative PCR needed to leave the country?  because!)  I will return in time for December 1 in Bangui - the national holiday commemorating the declaration of the Republic.  Th

  Great run over two weeks - zero deaths in the PICU.  I am perhaps jinxing things as there are one or two kids I hope to see tomorrow morning but would not surprise me if they don't make it.  Today two little kids out - home! - after long and complicated stays, the moms kind of bonded because they were the longest residents, seeing the other kids come and go.        More important, I finally got a yes from boss's boss for some projects, "I will support you" - a first.  Maybe I can get some real improvements started (not expecting to complete anything) of the many things pediatricians and visiting experts have been writing about for years, without anything actually getting accomplished.  And, most important - Thanksgiving!  I leave post in two days.  The trip from Bambari to Bangui to Paris to Atlanta to Richmond - few days there - to New Jersey -1 day there - to Paris to Bangui to Bambari will make 16 days away from the Hospital of which 5 days will be in US.  Worth

We exceeded one week with no pediatric deaths.  I do not want to jinx it, but still cannot resist celebrating our collective success, or good luck, or who knows what.  I am very lucky to spend every day in a place that is just so rewarding - the peds icu.  Because, beyond that. . . Looking towards pediatrics from the Peds ICU room walkway Pediatrics building ramp under construction - thank you NGO "Humanity and Inclusion."  And yes that young man has elaborate external fixator emerging from his fractured right arm.      I am now halfway-ish through my contract.  I have read the reports of the visiting experts, and my predecessors, who have revealed much to me by all the documents they leave on the laptop we pass down one pediatrician to the next.  The recommendations for meaningful improvement are the same, over and over.  I decided to see what my predecessor did, and why it yielded little to no lasting benefit, then try to move the ball down-field a little by going at the pr

     My European/American expat colleagues did not know about Mami Wata.  This (usually white, blond) female spirit lives within bodies of water, from which she can emerge to . . . well, it depends whom you ask, but it's usually not good.  In any case, she causes many problems here.  Back in Peace Corps days I recall that the fish-farming volunteers were challenged by reluctance of Central Africans to sleep next to their fish ponds to prevent fish theft, because of the risk of Mami Wata (knowledgeable readers feel free to correct me).  Also, when I briefly visited the hospital in my Peace Corps town of Berberati while in medical school,  the second most frequent diagnosis in the internal medicine ward was possession by Mami Wata (these were young men who spent several days catatonic, after which the curse lifted.)  The topic arose when I asked about the danger she might pose to fisherman in the nearby river (thankfully there are few Mami Wata in the Ouaka River near Bambari!)  The