Greetings from Bambari

      A culturally eloquent version of  Hear no Evil, See no Evil, the modification of which captures the principal of hierarchical deference found in CAR, and in my NGO.  On the wall in the CAG office (they provide HIV and TB meds for both inpatient and outpatients, they are super amazing folks) is a painting, a gift from a grateful client.  It reads, "The 4 secrets of happiness"  "Hear nothing" "See nothing" "Say nothing" and the added 4th, "which authority should you recognize."  While profoundly Central African, this attitude is not endemic to my NGO globally, perhaps only in this country, says the visiting expert consultant.  My boss, who has worked for this NGO across the globe, says no it's like this everywhere.      I walk into the surprisingly underfilled PICU this morning.  A child is in cardiorespiratory arrest.  He is not cold yet.  I know nothing about him.  Ambu bag is broken.  There is no accessible replacement.  Gluc

Sorry to all for the long gap in posts!  I am now on a brief, asymptomatic COVID + isolation so stuck in my room and internet is cooperating.  Some odds and ends:      Just had a 5 month old reasonably well-nourished kid sign out against medical advice, which I can't fault because in 5 days of escalating care I got nowhere with her pneumonia, and her persistent severe respiratory distress.  I asked parents why now and they explained the diagnosis of "Fish Disease" which entails respiratory distress including skin retractions between the ribs, much like the gasping and gill slits of a landed fish.  The treatment, which was successful in the child's older sibling in the past, entails tying pieces of fish around child's neck and chest.  I offered to add the fish treatment to existing hospital-based care but parents declined.      The rag-rug is progressing.  I will probably call it quits in December and give it away.  It is becoming quite heavy and will be very hard