Bangladesh Day Zero

It’s been an emotional rollercoaster already and we haven’t even got there yet. 

I’m sitting on the plane reflecting on the days, weeks and months leading up to our deployment to Bangladesh today. 

I’ve been a member of the UKEMT since May. I’m proud and privileged to have been chosen to be part of this team of experienced clinicians, like minded people who want to use their skills and experience to provide help during humanitarian disasters. All the training in fields at Army camps and at various Fire Service locations has lead to this. 

I’ve been on call for most of the last six months, ready to go at 12 hours notice to wherever in the world we might be needed. When the call finally came last week, it felt like a luxury to have all this time to prepare.  Having Christmas at home with my family was a bonus. Being able to see and speak to special people before I went meant a lot. 

My time in Malawi gaining at least some understanding of healthcare in a low resource setting and seeing some of the things I saw for the first time there has formed the basis for my imaginings about what we will encounter in Bangladesh. That and the news footage and pictures I’ve seen. 

The team met yesterday morning for a final briefing and day of training. Imagine my joy when I arrived to find two of my Malawi buddies there too!  Quickly though, I find other familiar faces and some new ones, too. We chat, share experiences, thoughts and fears. We begin the process of becoming a team. In a few days we will be reliant on each other in critical moments, both in the clinical context and beyond. 

We reflect on the fact that very few UK medical professionals have seen diphtheria. We talk about how we will manage clinical decisions, about how valuable the experience of those already on the ground will be. There is not enough diphtheria antitoxin available at the moment. We know that some difficult decisions may need to be made. 

I know this will be like nothing I’ve ever done before. Am I ready? I hope so. 

Team Time after a tough week

It’s been a tough week and as we gather for Team Time I feel a sense of people not knowing where to begin. 

We’ve had hundreds of kids through the door, two cardiac arrests, many very sick children and the funeral of one of our long term patients. 

As I ask the team “what’s on your mind?” I can feel them processing the week in the silence that follows. In a break from the norm, I am the one to speak first. I tell them about the funeral and the great strength shown by the child’s family. I say that I am constantly awestruck and inspired by the ability of families to bear the things that life throws at them. I am moved that a child has the courage to say “I’ve had enough; I’m not going to fight any longer. Let me go” and that his parents can respect his wishes. 

And then others start opening up too. Sharing feelings and emotions. Reflecting on some of our other long term patients. Wondering what they would say if some of them who are non-verbal could speak. 

Some of what we share is hard to hear. The emotions are raw. This is so immediate. Thoughts being processed out loud, in the moment.  

Someone says how much they have valued teamwork this week and all of a sudden we are talking about positive things: how we have pulled together, that there’s a sense of solidarity, that being kind to each other is so important. Our fifteen minutes is nearly up and with hardly any facilitation at all the group have run through a world of emotions. 

This is one of the many things I love about this team: their ability to be honest. To share themselves with each other and with the families they care for. We go back to work with a little more understanding of our teammates and maybe a bit more strength to face whatever comes next. 

Goodbye Malawi

As I head home, I am spending time reflecting on my time in Malawi and some of the things I have learnt. 

This is one of the poorest countries in the world and this is evident in many ways, not least in terms of the healthcare system. The team in QECH, Blantyre are doing amazing work but there is a limit to what they can achieve within their minimal financial resources. 

Children born with cerebral palsy or other long term conditions have a profoundly different life than they would back in the UK.  There is no community nursing back up, no access to feeding support such as gastrostomies or even long term nasogastric tubes. If children are unable to take full feeds orally, they will not get enough.  One of the children I met on the malnutrition ward was a 9 year old with cerebral palsy. He weighed 10kg, the weight of a 1 year old at home. His wasting and stunted growth were upsetting to see. He was on the ward for one of his regular admissions for nasogastric feeding because he is unable to maintain adequate nutrition orally at home. His suck and swallow reflex is just not up to the job.  The child's mother was gently trying to coax him to take some feed off a spoon, in the hope that he would be able to go home soon. I could hear that he was having trouble swallowing it and was acutely aware that he was heading for another episode of pneumonia caused by aspirating food into his lungs. Nonetheless, his mother persevered gently, uncomplainingly, lovingly. What other choice does she have?