“The work is exhausting, but rewarding”
N’Djamena: A day in the life of a pediatric doctor devoted to malnutrition
Despite a recent scaling up of activities to respond to the nutritional crisis in Chad’s capital, N’Djamena, health facilities continue to receive an alarmingly high number of children suffering from severe acute malnutrition.
Doctor Ousmane Abdoulaye, an attending physician with ALIMA/Alerte Santé within the Chad-China Friendship Hospital’s Inpatient Therapeutic Feeding Center, describes what it is like to work each day, caring for children during a peak of malnutrition cases.
"During this peak period of malnutrition, which coincides with rainy season, it is very busy in the ward. Each day, I wake up at 5:30 in the morning.
I am usually very tired from the day before, but force myself out of bed. If I have time, I try to grab a quick breakfast before leaving the house. But usually I set out hungry to make it to the hospital before 7am for the daily handover meeting. For one hour, with the night shift doctors, we talk about all the current patient cases and flag any potential medical issues.
Often during this peak period, the meetings sometimes go beyond 8am, because there are so many patients and so much to discuss. After the meeting, I join the other doctors on duty to start our rounds. We check in on each patient, examining them, providing care and updating their medical charts.
Today, when you walk into the ward, you see many, many children. We are currently receiving about 30 new patients every day. As you complete your rounds, you must walk not only between beds, but also around mats, where some of the children and their parents have found themselves sleeping by default, due to a lack of bed space. We normally see a spike in cases around this time of year, but this year, it started early, as early as the month of March.
When a child arrives at the hospital, we immediately screen them for malnutrition using the MUAC (Mid-Upper Arm Circumference) bracelet. If the MUAC shows yellow or red, it means the child is malnourished. We explain what this means to the parents, and the child is registered and weighed. Then a nurse will do a consultation to see if the child is suffering from any other illnesses, like malaria or a respiratory infection. Based on this, we decide if the child will require inpatient or outpatient treatment.
Personally, I begin my rounds in the intensive care unit, where a number of children are currently on makeshift tables, due to a lack of beds. Some children are in need of resuscitation, which I perform with the help of a nurse. Those patients who have already been stabilized require a minimum of 2-3 follow-up consultations throughout the day. I work this way, caring for the children and reassuring their mothers, until the afternoon. If I have time, mid-morning, I have a quick cup of coffee to keep my energy going. Later in the day, we process new admissions and readjust the treatment protocol of certain patients, if necessary.
At the end of the day, I make my final rounds with patients, ensuring they have everything they need, and then again meet with night duty doctors to brief them on the day’s patients. Then I return home, fatigued, but finally able to eat a good, hot meal and recharge for the following day. At night I try to rest, but it is hard to stop thinking about all the children in the ward, and wondering whether they will survive until tomorrow. In conclusion, the work is exhausting, but rewarding.”