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FROM BURUNDI Kelly Dilworth is an anaesthetist from Perth. She is working in Makamba, the southernmost province of Burundi. This is her first mission with Médecins Sans Frontières. Salut! Hello to everyone in the office at Médecins Sans Frontières Australia and all the Aussie expats on the ground elsewhere in the world! This is an update from Burundi just over half-way 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 main problem for me at the moment is the dwindling supply of narcotic analgesics. These are drugs like Morphine and Pethadine 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. Many medications are difficult to obtain in Burundi for a number of reasons that ultimately deny the general public access to health care. At the end of 2003 we were informed that this particular group of drugs was interdicted – because quotas had been exceeded, meaning Médecins Sans Frontières (which normally supplies these drugs in the command along with all the other materials), cannot bring these medicines into the country at the moment. 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. Just 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.
After discussion with the Médecins Sans Frontières medical coordinator and surgeon in Bujumbura, the baby, mother and yours truly 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. No worries mate! 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 (kind of – the thermostat’s a bit dodgy I think…) 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 nasogastric tube. His mum picks up the feed from the Therapeutic Feeding Centre near the hospital 6 times a day – courtesy of Tear Fund, the aid organisation that runs the CNT. He still lives in the incubator but mum does all his cares, 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! These are some recent photos of him and his home for now. OK guys, that’s all for now, Kelly.
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