I come from a country with a good healthcare system.  I come from a country where resources seem endless.  I have come to a place where nothing is certain and everything is complicated.  It has been a huge adjustment to work here.  Working in Boguila is teaching me endless lessons of flexibility, creativity and resourcefulness.  It has required an adjustment in expectations.  The work we do here is amazing.  And when you consider where we are and what we are working with, in my opinion, it becomes even more amazing. On a daily basis we are faced with treatment challenges.  Knowing the treatment we need exists in this world, just not in this part of the world, can be very frustrating.  In some respects it simplifies our practice, as the medication, the treatments, the diagnostics are limited. In other respects it poses huge challenges in finding solutions, being resourceful and changing our expectations.  Along with the challenges of treatment, the stories we hear are equally as challenging.  Endless stories filled with sorrow.  However, with time, one can see the small miracles behind each story.  Second chances, hope, strength, supportiveness,  commitment and belief. Here are a few stories. A young man. A motorcycle accident. Brought into the hospital unconscious hours after the accident. Friends and villagers transported him by foot to the hospital through the night.  Without any diagnostic imaging, it was impossible to know the details of his head injury and more impossible to do any procedures. We relied on simple medical assessments; frequent assessments, watching trends and providing support. The family was around the unconscious patient day and night. Trying to wake him up.  Trying to feed him. Trying to do all the normal things a parent would do to try and make their son feel better. It was heart breaking to watch.  But they could not understand why he could not wake up. We tried explaining to them the complexities of the brain and brain injuries, but they did not understand. They wanted to take him home. Take him to a traditional healer. Medically, we could not discharge the patient, he was not stable enough, but at the same time, here, we can not forbid a family to take their son home. The family hopes that traditional healing methods will help their son. Sometimes hope is the only thing that we can give, so we watched the family take their son home. A baby.  A fat healthy looking baby.  Brought into the hospital early morning by his maman and papa.  The baby had a really high fever and was starting to have difficulties breathing.  We confirm malaria; one of the most common reasons for admission into hospital for children under 5 years of age.  We immediately start the treatment and start an IV to give the baby energy through fluids.  The parents are at the bedside all morning. The baby's breathing is not improving and the baby is not responding to the treatment. The fever persists.  What more can we do?  Hope that the treatment kicks in soon. help support the baby.  The parents wait patiently beside their baby son.  A couple hours later, I hear the heart wrenching sounds of the maman and the papa wailing.  They were walking out of the hospital, with their precious little baby boy wrapped up.  He was not strong enough to fight the malaria this time. A mother with an untreated seizure disorder.  She had a seizure while cooking over the fire.  She was holding her 6 month old baby at the time and during her seizure; the baby fell into the fire.  Baby's right leg sustained severe and deep burns, from toe to hip.  The maman sustained minor burns on her arm.  The maman took herself and her baby to a nearby MSF hospital.  The wounds were assessed, cleaned and re-dressed on a daily basis.  But the burn was so severe that it had burned the foot off.  What was left of the leg was a big open wound.  Without the capacity of skin grafting in CAR, this wound posed a huge infection risk.  Without drastic treatment the baby would eventually succumb to infections. The question is how can we save this baby with our limited resources? Our colleagues at the other MSF hospital site asked us if our surgeon could perform amputation. Baby and her maman got transferred to our hospital for surgery. The next day our surgery team took the challenging decision to performed an above the knee amputation.  It is the only hope for this baby. After surgery, baby is still with us. She continues to need daily dressing changes and medical care.  But slowly her little body is healing and recovering.  And slowly her smile is returning.  She now has a fighting chance to see her next birthday!  It may not be picture perfect; but it is hope and a second chance. The stories are endless.  Listening to these stories, I wonder how these people still have a smile on their face.  They get up every morning, make a fire, cook food, feed their babies, wash their clothing, make more food, work in the fields, take care of their sick and continue to find a reason to laugh.  This amazes me.  The people here are strong. They accept, they hope, they believe and they keep moving forward.  This is bravery.

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