Getting into the swing

February 17, 2015 – Haven’t written much in the past couple of days – now that I’m treating patients, there is a certain sameness to the rhythm that isn’t “anecdotal” enough to inspire the impulse to write. Things are going well. Or, rather, within the limits of a constantly changing staff, working in an underequipped facility, in an extremely poor country, against a deadly disease – things are going well! I remain dispirited at the fact that we aren’t succeeding in curing that large a percentage of patients. That, as I talked about in a previous post, the main benefit we are providing is isolation of cases; actually helping, in an assured, dependable way, those “cases” (i.e., people) remains a harder task. As you probably know, all (er – I’m pretty sure it is all) of the western folks who have contracted Ebola and been flown back to the US, Switzerland, etc., for care have survived. This is not a very large sample – maybe it would regress toward the mean if more people had been infected – but it certainly suggests something that I think “doctorly instinct” makes us all feel, as well – that with top-of-the-line care, the disease is very, very survivable. That we know this, but still are seeing upwards of 50% of patients dying, because, in the end, we can’t deliver/aren’t delivering top-of-the-line care (and distinguishing between those two is key), is frustrating. Upsetting.

However, I MAY have some happier news in the next couple of days. Don’t want to talk about it yet, just in case. But stay tuned.

I’ve been working evenings and nights. Different rhythm, because instead of having 5 or 6 people to look after, you have the whole unit – 15, 20, 25 people. It’s definitely more “make a plan – go in and execute – get out” than it is “holistic” care. But, in fact, I suppose it’s never that here – frequently being unable to understand even one single word between you and the patient (and sometimes close to that between you and the translator!) makes that a difficult goal to achieve. Evenings and nights, we focus on who most needs fluids, along with what medications remain to be given for the day. If we’re working well, as soon as we enter the unit, we go hang fluids on those who most need them (so there will be a maximum amount of time for them to “run,” equaling a maximum volume delivered), then start administering necessary medications, and only at that point do we turn to cleaning up a patient lying in his diarrhea, or finding something to eat for someone who (happily!) has developed an appetite, or finding a covering for someone who is chilly. In fact, we almost always get to those things, too, I’m happy to say. But sometimes you leave things till morning.

I went for a bike ride during the day yesterday. Stayed on the road. Hot, humid air; baking, unruly green land; iron-red soil. It sort of reminds me of the North Carolina of my youth, if it had been left in a "natural" state, rather than fenced and cultivated. Although dustier – dust everywhere. And, of course, little children calling after us at every turn. I think they were usually just saying “white person!” (“apato!”, if I have that right), but it was a very cheery sight/sound. I wonder if, in the Depression, when the land in North Carolina probably WAS a good deal less fenced and cultivated, a fair number of residents there lived at a comparable level of poverty? Probably so – although, even then, the richness of the country as a whole, the availability of educational resources, the relative nearness of cosmopolitan cities, may have modulated it somehow. But it’s true, the Dorothea-Lange-like pictures one sees – large families in one-room shacks – it does seem similar to the rudimentary dwellings and many children you see along the roads, here. Someone was talking last night about the illusion that “we” are different than “them,” whoever them might be. It is very easy to fall into that, here – to think this level of material poverty is somehow inconceivable, as though it pertains to people from another planet. I like it when I see the connections, hard as it is for me to do.