On first glance the MSF hospital doesn't look like much - a dozen or so decidedly mismatched ramshackle built dome tents and two buildings with tin roofs linked together by interconnecting dirt and concrete walk ways. But inside you'll find everything you could need in this setting including inpatient and outpatient therapeutic feeding centres for malnourished kiddies, a two-bedded emergency room, an adult medical and surgical ward, an operating theatre (emergency surgery only), a maternity ward and delivery room. The lab can do parasitology and blood crossmatching and there is one building (blessedly cool on the inside) where all the medications and vaccines are carefully stored under controlled conditions.

You won't find an X-ray or a CT scanner, there's no life support machines, cardiac monitoring or dialysis, nowhere to grow blood cultures or fill oxygen tanks, but what MSF may seem to lack in fancy first world equipment they more than make up for with a wealth of experience in working in resource-poor settings. The bible for all medics out here is the MSF Clinical Guidelines book, which takes you through a basic, but thorough clinical assessment, diagnosis and prescribing for all common conditions - common conditions for here that is. Given that that the average life expectancy is below 50 I don't expect I'll see a single case of heart disease, emphysema or diabetes while I'm here.

There is also a six bed Intensive Care Unit - although again, I imagine no one from my hospital at home would probably recognize it as such! It's covered by one health worker usually although, during my first buddied on-call night, an extra one was called in. Upon the first day of my arrival on site i remember a post-op septic man, two very very sick babies on oxygen, and a five-year-old girl seizing and comatose probably as a result of meningitis.

In retrospect, one of the most dominant emotions during that whole experience was not what I expected. Fear? Yes. Concern? Check. Sympathy? Tick... But revulsion?

The five- year old girl seizing took over 24 hours and three more trips to the ICU during the course of the next day to sift through that one. The revulsion is at the full frontal experience at the barefaced wrongness that is a system, a country, a world, where a child could be this sick and not have more done for it. In any western country that child would have been sedated, ventilated, monitored, have a central line, a feeding tube, a catheter, a BIS neuro monitor taped to the tiny forehead to catch low grade seizure activity...

But here, the only way for us to gauge seizure activity is to test the arms for rigidity, or lift the eyelid and look for the faint flickering movement that betrays an electrical storm going on inside the brain. I watched and learnt to stay calm, use the protocol in the book, base your fluid boluses and IV diazepam on their vital signs, monitor regularly. Too much diazepam and you depress the effort of breathing, making it shallow and ineffective. Too much and the seizure continues unchecked...

Somehow they all made it through the night. And so did I. Albeit tense, tired and slightly tearful. 

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