* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Our team arrived to start working at the Lulimba hospital at the height of the malaria season. We barely had time to unpack our boxes because we were greeted by a crowd of sick children, and more have been arriving in ever-greater numbers since. We also found out very quickly that the hospital had only one thermometer.
When you are unable to do most tests, being able to take someone's temperature in an area endemic for malaria and other tropical diseases is critical. So the staff spent the first few days running between the outpatient clinic, maternity, paediatrics and internal medicine, chasing the small tube of glass and mercury needed to place under the arm of a hot, lethargic child. We found two more thermometers in MSF's own medical kits, kept in our vehicles.
The lack of thermometers is only one of many shortages that beset the hospital, which is now trying to cope with a surge in patient numbers since healthcare was declared free with the arrival of our team.
There are plans to build a new hospital. But in the meantime, we are roaring through our first supply of medications, especially antimalarials and paracetamol. The number of children is growing, with two or three having to share a mattress, along with mothers and often siblings. The hospital staff are overworked, but are handling the white-water ride of this startup with patience and humour.
When I asked one mother, after seeing her child, if there was anything else I could do to help, her reply in Swahili prompted laughter from the other mothers. The nurse on duty, Silele, grinned and translated for me: "She was asking if you could sort out the problems between her and her husband, but I think we have enough to do already.''
The shortages, particularly of nursing staff, impede our work at every turn. At the start, we lacked a rapid test for malaria (there's apparently a shortage of these tests across the globe) and the large number of children presenting with fever overwhelmed the tiny lab; a dusty little room where the single microscope is placed carefully in front of a window to capture enough light to be able to search for the parasites that plague our patients. The lab technicians use a torch at night to bounce off the microscope's mirror.
In the operating theatre the patient is anaesthetised with ketamine, and a small wisp of cotton wool is placed over one nostril. If it moves up and down, the operating team knows the patient is breathing. The wisp of cotton wool in place of winking, bleeping machines found at the anaesthetic end of operating tables in the UK is the perfect illustration of why a certain phrase in French is never far from everybody's lips – Il faut se débrouiller! (You'll just have to muddle through).
Building a hospital takes time, but the flood of patients means we've had to improvise quickly. We've moved the internal medicine and paediatric services out of their overcrowded, dark rooms into four large tents while we wait for the new hospital. This has also created space for other services.
We now have bed nets for each patient to prevent the mosquito vector from spreading malaria from one patient to another. Each service has buckets with chlorinated water for drinking and hand-washing to help prevent cross infection.
The operating theatre now has a light, and the instruments are properly sterilised, instead of being placed in pressure cookers on charcoal braziers as they were when we arrived. We now have a generator that we can use to provide oxygen to patients with breathing problems. We simply treated all feverish children for malaria until the rapid tests arrived. When we started collecting data from the tests, 85% of them were positive for the potentially deadly P falciparum form of malaria.
I was woken this morning by a crack of thunder and the pummelling of heavy rain on the tin roof. The rains threaten more malaria and more patients, and the already parlous dirt roads and airstrip that we rely on for the delivery of drugs and equipment that this isolated hospital so desperately needs.
