Greetings from Bambari

 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, souve...

  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 commemorat...

  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 Hospit...

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...

     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...

      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...

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 b...