Kala azar in pregnancy is something I have learned to fear as it always seems to be more complicated. One patient I shall not forget is a woman of my age, six and a half months’ pregnant and severely ill with an overwhelming infection in addition to resistant kala azar and malaria infection. After some days on the ward she went into labour, delivering a very premature baby who at home would have warranted neonatal intensive care for its age alone. Miraculously, after she returned from the obstetrics hospital, she walked out of our treatment centre with a healthy little bub. The treatment centre offers the basics, but often that is all that is needed.
I never really had a chance to establish a daily routine, but I think that may not be so uncommon working with Médecins Sans Frontières. At the start of my field placement, I was learning anything I could about kala azar from the staff who have been working with the disease for some time. Generally we would do a ward round of the hospital patients (with my fairly dismal attempt at Arabic) then review and admit patients as needed. Only a few weeks into my placement, we saw our first measles case in a kala azar patient and I guess we knew from that point that things were going to get a little crazy. Before we knew it, Médecins Sans Frontières was taking the lead in managing a measles epidemic.
A Médecins Sans Frontières tent extended the existing isolation ward at the back if our hospital and by the end of the epidemic we had treated over 600 active measles cases. We would often get waved down by people in the villages when passing through, to the point that we carried medicines for measles in the car so we could treat the cases we saw. It is a common misconception even at home that measles is a benign childhood disease, but children can go blind, have permanent brain damage or die from the complications of measles. The only treatment is supportive, to try and prevent complications. The mainstay of a measles response is to vaccinate kids at risk. After much negotiation we embarked on a vaccination campaign across the entire locality, vaccinating over 44,000 children over eight days. Helping manage the epidemic was an utterly exhausting but extremely rewarding experience that I am still not quite sure how I fell into. It was my first taste of emergency responses and I admit I can see why people are drawn to them.
Life in the field is a world away from Australia but it quickly becomes the norm as it is the reality everyone around you is living too. My little hut with a grass roof becomes home. We shake out our beds looking for scorpions each night without thinking. We know that to send an email might take half an hour to get the network working. We occasionally make excuses to visit the pharmacy (which has the only air conditioner in town) when the mercury hits 50. We wear gumboots when it starts raining as even our hiking boots don’t stand a chance against the mud. Completely different from home, but that’s what I love about it.
Kala-azar remains a neglected disease, but awareness is increasing and more funding and research will hopefully improve the treatments available and lessen the impact of the disease in the future. Although as international staff, our time here will come to an end, the national staff continue and the project is ongoing, one day to be transferred back to the Ministry of Health. When leaving the field, I feel I gained more than I was able to give back, but for next time with these experiences, maybe the tables will be turned.
