And my very first thought: "What did I just get myself into?" I left a safe, comfortable, well paid position at a hospital in the states to work longer field assignments for Doctors without borders. And here i am, MSF 6months!!
Upon arrival to Yangon, I was introduced to the team, the hospital and my new home for the next months of my life. We have showers (cold only) and sinks with running water, so I was happy to see that! All the facilities are in an outhouse. I’m getting used to the bugs. Really big ones fill the sink every am. I turn the water on and run while they scramble to get out. The toilets are my least favorite, basically a concrete port-a-potty, no running water.
There is a small kitchen and people make our food everyday. Very simple meals. Lots of potatoes, rice, beef, and a variety of veggies: eggplant, tomato, ocra, cucumber, spinach. We also have some canned veggies and canned fruit. The main fresh fruits are banana and occasional watermelon due to cost.
The hospital has been the hard part for me. We have very few non-clinical diagnostic capabilities. We can do some basic blood work; hemoglobin and a white blood count (infection marker). We have urine dipsticks. On CSF fluid from a lumbar puncture, we can get a gram stain (looks for bacteria), protein and white blood count. We have a rapid malaria test and we can do a blood smear for malaria. We can check glucose levels. It's rumored we can do liver function tests, but we have not been able to since I have been here. We can get ova and parasite tests on stool.
We have limited drugs, but they cover most needs, just no MRSA coverage (resistant staph coverage).
No jaundice treatment for neonates. No surgical treatment other than an Obstetrician for the pregnant women and we can do some small procedures (mostly drain abscesses and dressing changes for wounds and burns). A few surgical cases we can transfer to another region for surgery. There is very little blood for transfusions (families are responsible for donating for their children). We are working on a blood drive to try and increase blood supply for malaria season. We can get basic x-rays, but we are responsible for interpreting our own films.
Most of the time we rely on clinical judgment and treat the best we can, our testing abilities and treatment supplies cover our most common pathology seen which includes tetanus, malaria, neonatal sepsis, asthma and respiratory infections, malnutrition, diarrhea and dehydration.
For me, the most difficult cases are the children who come in so sick with an unknown diagnosis and the ones not responding to treatment. We try everything we have, but it still feels limited and there are so few diagnostic tests.
Also there are days the system is so overwhelmed that its difficult to treat every child with the attention they need.
The medical staff that is local has very little training as they come from a region that has experienced decades of conflict. Very few people have had a chance to go to school and get a proper education. They follow MSF protocols well and a major part of my role with MSF is to teach them medicine as they are very eager to learn.
It has also been really hard on me when a child suffers and I know there is nothing I can do (bone infections, cardiac babies, stomach or intestinal bleeds). My goal is to make them as comfortable as possible.
The days are up and down, I read a lot to try and expand my differential, as tropical medicine is not something I have a lot of experience with. I am very lucky and grateful to have such a strong group with me!
Not to mention so much emotional support and encouragement from a some very key people in my life that I love, surely miss and am beyond grateful for.