Something "More Personal"

The people at El Periodico asked me for something "more personal" for the kala-azar blog. I am not sure what they want, but this is what I sent them:

In this entry, I describe a typical day as a field doctor in India. I hope this helps convey what it is like to work as a doctor in with MSF in Bihar.

7:00 am- I wake up to the noise of my ceiling fan. The fan functions more as a noise-making machine than a cooling device. It also turns the room into a dust storm. The mosquito net over my bed started out white, but now it is a dark shade of grey. I take a cold shower. As soon as I dress, I start to sweat.

7:30 am- While I am eating breakfast, Sara--the field nurse-- comes into the room. She is doubled over in pain. She says that she started getting diarrhea and abdominal pain at 11pm last night. She looks terrible. I am responsible for the medical care of all expat field staff. I advise her to drink a lot of water mixed with oral rehydration solution and to hold off on taking any antibiotics. She tells me that she has already started herself on antibiotics. I advise her to rest all day in bed. She tells me that the medical order is due in the capital today, and that plans to work on it whether she is sick or not.

8:00 am—I walk down four flights of stairs and arrive at our office, which is located on the ground floor of our apartment building. I rejoice that the internet connection is working again. I check my personal email account. There are six SPAM messages, two or three work-related messages, and no personal messages from friends or family. I feel depressed.

8:15 am- I have almost two hours to work on administrative issues before I need to leave for the hospital. I review the medical coordinator’s report on his recent visit to the field. I write a memo to the project epidemiologist and medical coordinator about reorganizing our follow-up visit system. I make a list of essential medical books for our project library. I work on the national doctors’ rotation schedule for Sept-Dec 2009.

10:15- I arrive in the hospital for ward rounds. We round as a team of 4 nurses, 3 doctors, and a ward attendant today. The ward is almost full; there are about 40 patients inside, and ten patients on cots in the hallway. I feel bad for the patients outside; it is 40 degrees C and they are covered in flies. There are many complicated cases. Some patients may have typhoid that we have misdiagnosed as kala-azar. We suspect many patients are coinfected with tuberculosis. There are a couple patients who I think have neither kala-azar, enteric fever, HIV, or tuberculosis, but they are spiking fevers and look sick.


3:00pm- National staff nurses, doctors, health educators, and logisticians gather in the office for a brainstorming meeting on how we can improve our activities in the rural facilities. There is active participation in the conversation. Several good ideas are discussed, clarifying our priorities for the next 18 months of the project. Marlies—the project field coordinator—and I agree that the meeting has been productive.

6:30 pm—My commute from office to home takes less than a minute. I want to exercise, but it is impossible to do anything outside. Rafa and Marlies are doing yoga in the room where I often jump rope in the evening.

7:30 pm—I am having trouble getting work-related thoughts out of my head. I feel trapped inside the house. We are not allowed to walk outside the house alone in the evening or drive the car. When yogis are finished, Marlies and I convince Rafa to turn on the generator for three hours so we can watch a DVD.

10:30pm-- By the end of the movie I feel more relaxed. It has cooled down enough to make sleep a possibility.