January 31, 2013

Burma 2012 © Ron Haviv/VII

A doctor sees a patient at an MSF TB/HIV clinic in Myanmar.

Dr. Lucy Doyle has worked with MSF in DRC and the Dadaab refugee camps in Kenya.

Most patients’ deaths are anticipated by their physician. The doctor may observe a constellation of findings leading to a particular lethal diagnosis, and the physician prepares the patient as well as him or herself for this impending loss. This is similar in the field and at home, though in the field it hurts more to watch someone die of something that might have been treated easily here in the US.

The deaths that surprise us, that you can’t prepare for, are a different matter. At home, an unexpected death causes shock and questioning. It’s difficult to accept, for both the family and the medical staff. But I’ve seen different dynamics at work in my experiences in the field.

Perhaps my most unforgettable and unanticipated patient loss in the field was that of the five-year-old son of Abeli, one of our staff drivers at MSF’s project in South Kivu, DRC. Abeli brought the boy to our house one night with simple malaria. By the next morning he was declining despite oral anti-malarials, and we admitted him to the hospital. All of us on the team came to know him well. Two days later, however, after initial improvement, his condition deteriorated rapidly and he died.

It was a horrific death for a dear member of our team. Our whole expat team was shocked. But the national staff was not as visibly distressed. They calmly looked down and shook their heads, and continued on with their day. This is something they were more accustomed to than we were, given the realities they live with. They expect to lose patients like this. It’s not that they feel it any less deeply—the boy’s mother threw herself on the hospital ward floor, wailing at the top of her lungs and punching the ground. But Congolese families seemed to grieve with more fury and then complete the process and move on in a shorter time than we do.

A few days later we walked by the family’s home and saw that the national staff were making a quiet visit in solidarity with the grieving parents. The next week, Abeli was back at work. Tears came to my eyes as I asked how he and his family were coping. He just smiled and said, “C’est la vie,” and asked me how I was doing.