Sylvia's Journal

Never in my 30 plus year career in international health have I seen such a direct effect of what we do on the saving of lives, especially the lives of babies and small children. It is actually the mission of MSH to do so but so far in my career the contributions are indirect and difficult to measure.

It is not because of clinical skills applied directly to individuals (that too of course) but because of a triage system that we have been helping to set up – a triage system that moves seriously ill kids to the front of the line, straight to the resuscitation room – a system for managing the material supplies and human skills that combine into timely and appropriate care of very sick children.

With the help of a many experts in emergency pediatric care, some of them colleagues from Malawi, WHO treatment guidelines, with pharmaceuticals, supplies and equipment provided through our project by the people of the United States, the emergency triage, assessment and treatment is operating reasonably well. Every week we have a meeting with the hospital director, the chiefs of the outpatient department, the emergency ward, the hospital pharmacy, the chief anesthesiologist plus the chief of the department in the ministry responsible for child health.

I try to attend these meetings as often as I can because, unlike many other meetings that depress me, these lift my spirits. The meeting always starts with stories about the children that didn’t die because they received prompt attention in a manner they would not have even a month ago.

We had arrived a little early and got to witness the triage in action. During a brief lull in his work the nurse, a new nurse, excitedly told us about how his triage work saved lives. There were more stories like that, all told in Dari so I only got the rough idea.

In all cases the essence was that at the end of the day the hospital did not have to send some parents home in great grief. Of course children still die and we are awaiting with great impatience the first chart that shows whether there was actually a dip in the 24-hour mortality statistics. I expect and hope for a dip, however small, as the dipping will probably be self-reinforcing

In the dark forest of ‘hard and difficult and messy’ it’s nice to have a few points of light.