Triage Sudan

Not having had my fill of Maskalyk, I snuck into the local branch [part-time] of the library and borrowed his first book Six Months in Sudan A Young Doctor in a War-torn Village [2009].  In 2007, he went to Abyei at the border between Sudan and South Sudan as a volunteer with Médecins sans Frontières MSF. Like me, at the birth of The Blob, he elected to blog about the transition between clean sheets and sheet ice in Toronto to the squalor and red dust of Africa. The book excerpts from that blog and riffs on its themes in a more considered, grammatical, less immediate manner.

Every day and every dollar, MSF lives the dilemma of "Give a man a fish and you feed him for a day vs teach a man to fish and he feeds himself for life". By setting up a mission in some remote place trampled by all four horsemen, they allow the local government to bail out of their responsibility to/for the local people. 

In one example incident, the family of a sick child from a distant village gather, beg, hock, and spend all their resources to deliver her to the MSF hospital; and arrive ten minutes too late to save her. They now have nothing, less than nothing and ask if that idle land-cruiser could be used to carry their beloved tiny corpse to a pace for burial. MSF, fearing the thin end of an infinite wedge, refuse this charity. Their mission = Médecin, and they have to be strict in their delimitation of what they are prepared to do. But it is Maskalyk, fresh from futile chest compressions on the girl, who must be the mouth and face of "Policy". It is demoralizing and probably makes people wake up screaming years later . . .
"you want to drive every patient where they want to go . . .drip all of the blood into this patient bleeding in front of you even though it means there might be none for the next ten, but today you have it, and today is his lucky day and tomorrow you will worry about tomorrow. but we don't, we are measured, and careful. it is what tomorrow's patients expect of us and the tomorrows stretch towards forever, and today is nearly done". 

Whatever about Sudan, same thing happens in Irish ICUs. IF an old chap like me rocks up to ER = accident&emergency ANDIF he's really unwell ANDIF there's a bed in ICU THEN he'll be admitted. And once he's installed he'll stay until one of 
a) d.d. discharged dead 
b) a bed be found in palliative
c) miraculous recovery and return home, possibly via a regular ward bed in the hospital.

If 20 minutes later, my pal V, aged 35, father of four, gets poured out of an ambulance shattered after a head-on car crash . . . he's out of luck. The best the system will do it expedite him to another ICU bed in a different part of the country. As it happens, there was a bed for V that night, and an orthopedic surgeon got back into scrubs and spent the next eight hours in theatre deciding which broken long-bone to fix next. V died twice in ICU in the following 12 hours but eventually made a good recovery. Good enough to go back to work to support his family.