Asara ye ape (It doesn't matter - Sango). Miwali jam (I have awakened in peace - Fulani)

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 problems from another angle.  So far, near total fail.  And, this is not a Central African Republic-induced problem.  As the pediatrician at the other in-country hospital run by this NGO said the week he quit, "they seem just to want to cover up and avoid problems."  Well, he said it, not me.  Also, it's much more than just that.  Asara ye ape.  Miwali jam.

     I may have encountered some delayed malaria parasite clearance with standard therapy which would be a big deal if true.  I felt obliged to report it up the chain;  much drama ensues, no one told me to actually stop trying to document these cases but, if I could read the minds of some . . .

     On my second day in country, during a briefing with a high (not highest) placed administrator in Bangui, she told me, "we didn't take good advantage of [my predecessor]".  I suggested some steps we could take to do better this time.  Answer was, "great!  let's start tomorrow!" which did not happen.  Four months later, i.e. today, I get the answer, "no."  See, they don't want to "distract" from the mission.  I believe I understand and cannot change the actual drivers of the "no."  But, at least now I know.  Asara ye ape.  Miwali jam.

     On the plus side, my nurses just about never yell at the parents any more!  Sometimes, they even tell nurses from other units to speak more gently!  Also, Fulani (aka FulBe, Peul, Mbororo, Fulfulde, Pulaar) is very fun and now that CPC is once again burning and killing in the countryside (welcome to dry season) we will likely have more dispossessed, internally displaced and therefore malnourished/tuberculous/typhoid etc showing up in town.  The flavor of Fulani from Northern Cameroon to here is called Adamawa on the internet, but here they call it Mbororo which means "nomad"  cause these folks do not like to stay in towns.  My vocabulary is terrible but I have the greetings down, starting to understand the grammar which is not all that hard (ok, harder than Sango, but still not bad) and the coolest thing is that it has three sounds I have never heard elsewhere, implosive b and implosive d which I can produce, and implosive y which I cannot (yet!).  Wikipedia gives an example of an implosive by English speakers,  "imitate the "glug-glug" sound of liquid being poured from a bottle" which is either an implosive K or implosive G, depending on the person making that sound.  There is no implosive G nor K in Fulani, but still the implosive d is my favorite.

     I had a case of anaphylaxis, likely due to yellow fever vaccination.  There is a World Health Organization mass vaccination campaign in progress and teams are going everywhere to vaccinate kids - my patient inadvertently got jabbed twice, once in the neighborhood and once at school.  Did quite well with usual treatment, and apparently WHO is recording as an adverse event - good for them!  Unfortunately they came to the ICU and jabbed two severely ill HIV kids which is a no-no for a live attenuated virus.  I asked my boss for the WHO contact in town and will ask him to count those cases, too.