The more things change

All views represented here are mine alone and do not represent Médecins Sans Frontières.

Democratic Republic of Congo

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"AFYA!"                     "KWA WOTE!"

"AFYA!"                     "KWA WOTE!"

I wanted to write about life this week. So I'll start with my favorite thing about health in Congo. Every health-related meeting I've been to, every support group, every time someone speaks they start and end with "AFYA!" (health) to which the group responds "KWA WOTE!" (for everyone). There's an incredible energy within it. It makes it easy to feel like an insider. And it adds to my very rudimentary Kiswahili (without it...there is no speaking with patients. Not much beyond "Bonjour." At all). This includes the group of PVV (Personnes Vivant avec le VIH, or People Living with AIDS) who actually search for patients who are "lost-to-follow-up" (have missed appointments for over two months). For patients who are newly diagnosed, they accompany them home. So many meanings in that word. We've been discussing plans for World AIDS Day (December 1st), and they're creating plays, songs, there will be dancing...apparently, "karaoke" just means a band with instruments. I have to admit I was very disappointed by the (to my ears) misnomer. (There's at least one Congolese song I could do, at this point...the lyrics are mainly "Sawa Sawa," which means "okay, okay").

There's life, here.

I don't need to mention the 3-month-old who died during my consultation (in obvious respiratory distress, complications from likely AIDS). Or how pediatric AIDS was the first thing I learned to diagnose in 2005, eight years before I was officially a doctor.

It's been awhile.

Transmission of HIV from mother to baby, throughout pregnancy, during labor and birth, and while breastfeeding (or, more usually, not) is something we've learned to and can prevent. Usually. When conditions allow. One part is that here, not only is formula expensive, not only is it stigmatizing because then people assume you have HIV, but access to clean water is so uncertain that it's actually much safer to take the risk of transmission than to take the risk of giving a baby formula mixed with water. Official WHO (World Health Organization) recommendations. This, too, is something I learned in 2005. And it hasn't changed.

I'm not writing about that, not right now. Because the patients before and after the baby were well. Complaints I could easily have heard in the Bronx, or anywhere. "I had stomach pains after eating manioc leaves, and a lot of itching." "When did that happen?" "A week ago." "And how is it now?" "Gone." Another patient got hydrocortisone (or, I wrote for it, and she would have gotten it if it were in stock) for eczema. At the most remote health center we're currently working in, I saw the most stable patients I've seen in two weeks.

There was no time to mourn the infant. I wanted a minute, or five, or fifty. But my colleague brought the next patient in immediately, handing me the chart. And so it goes. Before she died, we were planning to evacuate her with us to the hospital...no way to really treat respiratory distress en brousse. There would be oxygen and more antibiotics at the hospital, at least. I might have actually been holding her head (three months old, couldn't hold her head up, weighed less than 8 pounds) while she died, helping her mother dress her after undressing for the scale. My part doesn't matter.

I know what active dying looks like. Somehow, this week, I have chosen to forego that hard-earned knowledge and recognition. Hoping I could help, well, anyone. In two weeks at post, four of my patients have died (at least. Two others, I suspect might have/ could soon, but they left the hospital AMA, "Against Medical Advice."). In my first year of residency, the first part of it, the actively dying were the patients I checked on most anxiously. But I did the same for the passively dying ones, until I could tell the difference. And there are always surprises.

Passive dying. Passive labor. Active dying. Active labor. You leave this world in the order you came into it.

This week, I'll still try to end with life. I'm leaving this post tomorrow for my second (...I'll be back in two weeks). My colleagues here -- and by that, I mostly mean my national staff colleagues, or >90% of MSF -- are incredible. They are who I spend my days with; occasionally, with one other ex-pat when we go into the field, but she and I have different jobs. They are who make MSF run. They are here, have been here, some for the entire life of the project (this one in particular is 6 years old). One of my closest colleagues has been working with MSF since 2002, ie for most of his career. Ex-pats come and go, hopefully contribute something(s), add to the direction of the project, capacity-building, physically and personally helping with interventions, seeing patients, etc. But in DRC -- (and I assume it's the same in other MSF countries, but thus far, I only know this one), the real face, workforce, and energy of MSF is Congolese. I'm here to work. But I will learn, I will actually gain, far, far more than I can ever do. And that, too, is something I've known since 2005 and my first weeks in Cameroon.