Posts tagged field work

We are all exhausted. Most of us started the day tired after a long week and I wasn’t the only one planning a low-key weekend.

Worn out though we are, there are few complaints. This is what we are here for after all. And we would do it all again tomorrow if we had to.

It’s your birthday, you plan to relax, then the call comes in - there are many people wounded by gun shots down the river. Read how MSF nurse Emma and her team in South Sudan leap into action.  
Usually we receive no warning of the imminent arrival of bomb blast victims. They normally arrive in a cloud of panic; chaotic screaming ensues and staff members run to man their posts. This time we are prepared. From the time of the phone call it should be twenty minutes before they arrive, not much time to ready the Emergency Room but I am surprised at how much gets done. We clear the resuscitation room and triage area, we prepare IV bags and bandages and then we prepare a queue of stretchers outside.
MSF doctor Stefan writes from Kunduz, Afghanistan, on treating people injured by IEDs and traffic accidents. Please leave your questions and comments for Stefan below his blog post.  
Photo: Over the next four weeks, MSF project coordinator Will Turner and his team will mount an expedition to screen 40,000 people for sleeping sickness in remote villages of the Democratic Republic of Congo.
DRC: Through northern Congo with a fridge
Travelling along muddy rainforest tracks by motorbike and crossing swollen rivers by dugout canoe while carrying a refrigerator, a microscope and a generator is no easy task. But this is what MSF project coordinator Will Turner and his team will be doing for the next four weeks. 
Without treatment, sleeping sickess - transmitted by the tsetse fly - is always fatal.

Photo: Over the next four weeks, MSF project coordinator Will Turner and his team will mount an expedition to screen 40,000 people for sleeping sickness in remote villages of the Democratic Republic of Congo.


DRC: Through northern Congo with a fridge

Travelling along muddy rainforest tracks by motorbike and crossing swollen rivers by dugout canoe while carrying a refrigerator, a microscope and a generator is no easy task. But this is what MSF project coordinator Will Turner and his team will be doing for the next four weeks. 

Without treatment, sleeping sickess - transmitted by the tsetse fly - is always fatal.

Meet 2-Year-Old Nyota, a Malaria Survivor in Congo

When she saw that her two-year-old daughter was ill, Nyota’s mother brought her to the MSF clinic in Nyasi, Democratic Republic of Congo (DRC), where she was diagnosed with and treated for malaria. Malaria is the leading cause of illness and death in DRC. Last year, MSF treated half a million people in DRC suffering from the deadly disease.

We all knew that late in the dry season, malnutrition would peak. But this week it hit us hard. Our outreach teams had difficulty coping. The hospital was temporarily over-run. Dr. Johanna, our MSF doctor from Sweden, told me the hospital “looked like a refugee camp”. The team and myself surveyed the hospital grounds. Two patients shared a bed in some circumstances; the area we use for children’s play was covered with mattresses on the ground and patients ; and our tent used for epidemic infectious disease was filled with malnourished children … Quickly, we started making plans to deal with the increased numbers.
Doctor Raghu blogs from Chad where MSF teams are working hard to treat rising numbers of children with malnutrition as well as people displaced by conflict. Read about it and leave your comments for Raghu.

Being able to go to the hospital at night requires a proverbial blade, its attachment and a handle. Practically speaking we need drivers, cars, petrol, guards and radio operators to make it happen. We need nurses on duty, who first discover something is wrong. We need logisticians who ensure there are generators to give light to the hospital at night. We need non-medical team members to also order key medications that I or other medics might prescribe at night. We need a coordination team in the capital to reach an agreement with the Ministry of Health that we can work here in Amtiman. And we need donors and supporters who generously give to make all of this possible.

Late at night we need a doctor. But we need a lot more too.

 Photo: Getting healthcare to people living in freezing conditions in temporary camps in Kabul © Ben King/MSF
Snowed InLogistician Ben describes the process in photos on the MSF Afghanistan blog. 
“These people live in incredibly difficult conditions in camps spread throughout Kabul. Surviving by their pure will to live, in deep snow and sub-zero conditions. MSF has started an emergency mission to provide basic healthcare services to some of these people who are not being helped out by other NGO’s. We are working in six camps within Kabul city so far and seeing around 60 patients each time we run free public clinics. This will continue until the worst of the winter weather is over and the small children get some respite from the cold at which time they can fully recover from their respiratory illnesses which is the major ailment that comes through our clinics.”

 Photo: Getting healthcare to people living in freezing conditions in temporary camps in Kabul © Ben King/MSF

Snowed In
Logistician Ben describes the process in photos on the MSF Afghanistan blog. 

These people live in incredibly difficult conditions in camps spread throughout Kabul. Surviving by their pure will to live, in deep snow and sub-zero conditions. MSF has started an emergency mission to provide basic healthcare services to some of these people who are not being helped out by other NGO’s. We are working in six camps within Kabul city so far and seeing around 60 patients each time we run free public clinics. This will continue until the worst of the winter weather is over and the small children get some respite from the cold at which time they can fully recover from their respiratory illnesses which is the major ailment that comes through our clinics.”

Photo: The gate of Ahmad Shah Baba Hospital in Kabul Afghanistan 2012 © MSF
Hospitality Lessons During a Mobile Clinic in Afghanistan
“You’re a brave man, coming here without arms,” the Malik told me halfway through lunch. I wondered why I would need any courage to eat some meat and bread, after all, the Malik—governmental leader of a town or community—had just finished a story to illustrate the concept of Pashtu hospitality.
During our briefing at a mobile clinic, he stopped us and invited us for tea to get to know each other a bit better. He hinted the tea could be taken in a tea shop next to the clinic, or at least this is how I interpreted his pointing of the chin towards to entry gate of the hospital. Two minutes later, however, we stepped into his car, and not into the tea shop, and sped away over the sandy road towards his house a few hundred meters away.
Carelessness from our side, you might wonder? On the contrary, in rural areas such as these, and at this moment in time, we feel more at ease. Receiving invitations to work in these communities is the best protection possible, as illustrated by the anecdote above. Afghan people judge you not only by what you do, but also by how you do it. Refusing the tea invitation would probably have been a mistake.

Photo: The gate of Ahmad Shah Baba Hospital in Kabul Afghanistan 2012 © MSF

Hospitality Lessons During a Mobile Clinic in Afghanistan

“You’re a brave man, coming here without arms,” the Malik told me halfway through lunch. I wondered why I would need any courage to eat some meat and bread, after all, the Malik—governmental leader of a town or community—had just finished a story to illustrate the concept of Pashtu hospitality.

During our briefing at a mobile clinic, he stopped us and invited us for tea to get to know each other a bit better. He hinted the tea could be taken in a tea shop next to the clinic, or at least this is how I interpreted his pointing of the chin towards to entry gate of the hospital. Two minutes later, however, we stepped into his car, and not into the tea shop, and sped away over the sandy road towards his house a few hundred meters away.

Carelessness from our side, you might wonder? On the contrary, in rural areas such as these, and at this moment in time, we feel more at ease. Receiving invitations to work in these communities is the best protection possible, as illustrated by the anecdote above. Afghan people judge you not only by what you do, but also by how you do it. Refusing the tea invitation would probably have been a mistake.

I have never seen burn patients like we have had here over the winter. Often the burn victims are, again, women and children, as the women prepare the meals over open flame stoves and the children play around their mothers. We often had multiple victims from the same families. While we do our best, we lost quite a few of the patients to infections or they were simply too badly burned to survive. All we can really do is provide sterile dressings, increased calorie foods, and hydration. It has been hard to watch, and I am glad this season is pretty much behind us.

Certainly, the most difficult part of this mission, for me, has been the child deaths. Of course, everyone dies, but I am not accustomed to so many pediatric deaths.

MSF nurse Georgann writes about her work in Boost hospital, Afghanistan which has seen an increase in burn patients over the last few months. Please leave your comments and questions for Georgann below her blog post.
On this Earth, some children have access to life-saving medications, and others do not. This unfair imbalance means lives of equal value are treated unequally. Our MSF action seeks to make a dent in this injustice. It is unfair and tragic that children like Oumere die so early in their lives.

Syria: Behind the Lines

After two years of conflict, people in Syria are living through a catastrophic humanitarian crisis. Doctors Without Borders/Médecins Sans Frontières (MSF) has been able to open three hospitals in the north of the country. Medical teams provide emergency and surgical care, as well as primary health care consultations and maternal care. MSF teams have performed more than 1,300 surgical operations and provided 16,000 consultations inside Syria.

The ladies receive flowers from the Khodjeily MoH at the day of handover © Emily Wise
MSF Blogs: I Heart Shumanay
Up until now, my position in the Karakpakstan project has been as the doctor in the Khodjeily district. I took the baton in the short run-up to our handing Khodjeily back over to the Karakalpakstan Ministry of Health (MoH). Already by the time of my arrival, things were running pretty impressively in Khodjeily, and at times I have felt frustrated that there has not been a great deal for me to do. All of the hard-graft had already been done by my predecessors: doctors Jan (from what I can ascertain, some kind of Canadian medical God) and Johanna (an organisational guru). So, by the time I arrived in Khodjeily there was little left for me to do. No heroic lifesaving. No stamping my mark. No making a gigantic difference to rapturous applause. Great for the programme. Great for the patients. Khodjeily is a real success story. But for me, working in Khodjeily has always felt akin to sleeping with someone else’s husband.
And now my time has come: I am handing-over Khodjeily and opening the district geographically beyond. Shumanay is virtually uncharted territory for us: I believe MSF last ventured there in 2003. How many cases of TB will there be? How many will be drug-resistant? What is the state of TB-care in Shumanay? I am granted an MSF dream team for the job: joining Marielle and I will be our national nurse, Sarbinaz, and counsellor, Koral, both of whom are industrious, kind and capable. We will be starting from scratch. Shumanay will be our baby. We travel the hour and a half to Shumanay for the first time and survey the environment. It is similar to the rest of Karakalpakstan – flat, barren and parched plains without undulation as far as the eye can see, small shack houses and Lada cars kept just about road-worthy since Soviet days. But it’s even more remote, rural and sparsely populated than I have previously experienced. I can practically hear the untreated mycobacteria TB bacilli singing to me from the houses. This is a fine land.

The ladies receive flowers from the Khodjeily MoH at the day of handover © Emily Wise

MSF Blogs: I Heart Shumanay

Up until now, my position in the Karakpakstan project has been as the doctor in the Khodjeily district. I took the baton in the short run-up to our handing Khodjeily back over to the Karakalpakstan Ministry of Health (MoH). Already by the time of my arrival, things were running pretty impressively in Khodjeily, and at times I have felt frustrated that there has not been a great deal for me to do. All of the hard-graft had already been done by my predecessors: doctors Jan (from what I can ascertain, some kind of Canadian medical God) and Johanna (an organisational guru). So, by the time I arrived in Khodjeily there was little left for me to do. No heroic lifesaving. No stamping my mark. No making a gigantic difference to rapturous applause. Great for the programme. Great for the patients. Khodjeily is a real success story. But for me, working in Khodjeily has always felt akin to sleeping with someone else’s husband.

And now my time has come: I am handing-over Khodjeily and opening the district geographically beyond. Shumanay is virtually uncharted territory for us: I believe MSF last ventured there in 2003. How many cases of TB will there be? How many will be drug-resistant? What is the state of TB-care in Shumanay? I am granted an MSF dream team for the job: joining Marielle and I will be our national nurse, Sarbinaz, and counsellor, Koral, both of whom are industrious, kind and capable. We will be starting from scratch. Shumanay will be our baby. We travel the hour and a half to Shumanay for the first time and survey the environment. It is similar to the rest of Karakalpakstan – flat, barren and parched plains without undulation as far as the eye can see, small shack houses and Lada cars kept just about road-worthy since Soviet days. But it’s even more remote, rural and sparsely populated than I have previously experienced. I can practically hear the untreated mycobacteria TB bacilli singing to me from the houses. This is a fine land.

I learned a lot about closing a project in Liberia. It’s always difficult, but it’s important to maintain the capability to be the first responders in conflict zones and not have our resources tied up providing primary care. You get attached to the staff , you get attached to the patients, but it’s important that MSF is able to maintain the capacity to do what we do.
Forced to leave her project in Liberia unexpectedly, MSF mental health officer Athena Viscusi reflects on what it’s like to close a MSF project.
Photo: People line up for registration at a vaccination site. South Sudan 2013 © Corinne Baker/MSF
Preventing Cholera in South Sudan’s Remote Refugee Camps
MSF teams have completed a preventive cholera vaccination campaign in and around the refugee camps in Maban County, South Sudan. Hoping to prevent the spread of the potentially fatal disease, staff vaccinated 105,000 refugees in four camps and 27,500 other residents of the area.
MSF launched the vaccination campaign with the cooperation of South Sudan’s Ministry of Health as part of a cholera preparedness and prevention plan. While teams have already set up and pre-stocked cholera treatment facilities in the camps, the remoteness of the area and supply challenges mean that a cholera outbreak could be disastrous. That’s what makes the added prevention provided by a vaccination campaign so crucial.
“The key for preventing cholera is to ensure sufficient access to clean drinking water, and to have appropriate sanitation and hygiene facilities,” says Paul Critchley, MSF emergency coordinator in Maban County. “We are currently tackling an escalating hepatitis E outbreak in the camps, so we know that sanitation conditions here are not yet adequate. Hepatitis E is spread in similar ways to cholera, and this reinforces the need to do all we can to prevent cholera breaking out too.”

Photo: People line up for registration at a vaccination site. South Sudan 2013 © Corinne Baker/MSF

Preventing Cholera in South Sudan’s Remote Refugee Camps

MSF teams have completed a preventive cholera vaccination campaign in and around the refugee camps in Maban County, South Sudan. Hoping to prevent the spread of the potentially fatal disease, staff vaccinated 105,000 refugees in four camps and 27,500 other residents of the area.

MSF launched the vaccination campaign with the cooperation of South Sudan’s Ministry of Health as part of a cholera preparedness and prevention plan. While teams have already set up and pre-stocked cholera treatment facilities in the camps, the remoteness of the area and supply challenges mean that a cholera outbreak could be disastrous. That’s what makes the added prevention provided by a vaccination campaign so crucial.

“The key for preventing cholera is to ensure sufficient access to clean drinking water, and to have appropriate sanitation and hygiene facilities,” says Paul Critchley, MSF emergency coordinator in Maban County. “We are currently tackling an escalating hepatitis E outbreak in the camps, so we know that sanitation conditions here are not yet adequate. Hepatitis E is spread in similar ways to cholera, and this reinforces the need to do all we can to prevent cholera breaking out too.”

Treating Those Caught In Mali’s Armed Conflict

Doctors Without Borders/Médecins Sans Frontières (MSF) teams have remained in northern Mali throughout the recent crisis in order provide medical care to the local population. MSF has treated 35 wounded patients in Timbuktu over the past few weeks and is running programs in Mauritania, Niger, and Burkina Faso to assist those fleeing the conflict.