E-newsletter Issue 24 | Jun 2004
Letter home from Burundi
Kelly Dilworth is an anaesthetist from Gooseberry Hill in Western Australia currently on mission in Makamba, Burundi. This is Kelly's first mission with the medical aid organisation.
Salut! This is an update from Burundi just over halfway through my mission. Burundi is experiencing a period of uneasy calm at the moment. The main rebel group, the CNDD-FDD, is in the process of integrating into the government, the police force and the army. The other smaller rebel group, the FNL, has finally decided to make the first moves towards negotiations. This means that the nightly bombardments around the capital Bujumbura ceased about 3 weeks ago.
In Makamba (where my team is based), the hospital continues to be extremely busy. In addition, the numbers of patients are expected to rise once the Burundian refugees start returning from their camps in Tanzania. It is estimated that up to 250 000 people could return to this province, but it remains unclear as to exactly when and how this will happen.
The surgical team has been recently boosted by the arrival of an obstetrician - all the way from Germany! She has already transformed the delivery room and revolutionised the training for the local nurses, and is gamely starting to focus her attentions on the program against sexual violence. Her presence also means that the other (general) surgeon doesn't have to make all the (often-difficult) obstetrical decisions. He also gets more sleep at night since he isn't the one called in at 2 o'clock in the morning for the emergency caesarean section!
The main problem for me at the moment is the dwindling supply of narcotic analgesics. These are drugs like Morphine and Pethidine, which are essential to provide adequate pain relief during and after a major operation. These drugs are particularly crucial for the patient who cannot take oral medications immediately after surgery, for example a person who has had a bowel operation or is vomiting. It goes without saying that we, as the medical team, have an ethical and human responsibility to treat pain. Providing analgesia also hastens the patients' recovery and reduces the risk of post-operative complications like chest infections.
Our medical coordinator in Bujumbura has done a fantastic job of finding me a limited number of narcotic analgesics (which were already in the country) so that we can continue to do our work here in Makamba. I perform as many regional anaesthetic blocks as possible or use alternative techniques to conserve the drugs we have left. However patients with major trauma and other surgical emergencies continue to arrive, and I know the situation is going to deteriorate further.
But to illustrate that amazingly fantastic things can also happen in Burundi, two real-life stories about babies we've looked after recently to finish up.
The first involves a three-kilogram newborn that came into the hospital at 12 hours old with a bowel obstruction due to congenital absence of the normal connection between the large bowel and the skin. This condition, known as imperforate anus, means that there is no way that the baby can poo, and usually requires a colostomy. This baby was otherwise fine and didn't seem to have any other major congenital anomalies, so I put a tube into his stomach to decompress the bowel and started an IV infusion of dextrose/electrolytes. After discussion with the Medecins Sans Frontieres medical coordinator and surgeon in Bujumbura, the baby, mother and myself undertook the 4-hour journey by bumpy road to Bujumbura two days later. We did the operation that day, and the baby is now back home eight days later, with mum happily breast-feeding and changing the colostomy bags with aplomb.
The other baby is a tiny 1.1kg premature chap born at 30 weeks who arrived in the hospital with severe dehydration, hypothermia and failure to thrive at two weeks of age. His mother had just lost her husband to malaria, was herself malnourished and simply couldn't produce enough milk. We managed to find an incubator, which worked and slowly rewarmed him over the next six hours. He was hydrated through an IV drip over 48 hours and then we started feeding him a dilute formula milk through a naso-gastric tube. His mum picks up the feed from the Therapeutic Feeding Centre near the hospital 6 times a day. He still lives in the incubator but mum does all his care, feeds him using the tube and takes him out regularly for cuddles. At the last weigh-in, he was 1.3kg and we hope to get him on to a bottle soon - since he is now furiously sucking everything in sight!
OK guys, that's all for now,
Kelly.
4 March 2004