Finding my corner in this part of the world

The first couple of nights I crawled under the mosquito net, onto the super saggy mattress and lay awake. Exhausted, yet sleepless. My brain kept repeating "Where the hell am I? How did I get here? Why am I here? What am I doing?? Am I really this crazy??" over and over again.   I was surrounded by new sounds, new smells.  Dogs barking, people drumming & singing, roosters, bird calls, crows, more dogs and drumming. Did anyone ever sleep around here?!? After a couple of days, my initial anxieties passed.  I have been in Boguila for two weeks now, I am able to sleep at night and I have created a happy routine for myself.  I have settled into my saggy mattress and I am slowly grasping the tasks that lie ahead of me. Figuring out what to do with myself during the day did not take too long. Whether I'm being efficient or not is a different question.  Running a hospital, in the middle of Africa (literally) is no small task and there is plenty of work to do! Flash history lesson: Boguila hospital was initially constructed and operated by American missionaries in the 1960's, they trained local staff and managed the hospital until security issues became to dangerous and unstable.  The missionaries left in the mid 1990's... and after several years MSF came in 2006 to provide healthcare for the people around Boguila that have been struggling with government instability, insecurities and no healthcare.  For the past 3 years MSF has been working together with a team of national staff hired by MSF, to provide free healthcare for anyone in need.  And the need is great. The hospital has several basic brick structures with corrugated metal roofing.  Each building houses a different department, including, outpatient, TB/HIV, maternal health, inpatient (pediatrics, malnutrition, medicine), emergency surgery, Pharmacy and Office.  All the buildings are gated with guards. All buildings are within 50m of each other.  There are also two grass roof shelters (no walls) for meetings and trainings. My responsibilities: managing the inpatient department, maternal healthcare and malnutrition program.  I'm still not quite sure what that means... or how I'm going to do that. But here I am, and I am learning! The medical team consists of national staff:14 nurses, 25 secourist (similar to nurses aids, no formal training, trained on site), 3 midwives and 3 matrone(traditional birth attendants). The Expat team: 1 project coordinator, 1 logistician, 1 doctor (1 more coming next month), 2 nurses, 1 mental health officer. These are the people I work and live with every single day! Every morning I walk through the front gate of the hospital and wonder what may be waiting on the other side? One thing is for certain. There are many people in need, such as sick people, mamas, papas, kids and babies. People come to our hospital because there is no other health facility around. Some walk for many, many kilometres to find us. Often exhausted and very sick once they arrive at our door step. Imagine: being sick enough to realize you need to go to the hospital, then walking as much as 100km to get there.... many of us wouldn't make it. But these people are strong. And they usually make it, sometimes just barely. Our capabilities at the hospital are basic, but amazing at the same time.  We commonly treat malaria, chest infections, anemia, malnutrition, TB, HIV & HIV related infections, skin infections, and many other tropical diseases.  I have not yet spent a lot of time doing clinical work, as I've been trying to get a handle on the administrative side of my job.  I am looking forward to spending more time in the hospital, working with the nurses and midwives! I spent a couple of hours in the hospital one evening. The doctor on call had three patients coming in all at once, so I took the opportunity to go see how the hospital functioned at night. A baby with high fever and febrile seizures, malaria? A man complaining of leg pain due to a bullet in his thigh for the past several months, infection? A young girl with extreme ascites and edema all over her body, kidney disease? I went to the 'emergency room', with the baby. First we struggled with IV access to give fluids and antibiotics. Then we struggled with an nasogastric tube so that we could give oral medication to bring the fever down.  All the while struggling to keep the baby from wiggling all over the place. Everything was a challenge. All the equipment is locked up, because of theft risk. Nothing is available at hand and there does not seem to be any sense of urgency among the staff. Of course, in my head I am thinking, hurry, hurry, hurry... but I didn't know where anything was kept or locked up.  I felt like I was running around the room in circles!  Eventually we managed to find all the equipment after I made a special trip to the pharmacy with the doctor to sign out the necessary equipment. The baby took medication, got some IV antibiotics and then we brought it to the Soins Intensive (Intensive Care Room) for the night.  Don't be fooled when I say Intensive Care Room.  There is nothing special about this room, no oxygen, no monitors, nothing, just metal framed beds and mosquito nets, exactly like all the other rooms... and ironically it's  the furthest away from the nurses station!  I'm still not quite sure why it's called the Soins Intensive? That was only one patient. There are many more waiting at the front door.