UNTIL NEXT TIME...

Until next time…

03 October 2013

I can’t believe it but it is already the end of my mission. I have been in Boguila for six months and I must leave now. My heart is broken and I would like to stay in order to do more. However, I miss my family, my boys and my husband.

The rhythm of the last few weeks has not diminished – we are always busy with our patients suffering from malaria and respiratory infections. The raining season coupled with the fact that the population lives in the bush has increased the illnesses and makes our work more difficult. The children are arriving sicker than ever, suffering from serious malaria complicated by anemia, convulsions or digestive problems. Add a respiratory infection that can turn into pneumonia at any moment and you have quite the cocktail…We have also seen meningitis cases where they arrived to late for us to be able to treat them effectively (two adults and one ten year-old). The malnutrition cases are multiplying. The Centrafrican population, already malnourished and in poor health, tries by all means to survive with what she has. Which is to say, with nothing.

My replacement has arrived last week and I have attempted, as well as I could, to give him a decent handover. It has not been easy as there are always some small things that get forgotten because they are done without really thinking and they often make all the difference for the team. I do believe though that all will go well – he has already taken the reins very well.

With two days left in Boguila, I had the absolute fortune to go on an Outreach mission with the team. Candice is now the new expat supervisor and the team is well trained. We went to two villages - Bowansen and Bodomo – in order to hold a vaccination clinic. All the moms were lined up and waited with their children – the latter had no clue as to what was coming! Freddy (secourist) and I brought a crying fest when we gave all the injections (often two simultaneously as we tried to minimize the pain). We saw around 130 patients in both villages in a time frame of two to three hours. Well done!

Sunday, it was the departing party. I organized a little get-together at ‘Chez Colette’ to thank all the members of my teams for their support and good work of the last six months.  Everyone is happy, we talk, we dance and we joke a lot. I received nice departing gifts – a dress from the hygienists, one from the nurses and supervisors and a shirt from the pharmacy team. I was lucky to work with these fine people that want the best for their population and our patients. Singuila Mingui!

Monday, 30 September, it’s my last flag meeting. I am quite emotional but I am able to read my last goodbye words in Sango: « A yéké na voundou na bé si mbi yéké zia Boguila. Mbi mou ala koué na bé ti mbi. Mbi kiri na ala singuila mingui té ti jo bi alla na maboko so alla mouna mbi na goé ti kousala ti mbi. » [It is with great sadness that I leave Boguila. I am bringing all of you in my heart. I thank you for your generosity and support during my mission.]

I would also like to thank my expat team members with whom I have work relentlessly. Their professionalism and devotion is unbelievable: Michelle, Hans, Roberta, Elisa, Candice, Jorike, Kami, Elise, Francesco, Wibke, Margerete, Claude. You have supported me, each in your own way, during the six months of my mission. Merci! Thank you! Grazie! Danka!

To all my African friends: my supervisors (Alexandre, Daniel, Elisée, Jean-Didier, Auguste, Raïssa, Rachel); all the IPD nurses (Jean-Claude, Rassoul, Justin 1 et 2, Bernard, Gilles, Gladice, Ghislain, Orphée); all the IPD secourists (Marcel, Paterne, Hugues, Jacques, Thibault, Blaise, Mathieu, Sévérin, Pierre, Jérémie, Bienvenu, Guy-Marcellin, Nathan, Martin) and all the hygienists (Bienvenu, Élie, Jeannette, Vladimir, Alain, Natalie, Rosalie, Pulchérie, André, Patrick, Patrice, Désiré, Faustin, Jérémie, Polycarpe, Zéphirin, Narcisse, Roland, Philomène); you have shown great courage and you are inspiring. Continue with the good work and aim for your dreams.

To my family: Paul, Gabriel and Nicolas, my parents Ben and Loulou, my brother Francois and my sister Marjorie and their partners, Cynthia and Yves, many thanks for your good words, emails, and Skype conversations. They meant a lot to me and they allowed me to go on, despite the hardships.

Finally, I would like to thank you, my readers. Thank you for your support during my MSF adventure. I don’t think it is finished. This organization inspires by its values and its integrity and I definitely want to renew the experience and work with it in the future.

I finish with the following words, given to at the beginning of my military career by a supervisor that is very close to my heart. These words have become a daily inspiration in my nursing work:

« People don’t care how much you know until they know how much you care. » - John C. Maxwell

Janique

BAPTISM BY FIRE

We often say that some of our qualities surface when we are facing great challenges. It happened to me…Let me explain.

When I returned from my trip in France, the nurse who held the position of Medical Team Leader (MTL) was leaving for her vacation. The MTL is my immediate supervisor in the field. At that time, I took on some of her responsibilities temporarily.  But, as Murphy’s Law would have it, an incident prevented her to return to the project and I am still wearing her hat on top of mine.

For the last five weeks, I have taken under my wing the TB/HIV (Tuberculosis and AIDS), maternity, laboratory, and pharmacy departments. I also had to facilitate transfers and discussions about our patients between our doctors and others from Bangui (the capital) and Paoua (MSF-France). In addition, we are getting ready to send our international medical order, which will have a great impact on our care delivery in the spring of 2014.  Finally, our new expat doctor has just arrived and I have to help her integrate into our team and the project and figure out what her duties are – quite the challenge since we have not had an expat physician with us since June!

I have to admit that all these accumulating challenges allowed me to shine somewhat. My qualities of leader and coordinator have been well demonstrated. I love to do this kind of thing and the more I have, the better I perform.

I think the trick, for me, is to just take one item at the time – there is only one of me to accomplish all these tasks and I can’t divide myself in two or four in order to do it all. I was clear with the new PC – I will give it 100% but it might not be as quick as she might wish. All she told me was: “Do what you have to, do it right and all will be good.”

So I used all my assets – my team! All the supervisors (IPD, Maternity, TB/HIV), the new doctor, the other supervisors from the pharmacy, hygienists and laboratory and we hit it head on. And we succeeded in all of the tasks.

We were able to provide good care to our patients and we tackled the small daily issues brilliantly. The war wounded arrived, were taken care of and left all in good health. The orders were done and sent each week and we did not run out of anything (nor did our patients!) The international order was completed with the help of the doctor (Thanks Elisa!), our fin/admin (Thank you Roberta!) and me. We were even the first of the country to submit our orders – both medical and logistics (Bravo Boguila!)

And just when I thought that I could breathe easier…Our MTL must now go to Bossangoa, town located about 100km from here, without coming to Boguila. Bossangoa has seen a number of armed confrontations in the last little while and they are without expat nurses, which is why we are lending them one of ours while they wait for the assigned one to arrive. Life must go on!

But wait! I am now asked to replace the x-ray technician who has just resigned and we do need our patients suffering from respiratory infections and the TB/HIV patients to have chest x-rays.

I am telling you: with MSF, you are never bored and you learn constantly! Bring it on! I am ready for anything!

Janique

NEUTRALITY. IMPARTIALITY. INDEPENDENCE.

The hostilities have started. 

We are at the ready in Boguila because another rebel group – we call them the ‘Groupe d’Auto-Défense’ (AD) – is attacking the Seleka from Boguila. We have already received gunshot wounded; some gravely injured, others, less so. 

It is interesting to see the reactions from the hospital staff – it is easy to say that MSF is neutral and independent but practically, when emotions ride high, it is another story altogether. Here is what happened…

This past Monday, we were planning to transfer one of our patients to the hospital of MSF-France in Paoua (approximately 60-70 km from Boguila). All was well and we were just about to depart when we got the news that there was an armed confrontation between the AD and the Seleka on the road to Paoua. Needless to say that our transfer was cancelled for security reasons and that we stayed put.

A few hours later, a truck from the Seleka arrived at the hospital and the soldiers brought us two injured, both with gunshot wounds – one in worst shape than the other. The team from IPD was ready: our ‘Salle de pansements’ had been filled at capacity with dressings and IVs and the personnel had seen worst. 

The first injured only had a few superficial wounds that just needed a good cleaning and disinfection as well as dressings and a good follow-up.

However, the second one sustained gunshot wounds to the abdomen, and on both the legs and arms.  He was losing a lot of blood and was showing signs of shock. We quickly started to intravenous lines and covered the wounds before bringing him to the operating theatre. The OR team ran to get dressed with the OR clothes and get the room ready. In the meantime, we had to control the flow of soldiers wanting news from their colleagues. They only speak Arabic so we asked one of our nurse supervisors to translate for us. He calmly explained to them that we are doing all we can and that they have to respect our instructions – one of the soldiers had made his way into the OR while we were preparing the injured for the surgery!!! In order to help with this problem, we stationed an expat nurse outside the door of the OR – they seem to be a bit more respectful of the rules if a ‘white’ person is there versus a coloured one. Thankfully, they quickly understand that not everybody can circulate in the hospital.

The surgery starts and we find out that the injured had gunshot wounds – pellets – in the abdomen, the right leg and the right arm. We succeeded in removing the superficial fragments from the leg and the arm. The others that are slightly deeper will have to migrate by themselves to be removed later. We now open the abdomen – what are we going to find? Usually, this type of injury can cause lots of damage as the abdomen protects many vital organs – liver, spleen, intestines, kidneys, etc. We could also find a hemorrhage or a septic infection if the bowel has been touched. We can’t believe it! No organs have been injured! The bullets only penetrated muscle deep. This man is so lucky! In the end, we still remove two or three 9mm bullets… 

We finish the surgery and bring the patient back to the Soins Intensifs/Urgence pavilion where he will stay for a few days.

It is only after the surgery that we find out our patient is in fact the commander of the Seleka group stationed in Boguila. There are already many visitors – militaries, family, etc. – and they all want any news about him. We have to be careful of who enters the hospital and who does not. What are we going to do if civilian wounded start arriving? How many wounded can we expect?

We discuss with the national staff (secourists and nurses): it is important to remain neutral and to watch what we are saying when we work at the hospital. They have to remember and respect the MSF principles. We are not only treating the injured here, we have their families in the hospital and they can hear everything that is said. Our staff responds to these reminders in an exemplary fashion…When new patients arrive, the civilians will be placed on the pediatric side so that they are at opposite sides with the military, thus minimizing any altercations between them. And everyone completely understands the consequences a bad comment in the presence of any of the groups would bring. They can all wear their MSF ID badge with pride.

In the following days, as expected, injured civilian patients, from the older man to the fifteen-year-old girl: all were working in their fields and they were the unfortunate recipients of the retaliation of the rebels on the civilians. These little people work in their fields in order to gather some money that will help them eat and a lot of them become the unknown victims of the rebellion and its repercussions.

When will the international community intervene in order to stop such violent events on the inhabitants of this country that only ask to survive: survive the war, the malaria, the hard life.

Janique

PATIENCE IS A VIRTUE

At the end of July, I went for a well deserved 14-day vacation.  I left Boguila, traveled by vehicle to Bangui and took a flight for Paris, France.  I met with my husband and we spent the next two weeks visiting Normandy. I was fortunate to discover my French ancestors, the Gagnons, who left their homes in the hopes of a better life to go to the Nouvelle-France in 1640, and my fellow Canadians, who left their country to liberate France from the horror of German occupation when they participated in the Allies D-Day on 6 June 1944. 

The Circle of Life. 

Long-awaited homecoming to my French roots.  Respectful thoughts for the Canadian sacrifice.

Two separate events linked together by one goal: the hope for a peaceful and happy future.

This hope for happiness also exists here, in Central African Republic. It has lived here for many decades. It is unable, however, to set its roots – the living conditions here will not allow it.  Many have tried to force contentment by imposing their ideas, their culture, their way of life.  Despite the benefits brought by modernity in their mother land, here, they do not have their place as they are not well understood.  I could compare this statement with an infant that does not know how to walk and to whom we suddenly enforce running.  He is not ready – physically and intellectually.  We could try again and again to teach this child to run but he must first learn to walk.  And this takes time, patience, determination.

Western countries, the modern world, went through this learning phase: they know how to walk and now they are uncovering how to run.  They learned to walk over many long years, even centuries.  They fell many times, getting up and learning from each of their falls.  Then they realized that they would go faster and be more efficient if they ran.  At the same time, they want to teach the rest of the world how great it is to walk.  But in certain places, they are still crawling.  They need time to learn at their own rhythm and we need to respect their learning path.

I realized in Boguila that even if we come with great purpose, the African world needs time.  Time to learn, time to assimilate, time to integrate.  It has to grasp and digest in order to understand what we are trying to explain.  As long as this does not take place, our efforts will be unsuccessful.  In fact, they will not be well perceived and will cause conflict amongst the less educated populations.

I can arrive in Boguila, filled with dreams of changing their world and intent on teaching all I know to the nurses and secourists so that we improve a non-existent health system but if these notions are not understood by the population living in the bush, my efforts will be useless.  .  I understood that I have to take baby steps.  A specific concept, which might appear insignificant to us but means a huge change for the people of Boguila, will go much further if it is accepted and integrated slowly than if brought upon abruptly.  I am starting to appreciate that here, patience is important. And even more significant is respect. 

MSF Holland took over the Boguila project over seven years ago.  The people of Boguila have made giant leaps, thanks to the various teams that came here.  But now, the population requires more than a group of expatriates to help them.  If we want the changes that we brought to take hold and become the standard, the country needs to take charge.  The international community must become involved and show some patience.  We went from being barbarians to becoming civilized over a period of a thousand years.  How can we ask the same growth from the African people in less than fifty years?  « Rome was not built in one day… »

Don’t you think that we should give them some time to find themselves instead of insisting on a instant assimilation of our views and ideas?

Janique

REFLECTIONS

Rango lives here!

Regular visitors at the office

I have now shared the life of the Boguila community for a little over three months. It is time to reflect on the many events I have witnessed and that are making this experience an unforgettable one. Some are good, some not so good but all have shaped and coloured my stay here. Here is a short list of the most significant:

Child returning home

Sisters in nearby village

• The smile of an amused child watching two foreigners play badminton on a Sunday morning.
• The desperate cry of a mourning father after the death of his beloved daughter.
• The stunned look of a mother that has lost another child to malnutrition.
• The question “Where are you right now?” asked by my parents, my brother and my sister when I call them on the phone.
• The screams of running children waving and greeting us when we ride past their village.
• The laugh of the Water Mamas walking by with the jugs of clean water balanced on their heads.
• The hopeful gaze of a mother running with her child in her arms after our MSF vehicle.
• The surprised gasp I made upon learning that one of my staff named his daughter after me.
• The laughter of a group of strangers watching “Zoolander” on a Saturday night.
• The grunt of an exasperated nurse at the lack of resources.
• The weight of a dead child in my arms after an unsuccessful resuscitation.
• The tears rolling on my cheeks after losing yet another sick child.
• The happy faces of my kids when talking to me via Skype.
• The interested looks of the secourists and nurses during one of my training sessions.
• The never-ending discussions to obtain a compromise during a supervisors’ meeting.
• The frantic yet controlled actions made to save the life of one more child.
• The defying look of a rebel commander when asked for a third time to remove his weapon before entering the hospital.
• The covered head of a man shot behind his ear while running away from the rebels. The smell of this open gash.
• The coherence of the words pronounced by this same man after his critical surgery.
• The piercing cries of a child burned to the third degree on 70% of her body by a pot of boiling water resting on the fire at home.
• The disheartening sobs of the mother of this child after her untimely death.
• The shocked state of an operating team that unsuccessfully tried to save a pregnant woman and her unborn twins after realizing she was going into anaphylactic shock from the anesthetic given for her caesarean.
• The grateful look of a secourist in a health post at the news we are bringing him some vaccines and medical supplies.
• The sad look of a departing expat friend.
• The question “Who is this?” asked by my husband the first time I phoned via Skype on his cellular.
• The apologies of a supply worker about the fact that the items requested have not come yet from a delayed international order and therefore, we have to make do without them until they arrive.
• The broken heart of a Canadian nurse at the realization that the world seems to forget this part of the world and that she cannot do more than what she is doing now.



Peulh girl watching



Praying Mantis




• The hopeful heart of a Canadian nurse at the realization that the world may start to remember this part of the world because of her message and that, in the end, she is doing more by being here.

Thank you for your continued support. Please give to MSF. Every contribution, as small as it may seem will bring hope to this population.

Janique