Laso tongana nyen? Mbi hinga ape. (How was today? I'm not sure.)

     On the way to work we turn left onto the main road and straight into a huge parade, marching into and around us.  An enthusiastic throng in support of an upcoming referendum.  Our driver pulls over to one side of the road.

       One of the policemen escorting the paraders (you know them from their blue camouflage fatigues labelled "Police" and automatic weapons) approaches the driver's window angrily telling our driver that he is manifesting disorder.  The front seat passenger, a scrub nurse expat, starts explaining to the Central African driver how important it is to be deferential to an armed, angry law enforcement official, as if our driver reached adulthood in this country, alive yet somehow unaware of the danger such an encounter can pose.  Thanks, dude!  The moment, and the parade, pass quickly, and we continue on to the hospital.  I'm still not totally clear on when, or what, the referendum is to be.  There are several marchers carrying what look like clubs in the photo, slung over their shoulders.  These are hollowed tree roots which moments before were playing a lovely trumpet fanfare.

     Surgeon calls me to the OR for a stat cesarian section, 28 week gestation mom hemorrhaging.  I have not been in our OR before so I ask where to get scrubs and am directed to a room where I meet the scrub nurse (same one from the ride to work) who in frustrated style tells me how I'm doing everything wrong and to go there, not here; do this, not that.  Are scrub nurses born this way, or made so?  This unhelpful commentary continues as I rush to setup in the OR with delivery impending - where are the towels?  Where is the heat lamp?  Baby emerges looking not terrible and first 30 seconds of resuscitation go pretty well - until scrub nurse tells me again how wrong this is.  I didn't realize, there is actually a resuscitation room off to the side where we are supposed to go.  Sorry!  We scoot.  The nurses are pretty good and baby makes a solid APGAR 8 at 5 minutes.  Vitamin K given, OK let's take the baby to the NICU!  What? ask the nurses; we always take the baby back to the maternity ward first.  Why, ask I, mindful of that unit's reputation of letting the babies chill before bringing them to the NICU (figuratively, and sadly literally).  To their great credit, the nurses look at each other and say, why do we do that?  How about we let him just take the kid to the NICU?  They agree, and after greeting mom, we go.

     Later that day, I am called from the malnutrition ward to the PICU.  A well nourished 8 year old girl was transferred there in the early morning with 3 days of vomiting and severe abdominal pain.  When I saw her earlier, she looked terrible.  Abdomen very tender.  I broadened her antibiotic coverage, gave her a bolus and signed her up for an x-ray to seek a perforation.  X-ray was negative except for pneumonia, which can cause severe abdominal pain, but the whole picture is wrong.  Kids this age, in this shape, do not end up in the hospital, let alone the ICU.  Of course, she has malaria which everyone does this time of year, but something is very off.  When I reach the bedside, mother and grandmother are praying over her body and yelling at her to wake up and speak.  She is dead.  The nurse tells me that the girl suddenly became very agitated, passed a large black stool, and died.  We are all shocked.  I must return to the remaining 10 kids not yet seen in the malnutrition ward, evenly divided between marasmic living skeletons and kwashiorkor balloon babies with their skin coming off in sheets.  I cannot delay because we have to get all the med requests for today and tomorrow into the pharmacy before they close for the weekend, in 20 minutes.

     On my way home I swing by the NICU.  This morning's baby is cute, and pink.  I go to maternity ward to thank the nurses from the resuscitation.  They already visited the baby and know how well he's doing.  They then tell me my NICU colleague refused a transfer earlier.  I don't understand, until I see the kid.  650 grams.  We don't take those - survival to discharge is zero at that birthweight.  I explain to the nurses, and back home discuss with our "Mental Health Service" psychiatrist a plan to visit mom to explain why her child will remain with her, and the prognosis.  

     And the rug advances!  I do not receive compensation from the Mocaf company for the product placement.