"Insha'llah!"

In June 2006, I started my journey to Ethiopia in the horn of Africa to work for MSF, and stayed there for 9 months. MSF had set up a medical centre in a small town called Cherrati in Somali region in Ethiopia to provide basic medical services to local people. In 2005 MSF launched a TB project and we have added kala azar to our list in the following year. Although facilities were not state-of-the-art and life was very simple (albeit much busier and difficult than I expected), these 9 months in Cherrati is definitely the best of times since my career began. What I treasure most is every bit I share with my colleagues and patients. I can still remember Abdi, a six years old boy suffered from kala azar. When he first arrived in our centre, just like many other kala azar patients, he had a his big belly. Anyhow he was in better shape when compared to other kala azar patients, at least he could walk to the treatment room for the quick test in his parents' accompany. The test result was positive but Abdi's condition was stable and we started the treatment next day. Visceral Leishmaniasis, also known as kala azar, is a disease caused by a protozoa and spread by the bite of infected sand flies. It affects internal organs of the body including: the spleen, bone marrow, liver and lymph glands. Symptoms include prolonged fever, weight loss, abdominal discomfort, enlarged abdomen and anemia. Without treatment, fatality is almost sure. Treating kids with kala azar is a painful process, which involves a 30-day injection. As majority of our patients were children, whenever you walked past the ward by noon, you could always hear their cries waving through. However, if patients reacted to the treatment positively, their miserable looks would turn into cheerful smiles in the second week. And a week after, they no longer needed to stay in bed all day, but shouted and ran around in the medical centre. Abdi was an exception. After the first few days, Abdi's conditions not only was not stabilised but had actually deteriorated, and developed jaundice and oedema symptoms. We worried that might be the side effects to his liver's functions and stopped medication as such. During the next week Abdi became weaker and weaker and finally fell into coma. Abdi's mother was at his bed side throughout the whole period, sitting in the suffocating ward under 40 degree Celsius swiping for him. Not a single grumble was heard. Another nurse from Sweden and I were very worried and anxious for Abdi. Although we had tried our best, Abdi was still in coma and that torn our hearts apart. Abdi's mother witnessed all these and one day when were examining Abdi, she consoled us and told us not to worry. She believed we had done what we could do. I remember her saying, 'Insha'lla! If Allah wants to take him away, we have to let him go.' Insha'llah is Arabic, meaning following god's will. Muslims love this saying and it is widely used in Islamic world. They also understand there are lots of things in life that we cannot control. I was deeply touched by Abdi's mother's words, touched by her trust and understanding towards us, touched by her resilience in difficult times. I realise that relationship between doctors, patients and their families can be that simple. We walk together and shouldn't be antagonistic against each other. It is sad that in nowadays' developed cities, environment and people's minds have become so complicated, that this kind of 'primitive' relationship has become rarer and rarer. Abdi's mother has taught me a lesson: even though we own nothing, we can still live our lives out positively. Joyce

Dr. Joyce CHING, who graduated from HKU in 2002, has been a volunteer with MSF since 2005. In 2006, she was sent to Cherrati, Ethiopia to join an MSF tuberculosis treatment programme. She shares stories of this nine-month mission with us here.