i'm struggling here - we're losing her

7
HURRICANE MATTHEW 2 FIGHTING YELLOW FEVER 6-7 THE LETTER THAT CHANGED ME 8-9 A FESTIVE SEASON IN THE FIELD 10-11 INSIDE Winter 2016 No 83 ‹ ‹ ‹ ‹ ‹ ‹ ‘I’m struggling here - we’re losing her...’ Yemen, pages 4-5 Photograph: Nurse Fatima Othman Saleh in Abs hospital © Rawan Shaif, 19 August 2016

Upload: truongtram

Post on 03-Jan-2017

218 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: I'm struggling here - we're losing her

HURRICANE MATTHEW 2

FIGHTING YELLOW FEVER 6-7

THE LETTER THAT CHANGED ME 8-9

A FESTIVE SEASON IN THE FIELD 10-11

INSIDEWinter 2016No 83 ‹ ‹‹ ‹‹ ‹

‘I’m struggling here - we’re losing her...’Yemen, pages 4-5

Photograph: Nurse Fatima Othman Saleh in Abs hospital© Rawan Shaif, 19 August 2016

Page 2: I'm struggling here - we're losing her

SITUATION REPORT2

MSF chosen as FT’s seasonal appeal partnerThe Financial Times has chosen MSF as its 2016-17 charity seasonal appealpartner. The FT appeal raises money and increases awareness of a chosencharity through dedicated editorial coverage of its work. FT appeals have raisedmore than £16 million for charities over the past 10 years.

“The scale of humanitarian crisis today is staggering,” says MSF UK's executive directorVickie Hawkins. “Many crises – be they conflict in South Sudan and Yemen, massdisplacement in Cameroon and Burundi, or outbreaks of disease in Democratic Republicof Congo – happen out of the public eye. This partnership between the FT and MSF givesus an opportunity to share the experiences of our medical staff working in these forgottencrises and provide lifesaving support to those affected by them.”

The appeal goes live at the end of November. Visit FT.com

HAITI

MEDITERRANEAN

Teams from MSF and SOS Mediterranée helprefugees and migrants transfer from a small woodenboat in the Mediterranean, 3 October. The MSFsearch and rescue teams on board the BourbonArgos, the Dignity I and the Aquarius rescued nearly2,000 men, women and children from 11 separateboats in less than seven hours on 3 October.Many of the rescues were conducted in dramaticcircumstances, with some people needing to beevacuated to the Italian mainland for urgent medicaltreatment. Since 21 April, MSF teams have rescueda total of 14,547 people from boats adrift in theMediterranean in more than 100 different rescueoperations. msf.org.uk/european-refugee-crisis

Photograph © Johannes Moths

CHAD

Drug company bows toMSF pressureDrug company GlaxoSmithKline (GSK) hasannounced it will cut the price of its pneumoniavaccine for MSF and other humanitarianorganisations treating child refugees as wellas children affected by other crises.

The move comes after MSF put sustainedpressure on the company over itsexorbitant pricing. Earlier this year, MSFwas forced to pay £50 a dose in order tovaccinate thousands of refugee children inGreece fleeing conflicts in Syria, Iraq andAfghanistan.

“GSK has taken a critical step forward forchildren in emergencies,” says Dr Joanne Liu,MSF’s international president. “With thisprice reduction, our teams will finally be ableto expand their efforts to protect children

against this deadly disease. GSK should nowredouble its efforts to reduce the price of thevaccine for the many developing countriesthat still can’t afford to protect their childrenagainst pneumonia.”

Pneumonia is the leading cause of childdeaths worldwide, killing almost one millionchildren every year. Children caught up inconflicts or other humanitarian emergenciesare particularly susceptible to pneumonia.

GSK has now pledged to offer humanitarianorganisations the vaccine for about £7per child. While GSK’s announcement iswelcome, drug company Pfizer continuesto refuse to offer an affordable price for itsequally-vital pneumonia vaccine.

“Pfizer should now match GSK’s move by alsooffering the lowest global price,” says Liu.

Find out more at msf.org.uk/gsk

An MSF nurse weighs a baby in Bokoro region, Chad. Malnutrition is endemic in Bokoro, with almosthalf of child deaths in the country associated with the condition. MSF is running 15 mobile outpatientclinics for malnourished children in villages across the Bokoro region.

Photograph © Tiziana Cauli/MSF

A teenager rests at the side of the road near Port Salut,in southwestern Haiti, after Hurricane Matthew torethrough the Caribbean on 4 October, devastatinglarge parts of the island. MSF teams rapidly begantreating patients, including those affected by cholera.“Many of us fear that malnutrition, further choleraand other waterborne diseases will emerge,” says PaulBrockman, MSF head of mission in Haiti.“Let’s notforget that Haiti was already at risk from Zika, dengueand malaria.”Find out more:msf.org.uk/haiti

Photograph ©Andrew McConnell/Panos Pictures

SITUATION REPORT 3

SYRIA

GREECE

MEDITERRANEAN SEA

IRAQ

MEDITERRANEAN

Teams from MSF and SOS Mediterranée helprefugees and migrants transfer from a small woodenboat in the Mediterranean, 3 October. The MSFsearch and rescue teams on board the BourbonArgos, the Dignity I and the Aquarius rescued nearly2,000 men, women and children from 11 separateboats in less than seven hours on 3 October.Many of the rescues were conducted in dramaticcircumstances, with some people needing to beevacuated to the Italian mainland for urgent medicaltreatment. Since 21 April, MSF teams have rescueda total of 14,547 people from boats adrift in theMediterranean in more than 100 different rescueoperations. msf.org.uk/european-refugee-crisis

Photograph © Johannes Moths

CHAD

CHAD

SYRIA

Some 250,000 people trapped in besieged east Aleppoare experiencing some of the fiercest bombing sincethe onset of the Syrian conflict. Medical facilities are atarget, with at least 23 attacks on the eight survivinghospitals recorded since the siege began in July.

“The situation is unbearable,” says Carlos Francisco,MSF’s head of mission in Syria. “The few remainingdoctors with the capability to save lives are alsoconfronting death. Only a few days ago, the managerof one of the health centres we support and his wholefamily, including his children, were killed by a barrelbomb.”

There are just seven surgeons left in east Aleppo totreat the wounded, out of a total of 35 doctors, and just11 working ambulances to bring the injured to hospital.

“The Syrian and Russian governments have takenthis battle to a new level,” says Pablo Marco, MSF’soperations manager in the Middle East. “The whole ofeast Aleppo is being targeted. Hundreds of civilians arebeing massacred; their lives have turned into hell.

Russia and Syria must stop the indiscriminatebombing now and abide by the rules of war.”

Mustafa Karaman volunteers asa physiotherapist in one of theMSF-supported hospitals in eastAleppo.

7 September

“Life has become almostimpossible in the city. Thesuffering is unimaginable, andpeople living in east Aleppo aretrapped here at the mercy of constant bombing. Webarely have any electricity or water.

All health facilities in the city have been affected. We dowhat we can and we use what we have to provide careto people trapped in the city. We can't afford to stop,not even for a day.

At my hospital we receive up to 100 sick and woundedevery day, and some days we carry out up to 30surgeries. The concept of working hours does not existhere; you need to be available around the clock.

The few remaining hospitals are under immensepressure, with very few staff. We are inundatedwith patients and the wounded. It’s impossible torefer patients elsewhere, because other facilities areoverwhelmed and this part of the city is totally cut offfrom the rest of Aleppo.

'We cannot leave our people behind'

As medical staff, we cannot leave our people behind.They have suffered, they are being wounded and killed,and we do not have the right to leave them. We knowthem – they are our relatives and our neighbours – andwe have to take care of them.

We hope that our supporters can put pressure on theinternational community to put an end to the suffering.They are our lifeline, and having a safe passage intoeast Aleppo will help us continue to do our job andtreat people.”

MSF supports eight hospitals in Aleppo city. It runs sixmedical facilities across northern Syria and supportsmore than 150 health centres and hospitals across thecountry, many of them in besieged areas.

msf.org.uk/syria

Roberto, from Brazil, comforts an elderlyman who was forced to leave his homebecause of the conflict, in Khanaquin campin northeast Iraq.

Photograph © Ton Koene

IRAQ

An MSF nurse weighs a baby in Bokoro region, Chad. Malnutrition is endemic in Bokoro, with almosthalf of child deaths in the country associated with the condition. MSF is running 15 mobile outpatientclinics for malnourished children in villages across the Bokoro region.

Photograph © Tiziana Cauli/MSF

A teenager rests at the side of the road near Port Salut,in southwestern Haiti, after Hurricane Matthew torethrough the Caribbean on 4 October, devastatinglarge parts of the island. MSF teams rapidly begantreating patients, including those affected by cholera.“Many of us fear that malnutrition, further choleraand other waterborne diseases will emerge,” says PaulBrockman, MSF head of mission in Haiti.“Let’s notforget that Haiti was already at risk from Zika, dengueand malaria.”Find out more:msf.org.uk/haiti

Photograph ©Andrew McConnell/Panos Pictures

Aleppo: Medical care under siege

Page 3: I'm struggling here - we're losing her

YEMEN4

It’s 2 pm,the desertsun isblazingand awomanwith mysteriousinjuries suddenly startsbleeding out as you’retreating her. For British-based anaesthetistDr Zhihao Oon, workingamid the conflict in Abs,northwest Yemen, thefight to save her lifebecame a gruelling testof skill and ability.

“I’m struggling here – we’re losingher,” I said to the surgeon as I squeezedthe adrenaline through the IV drip.“Maged, you need to slow down on thechest compressions and go harder.” Thecharge nurse grunted in agreement, hisforehead glistening with sweat fromthe effort of doing CPR. Three minutesearlier, her heart had stopped, but therewas no defibrillator. I looked desperatelyat the monitor for reassurance. There was

none. We didn’t have the equipment forit to monitor heart tracing. All it told mewas that it was picking up trace amountsof carbon dioxide from the patient. Mymind flashed back to my usual role as ananaesthetist in the NHS where all thisbasic equipment was taken for granted.

Half an hour earlier, the surgeon andI were in the minor injuries section of

the emergency room. It was 2 pm andthe desert sun was making its presencefelt. Outside it was 43 degrees; insidewasn’t much better. A 45-year-old womanwas brought in with a gash to her rightshoulder, just above the shoulder blade.

‘It looks like a stab wound’“How did this happen?” I asked herson, who had accompanied her. “A caraccident,” came the reply. The surgeonand I looked quizzically at each other. “Itlooks like a stab wound,” I muttered to thesurgeon. He nodded.

“We need to take her to theatre now,”declared the surgeon. “The wound’squite deep and it is still bleeding.” Soonwe were pushing her in a wheelchairalong the sandy path to the operatingtheatre. “Is she going to be ok?” her sonasked anxiously. “Inshah'Allah,” I repliedconfidently. “The wound is quite smalland the surgeon will probably give it agood clean and close it up. We’ve hadworse cases.” Just a few weeks earlier,we had operated on a patient with graveinjuries sustained whilst attempting todefuse a landmine. A laceration like thisseemed minor in comparison.

Just as we arrived at the operatingtheatre’s holding area, the woman’s headsuddenly lolled backwards and her eyes

glazed over. She was taking rapid, shallowbreaths and her skin had taken on a waxygrey tone. Her pulse was racing, a faintflutter underneath my fingertips. This wasclass four hypovolaemic shock – she wasbleeding out.

‘I’ve got my finger on theartery – it’s stopped pulsing’We rushed her into theatre and liftedher onto the operating table. I rapidlyadministered the anaesthetic – a mixtureof ketamine and diazepam with a smallamount of adrenaline – and secured the

“I’m struggling here – we’re losing her...”

Twelve-year-old Ali is treated for shrapnel injuries in Al Salam clinic after a bomb destroyed his house. MSF teams work in 11 hospitals and health centres throughout Yemen,and provide support to a further 18. Below: Ali with his sister and family.Photograph © Mohammed Sanabani/MSF

Dr Zhihao Oon and the team operate on a patient in Abs hospital.Photograph © Zhihao Oon

msf.org.uk/yemen 5

the emergency room. It was 2 pm andthe desert sun was making its presencefelt. Outside it was 43 degrees; insidewasn’t much better. A 45-year-old womanwas brought in with a gash to her rightshoulder, just above the shoulder blade.

‘It looks like a stab wound’“How did this happen?” I asked herson, who had accompanied her. “A caraccident,” came the reply. The surgeonand I looked quizzically at each other. “Itlooks like a stab wound,” I muttered to thesurgeon. He nodded.

“We need to take her to theatre now,”declared the surgeon. “The wound’squite deep and it is still bleeding.” Soonwe were pushing her in a wheelchairalong the sandy path to the operatingtheatre. “Is she going to be ok?” her sonasked anxiously. “Inshah'Allah,” I repliedconfidently. “The wound is quite smalland the surgeon will probably give it agood clean and close it up. We’ve hadworse cases.” Just a few weeks earlier,we had operated on a patient with graveinjuries sustained whilst attempting todefuse a landmine. A laceration like thisseemed minor in comparison.

Just as we arrived at the operatingtheatre’s holding area, the woman’s headsuddenly lolled backwards and her eyes

glazed over. She was taking rapid, shallowbreaths and her skin had taken on a waxygrey tone. Her pulse was racing, a faintflutter underneath my fingertips. This wasclass four hypovolaemic shock – she wasbleeding out.

‘I’ve got my finger on theartery – it’s stopped pulsing’We rushed her into theatre and liftedher onto the operating table. I rapidlyadministered the anaesthetic – a mixtureof ketamine and diazepam with a smallamount of adrenaline – and secured the

airway with a breathing tube. The surgeonwasted no time in beginning to explorethe wound, as I grabbed a bag of salineand squeezed it as hard as I physicallycould to get it through the IV – sheneeded fluids and fast. In the NHS we hada machine that did this for us. But thiswas not the NHS – this was Yemen.

The monitor buzzed; it was not pickingup a pulse. The surgeon exclaimed almostsimultaneously, “I’ve got my finger onthe artery – it’s stopped pulsing.” Herheart had stopped beating and she was incardiac arrest.

“Quick, quick, start CPR,” I said tothe charge nurse. Maged dropped theretractors and started chest compressions.“One… two… three… four…” he counted ashe pushed down.

“Fawaz, I want you to squeeze the bag,”I instructed the translator as I went toprepare the adrenaline solution. “You arenow breathing for her – each time youtake a breath, you squeeze the bag.” Fawazwould always help out where possible.

This brings us back to the presentmoment. I was in theatre with a deadpatient. CPR was ongoing. The surgeonwas desperately trying to stem thebleeding from the severed subclavian vein.

No phones, no hospitalswitchboard, no crash teamI sent Fawaz off to collect some much-needed blood from the laboratory. Twominutes later, he returned with a cool boxcontaining two bags of dark red blood. Hepanted, “Boss, the blood is here. The labsays that they can get more blood readysoon – they just have to bleed the relatives.”I thanked him and smiled bitterly.

In the NHS, if I wanted blood, a porterwould just get some from the blood bank.And in an emergency, we would call the

hospital switchboard and the crash team ofdoctors and senior nurses would be ‘fast-bleeped’ and be on site within minutes.

But here in Abs hospital, there were nophones, no hospital switchboard and nocrash team. No one else knew that wewere struggling with a dying patient inthe operating theatre. We were well andtruly alone.

More than 10 minutes had elapsed andthere were no signs of life from thepatient. We had done all that we couldwith the resources we had. We grimlywent outside to tell her son to preparefor the worst. And just then, a medicalmiracle happened. Her pulse returnedand she started breathing for herself.

'This was true teamwork'Astounded, we rushed back to theoperating table. She had a good bloodpressure and heart rate. Normal levels ofcarbon dioxide were being detected. Shewas alive. When the surgeon stopped thebleeding by tying the vein off, it allowedthe adrenaline that I gave her and theblood that Fawaz collected to take effect,with assistance from Maged, who helpedcirculate it around her body with his chestcompressions. This was true teamwork.

Two hours later, we wheeled her into therecovery room. We were not out of thewoods yet. As she was still anaesthetised,it was impossible to know if she hadsuffered irreversible brain damage as aresult of her cardiac arrest. We waitedanxiously by her bedside for her to wakeup. Soon her eyes flickered open. “Howare you?” I asked eagerly. “Alhamdulillah(praise be to God),” she replied, her voicea whisper. “Alhamdulillah,” I echoed, as Iclosed my eyes in silent gratitude.

We found out the next day that she hadnot been involved in a car accident. Herhusband frequently physically assaultedher and, on this occasion, had stabbed herin the shoulder with a kitchen knife.

Over the next three days, she made a fullrecovery and was discharged to a women’sshelter on the fourth day. If it wasn’t forMSF’s involvement in Yemen, this woman,and countless others like her, would havedied.

On 15 August, one month after Zhileft Yemen, Abs hospital was hit by anairstrike that killed 14 people, includingMSF staff member Abdul Kareem AlHakeemi. This was the fourth attackagainst an MSF facility in less than12 months. Find out more about our#NotATarget initiative. Visit msf.org.uk/notatarget. Read an interview with Zhiat msf.org.uk/DrZhi

“I’m struggling here – we’re losing her...”

Twelve-year-old Ali is treated for shrapnel injuries in Al Salam clinic after a bomb destroyed his house. MSF teams work in 11 hospitals and health centres throughout Yemen,and provide support to a further 18. Below: Ali with his sister and family.Photograph © Mohammed Sanabani/MSF

Page 4: I'm struggling here - we're losing her

DEMOCRATIC REPUBLIC OF CONGO6

When an outbreak of deadly yellow feverstruck Democratic Republic of Congo inAugust, MSF and Congolese authoritieslaunched a mass vaccination campaignto prevent the disease from spreading.

Over ten days, MSF mobilised 100teams to vaccinate 7.5 million peoplein the capital, Kinshasa. A vaccinationcampaign on this scale presentsnumerous logistical challenges, fromnavigating the crowded alleyways of thecity in a fleet of 65 vehicles, to ensuringthe vaccines are kept at between 2°C and8°C despite the hot and humid weather.

“This campaign is an essential step incontaining the spread of the outbreak,”says MSF emergency coordinator AxelleRonsse. “Vigilance will remain crucial inthe coming months.”

Photos by Dieter TelemansA girl waits calmly for her shot in the arm, administered by a local nurse, in the courtyard of a primary school in Kinshasa on the first day of the vaccination campaign.

First to be vaccinated are the childrн lining up ouʦide a school inKinshasa’s Zone д Santé Kikimi, whрe the campaign kicks off.

It’s early morning on day one of the campaign, and an MSF тam atbase camp unloads the vaccinс, which are stored in cool boxes.A young man screws up his face as the νrse pushes the syringe home.

Fighting a yellow fever outbreak

What is yellow fever?Yellow fever is a viral haemorrhagic diseasetransmitted by female Aedes aegyptimosquitoes – the same mosquito responsiblefor spreading the Zika and dengue viruses.The ‘yellow’ in the name refers to the jaundicethat affects some patients.

Symptoms include fever, headaches andmuscle pain, with some patients experiencinginternal bleeding. Up to 50 percent ofseverely-affected patients will die within14 days, according to the World HealthOrganization. There is no treatment foryellow fever, and vaccination is the mosteffective method of prevention.

What is yellow fever?Yellow fever is a viral haemorrhagic diseasetransmitted by female Aedes aegyptimosquitoes – the same mosquito responsiblefor spreading the Zika and dengue viruses.The ‘yellow’ in the name refers to the jaundicethat affects some patients.

Symptoms include fever, headaches andmuscle pain, with some patients experiencinginternal bleeding. Up to 50 percent ofseverely-affected patients will die within14 days, according to the World HealthOrganization. There is no treatment foryellow fever, and vaccination is the mosteffective method of prevention.

What is yellow fever?Yellow fever is a viral haemorrhagic diseasetransmitted by female Aedes aegyptimosquitoes – the same mosquito responsiblefor spreading the Zika and dengue viruses.The ‘yellow’ in the name refers to the jaundicethat affects some patients.

Symptoms include fever, headaches andmuscle pain, with some patients experiencinginternal bleeding. Up to 50 percent ofseverely-affected patients will die within14 days, according to the World HealthOrganization. There is no treatment foryellow fever, and vaccination is the mosteffective method of prevention.

What is yellow fever?Yellow fever is a viral haemorrhagic diseasetransmitted by female Aedes aegyptimosquitoes – the same mosquito responsiblefor spreading the Zika and dengue viruses.The ‘yellow’ in the name refers to the jaundicethat affects some patients.

Symptoms include fever, headaches andmuscle pain, with some patients experiencinginternal bleeding. Up to 50 percent ofseverely-affected patients will die within14 days, according to the World HealthOrganization. There is no treatment foryellow fever, and vaccination is the mosteffective method of prevention.

What is yellow fever?Yellow fever is a viral haemorrhagic diseasetransmitted by female Aedes aegyptimosquitoes – the same mosquito responsiblefor spreading the Zika and dengue viruses.The ‘yellow’ in the name refers to the jaundicethat affects some patients.

Symptoms include fever, headaches andmuscle pain, with some patients experiencinginternal bleeding. Up to 50 percent ofseverely-affected patients will die within14 days, according to the World HealthOrganization. There is no treatment foryellow fever, and vaccination is the mosteffective method of prevention.

What is yellow fever?Yellow fever is a viral haemorrhagic diseasetransmitted by female Aedes aegyptimosquitoes – the same mosquito responsiblefor spreading the Zika and dengue viruses.The ‘yellow’ in the name refers to the jaundicethat affects some patients.

Symptoms include fever, headaches andmuscle pain, with some patients experiencinginternal bleeding. Up to 50 percent ofseverely-affected patients will die within14 days, according to the World HealthOrganization. There is no treatment foryellow fever, and vaccination is the mosteffective method of prevention.

DEMOCRATIC REPUBLIC OF CONGO 7

A girl waits calmly for her shot in the arm, administered by a local nurse, in the courtyard of a primary school in Kinshasa on the first day of the vaccination campaign.

Bah Moudjitaba, an MSF water and sanitation exפrt fromGuinea, makes sure that all the used needles and ot herwasт are correctly disposed of.

A young man screws up his face as the νrse pushes the syringe home.

Fighting a yellow fever outbreak

Bartazard Tshimanga, a motorcycle taξ drivр who knows hisway around the backstreets of the city, is мployed by MSF to takevaccinatёn cards to the siтs that are impossible to reach by car.

Page 5: I'm struggling here - we're losing her

HAITI8

Dr JavidAbdelmoneimtravelled toHaiti in 2010to assist inthe aftermathof the devastatingearthquake. In themidst of the mayhem,a patient handedhim a letter thatwould change hislife. Four years onand still coming toterms with the deathand destruction he’dwitnessed, Javid satdown to write a reply…

“Dear Dr Javid, I salute you in thename of He who, through his death, gaveus life, Jesus Christ.”

Thus starts one of the most importantthank you letters of my life. The setting:Haiti, 2010, post-earthquake, intra-hurricane, pre-cholera. I cried when Iread it then. I cry when I read it now.Different tears though.

The patient who wrote it doesn’t knowhow much it means to me. I haven’t seenor heard of him since the day he gave it tome. Perhaps he has since died of anothernear-fatal asthma attack. I’ll never know.But even today, in my darkest moments,all I have to do is recall his letter and I amcomforted.

Emergency care in Cité-SoleilI went to Haiti with MSF in June 2010to help reinstate emergency and internalmedicine services at our hospital inCité-Soleil. ‘Sun City’ is the capital’sgang-ridden slum and is anything but

filled with rays of hope. I found violence,accidental trauma and infectious diseases;death, death and death.

In November in Cité-Soleil we were busy.Hurricane Thomas was due the nextday. We intended to evacuate the entireground floor of our 100-bed hospitalto the first floor to avoid the expectedflooding. The logistics of the move hadtaken our team one week of planning andpreparation. Persuading the Haitian staffand patients to enter the building’s upperfloor, which had no quick escape route incase of emergency, was difficult. Peoplewere still scared, despite it being nearly 11months since the earthquake.

I’d been there almost five months. It hadbeen very hard, and I still had to persuademyself every day to remain, not to give upand go home prematurely.

As head of the medical department, I wasto supervise our part of the evacuation.I made the rounds of the 22-bed tent,which served as an inpatient ward, withthe aim of discharging as many patientsas possible. The wind had really picked upand gusted ominously through the tent.I wasn’t even sure how many spaces Ihad been allocated upstairs, tucked awayat the back of the neonatal ward. It was

going to be a tight squeeze. I rememberthinking, “Is there room for this one?Evacuate upstairs or discharge?”

Then I was handed a letter by a patient.

‘I couldn’t believe I hadforgotten him’Oddly, I couldn’t recall him at all. Theresident doctor told me the patient hadbeen admitted a week previously withacute asthma and cardiac arrest. Sheconfirmed that I had seen him when I wascalled into the emergency room. He hadnot responded well to nebulisers (a devicethat enables you to breathe), then had hada seizure followed by cardiac arrest. Still Ihad no memory of him. Then suddenly itcame flooding back and I couldn’t believeI had forgotten him.

I remembered: he was young. I watchedhis eyes cloud over as he stoppedbreathing. He continued to struggle andlooked straight into my eyes. We didn’tstop. We tried every treatment available:adrenaline, aminophylline, magnesiumand salbutamol. We carried out CPR forwhat seemed an age, through three arrestsand three returns. I reflected afterwardsthat I’d forgotten ketamine, but we wouldnever have intubated him anyway, sincethere were no ventilators and no blood

gas measurements.

He had survived and written me a letter.

“‘He who despises his neighbour, sins.Blessed is he who pities the poor.’ Proverbs14:21. God is the source of life but it isfor man to try to conserve it. God raisedyour spirit and you did not abandon me.Therefore you are blessed. You are blessedby God in your hard work in saving life. Itell you ‘thank you’ – the biggest words inthe human dictionary.”

‘He was watching me as I cried’I was reading this eloquent letter in thebusy tent in front of him as he preparedhimself for discharge. The beds werebeing lifted up around us by the orderlies.The nurses were dismantling their desk.The medication was being packed awayby the nursing assistants. The logisticianswere taking down the electrics andsecuring the tent. It looked like it wouldstart to rain at any moment and he waswatching me as I cried.

Why was I crying? Because he wasmy exception to the rule of death inHaiti. Because I was ashamed that Ihad forgotten him. Because I was tired.Because I had had enough. Because he’dtouched a raw spot.

Hurricane Thomas did not strike us withfull force that night. It swerved north at

The letter thatchanged me

Children play in the streets of Cité-Soleil. Photograph © Stephane Delpech

HAITI 9

going to be a tight squeeze. I rememberthinking, “Is there room for this one?Evacuate upstairs or discharge?”

Then I was handed a letter by a patient.

‘I couldn’t believe I hadforgotten him’Oddly, I couldn’t recall him at all. Theresident doctor told me the patient hadbeen admitted a week previously withacute asthma and cardiac arrest. Sheconfirmed that I had seen him when I wascalled into the emergency room. He hadnot responded well to nebulisers (a devicethat enables you to breathe), then had hada seizure followed by cardiac arrest. Still Ihad no memory of him. Then suddenly itcame flooding back and I couldn’t believeI had forgotten him.

I remembered: he was young. I watchedhis eyes cloud over as he stoppedbreathing. He continued to struggle andlooked straight into my eyes. We didn’tstop. We tried every treatment available:adrenaline, aminophylline, magnesiumand salbutamol. We carried out CPR forwhat seemed an age, through three arrestsand three returns. I reflected afterwardsthat I’d forgotten ketamine, but we wouldnever have intubated him anyway, sincethere were no ventilators and no blood

gas measurements.

He had survived and written me a letter.

“‘He who despises his neighbour, sins.Blessed is he who pities the poor.’ Proverbs14:21. God is the source of life but it isfor man to try to conserve it. God raisedyour spirit and you did not abandon me.Therefore you are blessed. You are blessedby God in your hard work in saving life. Itell you ‘thank you’ – the biggest words inthe human dictionary.”

‘He was watching me as I cried’I was reading this eloquent letter in thebusy tent in front of him as he preparedhimself for discharge. The beds werebeing lifted up around us by the orderlies.The nurses were dismantling their desk.The medication was being packed awayby the nursing assistants. The logisticianswere taking down the electrics andsecuring the tent. It looked like it wouldstart to rain at any moment and he waswatching me as I cried.

Why was I crying? Because he wasmy exception to the rule of death inHaiti. Because I was ashamed that Ihad forgotten him. Because I was tired.Because I had had enough. Because he’dtouched a raw spot.

Hurricane Thomas did not strike us withfull force that night. It swerved north at

the last minute. The cholera epidemicarrived in the capital with the overflow ofrainwater the next day. My last few weeksin Cité-Soleil swept me up in a whirlwindof vomit, diarrhoea and much more death.I’d never before seen so much uncheckedmisery. It took me a while to recover. Itook away many memories, both fond andfoul. I took away one particular memoryof one particular patient. I took away aletter.

‘Your letter helps me’Mr Letter-writer, I salute you. I’m sorryit’s taken me so long to write back, but Iwas hurt by Haiti. You’ve helped me a lotand I haven’t forgotten you.

I can honestly say that I have struggledevery day with what I do and why. Myneed to find fulfilment in what I doovertakes me frequently. Sadly, I am oftenleft despondent after my day’s work. Idon’t know when I became this full ofangst. Did I make the right choice inbecoming a doctor? It’s been 13 yearssince I graduated. Should I still be askingthat question? Your letter helps meanswer it.

Your letter addresses my needs, allays myfears and gives me emotional support.Your letter shows me that the doctor-patient relationship runs two ways. I amnot sure that this is revolutionary, but ithas been to me.

Your letter reminds me to be kind, gentle,patient and humble, even if I don’t feelthose things some days.

I feel as indebted to you as you felt to me.Do you think of me as often as I think ofyou?

“May the All-Powerful grant you alengthy and successful career, which youaccomplish so well. Be blessed by God forever, Dr Javid.” Thus ends your letter.

The biggest words in the humandictionary end mine. Thank you.

The letter thatchanged me

A woman recovers from cholera in a hospital compound in St Marc, Haiti, in November 2010. Cholera patients need to replace lost fluids by drinking lots oforal rehydration solution or receiving fluids intravenously. Photograph © Spencer Platt; Bottom: Javid outside the MSF hospital in Cité-Soleil. Photograph © JavidAbdelmoneim

Page 6: I'm struggling here - we're losing her

This December, more than100 British volunteers will beworking for MSF in the field.We asked two membersof the team to tell us whatit’s really like to work forMSF and how they will bespending Christmas thisyear.

Dr Sarah Wookey, who isin charge of clinical careat a hospital in NorthKivu, Democratic Republicof Congo (DRC), and DrPaul van den Bosch, whomanages our medicalactivities in Irbid, Jordan, tellall…

What made you want to workfor MSF?

Dr Paul van den Bosch, Jordan

“I left my practicein the UK and Iwanted to workoverseas with anorganisation I knewto be effective.”

“I was a GP in theUK for over 20years. My childrenhave grown upand I wanted todo somethingdifferent with theskills I’d acquired.I was looking for

an organisation which was efficient,effective and which treated people onthe basis of need. MSF fitted the bill.”

Dr Sarah Wookey, DRC

Away from homeVOLUNTEERS10

Is this your first mission?

Sarah “Yes, I’m a newbie! I’m in chargeof clinical care at Mweso hospital in NorthKivu, DRC. It’s the only health facility inthe area.”

What kind of work are youdoing?

Paul “MSF’s clinics in Irbid, in the northof Jordan, provides medical care to Syrianrefugees. The majority live in towns andvillages, rather than camps, but life is stillvery difficult for them. Not only are theyliving in distress, having lost their homesand sometimes their family members,but legally they are not allowed to work.Although they can use the local healthservice for urgent problems, they can’t useit for chronic problems such as diabetesand heart disease. MSF’s clinic in Irbidaims to fill this gap.”

What’s been the biggestsurprise?

Sarah “We’re able to grow our own freshvegetables. We’re very lucky here – thehospital is situated in a beautiful, lush, hillyarea which is very fertile.”

What is a typical day like?

Paul “My role is to supervise, supportand guide the young and able Jordaniandoctors and nurses. This means beingalongside them, discussing clinicalproblems, running education sessions,developing protocols and a host of otheractivities. But while perhaps half my timeis spent in the clinic or on home visits,the other half is spent in meetings andin front of a computer. But as the cliniconly operates during office hours, I amfree most evenings for the first time in myworking life.”

Sarah “We’re only 100 km from theequator, so there’s no such thing as dawnor twilight. It goes from darkness to dayinstantly, so we tend to get up at dawn. Theday is spent supporting the local doctors,who are doing an amazing job looking afterpatients in this large hospital. There arealways lots of meetings as well as planningand audit activities. As it gets dark so early,we tend to go to bed early. But we do havetime for a couple of hours’ relaxation withthe other members of the team.”

Do you miss anything abouthome?

Paul “I miss my family, although my wifehas been out to visit me twice, and I’vebeen back to the UK. Skype, WhatsAppand FaceTime keep us in touch in a way

that was unimaginable in my previousmissions overseas. The internet servicehere is generally fairly good, so I certainlyexpect to be in touch at Christmas,although it will be the first Christmas mywife and I will have spent apart in nearly40 years.”

What will you do thisChristmas?

Sarah “We’ll have a party – everyone willcook something from their home country.At the moment, there are staff from theUK, Canada, France, Romania, Hungary,Kenya, Poland, Sardinia, Cameroon andSwitzerland, so we’ll probably have beefand maize perogies with goat goulashpizza, and plantains with maple syrup onthe side.”

What are the biggestchallenges?

Paul “The challenges are in trying toprovide the best possible service with otherpeople who may share the same ambition,but want to do it in a different way. Wehave robust and sometimes difficultdiscussions, but remain friends in the end.”

What is daily life like?

Sarah “Everyone is incredibly friendlyand patient with my terrible French – theteam I’m working with is really supportive.I love the food!”

Paul “Jordan has virtually everything youcould need, but one of the best aspects ofworking for MSF is the range of peopleyou have the privilege of meeting. I was ata party yesterday with a group of about 15people, and I ran out of fingers countingthe nationalities. There is so much food,but most of it is rather high-calorie, so I’mstarting to miss home cooking.”

Is there anything you forgot topack?

Sarah “My hairbrush! It’s a bit difficultto get stuff sent here, as there’s no postalservice, so I haven’t received any parcelsyet.”

Paul “The things I lack are not oneswhich can be sent, unfortunately. Perhapswhat I miss most is that there is nowherenearby where one can walk. We live in anoisy urban environment with little in theway of green space.”

Sarah stands in front of an MSF Land Cruiser in North Kivu. She was delighted to find that the team growtheir own vegetables in the MSF compound. Photograph © Sarah Wookey

Away from homemsf.org.uk/ecards 11

Paul “My role is to supervise, supportand guide the young and able Jordaniandoctors and nurses. This means beingalongside them, discussing clinicalproblems, running education sessions,developing protocols and a host of otheractivities. But while perhaps half my timeis spent in the clinic or on home visits,the other half is spent in meetings andin front of a computer. But as the cliniconly operates during office hours, I amfree most evenings for the first time in myworking life.”

Sarah “We’re only 100 km from theequator, so there’s no such thing as dawnor twilight. It goes from darkness to dayinstantly, so we tend to get up at dawn. Theday is spent supporting the local doctors,who are doing an amazing job looking afterpatients in this large hospital. There arealways lots of meetings as well as planningand audit activities. As it gets dark so early,we tend to go to bed early. But we do havetime for a couple of hours’ relaxation withthe other members of the team.”

Do you miss anything abouthome?

Paul “I miss my family, although my wifehas been out to visit me twice, and I’vebeen back to the UK. Skype, WhatsAppand FaceTime keep us in touch in a way

that was unimaginable in my previousmissions overseas. The internet servicehere is generally fairly good, so I certainlyexpect to be in touch at Christmas,although it will be the first Christmas mywife and I will have spent apart in nearly40 years.”

What will you do thisChristmas?

Sarah “We’ll have a party – everyone willcook something from their home country.At the moment, there are staff from theUK, Canada, France, Romania, Hungary,Kenya, Poland, Sardinia, Cameroon andSwitzerland, so we’ll probably have beefand maize perogies with goat goulashpizza, and plantains with maple syrup onthe side.”

What are the biggestchallenges?

Paul “The challenges are in trying toprovide the best possible service with otherpeople who may share the same ambition,but want to do it in a different way. Wehave robust and sometimes difficultdiscussions, but remain friends in the end.”

What is daily life like?

Sarah “Everyone is incredibly friendlyand patient with my terrible French – theteam I’m working with is really supportive.I love the food!”

Paul “Jordan has virtually everything youcould need, but one of the best aspects ofworking for MSF is the range of peopleyou have the privilege of meeting. I was ata party yesterday with a group of about 15people, and I ran out of fingers countingthe nationalities. There is so much food,but most of it is rather high-calorie, so I’mstarting to miss home cooking.”

Is there anything you forgot topack?

Sarah “My hairbrush! It’s a bit difficultto get stuff sent here, as there’s no postalservice, so I haven’t received any parcelsyet.”

Paul “The things I lack are not oneswhich can be sent, unfortunately. Perhapswhat I miss most is that there is nowherenearby where one can walk. We live in anoisy urban environment with little in theway of green space.”

Burundi Judith Kendall, AnaesthetistCentral African Republic Miriam Franca, Nurse;Andrew Ledger, Logistician; Michael Barclay,Logistician; Ghita Benjelloun, HR manager;Miriam Peters, Medical team leader; TimothyTranter, Deputy head of mission;Chad Victoria Neville, HR manager;Lydia Giramahoro, NurseDem Rep Congo Laura Esposito, Projectcoordinator; Sarah Wookey, Doctor; JustinThomas Healy, Doctor; Anna Halford, Deputyhead of mission; Emily Gilbert, Projectcoordinator; Anthony Channing, Logistician;Sarah Maynard, Head of mission; AliceGautreau, Midwife; ; Forbes Sharp, Head ofmission; Mark Blackford, Finance coordinatorEthiopia Isla Gow, Midwife; Cara Brooks, Logistician;Thomas Hoare, Psychologist; Georgina Brown,Midwife; Lucy Williams, Nurse; Aoife Nicholson,Lab scientist; Kate Nolan, Deputy head of missionEuropean migrant and refugee mission JaneGrimes, Psychologist (Greece); Jonquil Nicholl,Midwife (Italy); Jens Pagotto, Head of mission (Italy);Andrea Contenta, Advocacy manager (Serbia)Georgia Mark McNicol, DoctorGuinea Sophie Sabatier, Project coordinatorGuinea Bissau Danila Luraschi, Paediatrician;Johanna Francesca Phelan Bosowski, NurseHaiti Mathieu Vanhove, Epidemiologist; SarahCoates, Midwife; Dominique Howard, HRcoordinator; Stuart Garman, Project coordinatorIndia Ian Cross, Doctor; Christopher Cunningham,Doctor; John Canty, HR manager; SakibBurza, Medical coordinator; Rebecca Welfare,Project coordinator; Gillian Fraser, DoctorIraq Jonathan Henry, Head of missionJordan Usman Ali, Anaesthetist;Paul van den Bosch, DoctorKenya Anthony John Trethowan, Logistician;Daniel Acheson, Logistician; Sam Faber, DoctorLebanon Yvonne Ovesson, Logistician;Michiel Hofman, Head of missionLibya Jean-Marie Karikurubu, Head of missionMozambique Besufekad Yirgu Asfaw, DoctorMyanmar Marielle Connan, Projectcoordinator; Christopher Peskett, Nurse;Federica Kumasaka Crickmar, HR managerNigeria Ali Abdella, Medical team leader; AimenSattar, Logistician; Ann Lomole, Finance coordinatorPakistan Andrew Burger Seed, Projectcoordinator; Keith Longbone, Projectcoordinator; Lily Daintree, Midwife; MeganPowell, Logistician; Roberta Masotti, MidwifeSierra Leone Romy Rehfeld, Advocacymanager; Antonia Carrion Martin,Epidemiologist; Niamh Allen, Doctor; ChristopherSweeney, Nurse; Niamh Burke, NurseSouth Africa Lucia O’Connell, Activitymanager; Amir Shroufi, Medical coordinator;Andrew Mews, Head of missionSouth Sudan Aiden Berry, Logistician; MelissaPerry, Deputy finance coordinator; Rachna Kurl,Pharmacist; Philippa Pett, Doctor; Claire Reading,Midwife; Ann Marie Crosse, Health promoter;Jenna Broome, Doctor; Komal Gill, Doctor;Hilary Evans, Doctor; Laura Holland, Water andsanitation coordinator; Elizabeth Harding, Headof mission; Cristian Ceroli, Midwife; Robert Allen,Logistician; Hadyn Williams, Project coordinator;Swaziland Simon Blankley, Doctor;Maria Verdecchia, Epidemiologist;Shona Horter, ResearcherSyria Valerie Boutineau, HR supportTajikistan Nina Kumari, Mental health officerTurkey Simon Tyler, Head of missionUganda Jane Bell, DoctorUzbekistan Monica Moschioni, Headof mission; Mansa Mbenga, Medicalcoordinator; Claire Simpson, PharmacistYemen Diane Robertson-Bell, Hospital director;William Turner, Head of mission; Iain Bisset,Logistician; Christopher McAleer, LogisticianZimbabwe Mihir Rajnikant Pithadia, Doctor

MSF’S UK VOLUNTEERSWhat could you not livewithout?

Sarah “Earl Grey tea – I’m using each bagthree times.”

Do you have a message forMSF’s supporters?

Paul “However much we grumble aboutour difficulties – and most of us do – weusually have control over much of ourlife, and we have some freedom to makechoices. Most of our patients here inJordan don’t have this luxury, so MSF’swork here is really important.”

What would you be doingif you were at home forChristmas?

Sarah “Doing a shift at the localemergency GP service in Oxford, beforemeeting up with the family, and mydaughter’s best friend’s family, for smokedsalmon, silly games and champagne. Inour house, our proper Christmas meal isusually on Boxing Day, with roast goose.”

Paul “Probably eating rather too muchdinner and then going on a family walk.”

Is there a person who hasreally stood out for you on thismission?

Sarah “I remember a small boy withan injury who was carried to the hospitalby a series of porters. The journey tookthree days and went through several areascontrolled by different armed groups. Atevery crossover point, those carrying theboy handed him over to another teamwho were able to carry him safely throughthe next stage of the journey. There wassomething very moving about that.”

Paul “Two people who stand out forme are Jordanian doctors in the clinic.They are, as are young doctors in the UK,thoughtful, questioning and ambitious.They are professional, kind and committedto helping serve the patients. We in MSFneed to do our best to help nurture thesequalities, as these doctors will be aroundlong after we have moved on.”

Please send a message ofsupport to Sarah, Paul andother members of the MSFteam working abroad thisChristmas:

visit msf.org.uk/ecards

Sarah stands in front of an MSF Land Cruiser in North Kivu. She was delighted to find that the team growtheir own vegetables in the MSF compound. Photograph © Sarah Wookey

Page 7: I'm struggling here - we're losing her

Tel 0207 404 6600 Address Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London EC4A 1AB @msf_uk msf.english

29172_MAG_UK

Spread the word about MSF! Pass your copy of Dispatches on.

About DispatchesDispatches is written by people working forMSF and sent out every three months to oursupporters and to staff in the field. It is edited byMarcus Dunk. It costs 8.6p to produce, 2.3p topackage and 31p to send, using Mailsort Three,the cheapest form of post. We send it to keepyou informed about our activities and abouthow your money is spent. Dispatches gives ourpatients and staff a platform to speak out aboutthe conflicts, emergencies and epidemics inwhich MSF works. We welcome your feedback.Please contact us by the methods listed, or email:[email protected]

Sign up to emailGet the latest MSF news delivered to your inbox.Sign up at msf.org.uk/signup

Making a donationYou can donate by phone, online or by post. Ifpossible please quote your supporter number(located on the top right-hand side of the letter)and name and address.

Leaving a gift in your willHave you thought of remembering MSF in your will?Any gift is welcome, however large or small. For moreinformation, contact: [email protected] call us on 0207 404 6600.

Changing your addressPlease call 0207 404 6600 or email:[email protected]

Changing a regular giftTo increase or decrease your regular gift,please call us on 0207 404 6600 or email:[email protected] with your request.Please also get in touch if your bank details havechanged.

Eng Charity Reg No.1026588

LucyWilliamsis a nurseworking inBentiu, SouthSudan. The‘protection ofcivilians’siteis home tothousandsof peoplewho have

been displaced from their homesby fighting in the area.“I first arrived in Bentiu last Novemberas the rainy season was ending. At thebeginning, malaria was our main issue.I was working in paediatrics and, onan almost daily basis, I saw childrenconvulsing, suffering from the mostsevere form of malaria. Many hadscarily low haemoglobin levels and wenever had enough blood in the bank.It was tough.

On top of that, the numbers were so hugethat we didn’t even have enough beds.Doing the rounds each day, I had to stepover children sleeping on mattresses onthe floor while an additional ward wasunder construction.

‘The girl went into cardiac arrest’There’s one evening in particular that I’llnever forget. As a nurse, you do on-callshifts through the night. At around 9 pm,I was called to the emergency room. An11-month-old baby had been carried in,unconscious and very pale. We quicklytested her haemoglobin levels and theywere the lowest I’ve ever seen: they should

be at least 10, but hers were just 1.8.

Immediately we rushed the mother to thelab to donate blood and see if her bloodgroup was compatible with her daughter’s.While the mother was being tested, thelittle girl went into cardiac arrest. Wespent the next five minutes doing chestcompressions and breathing for her. Wealso administered adrenaline. Finally, herheartbeat came back, but she still didn’tstart breathing.

Thankfully, mum’s blood was compatible,so we administered it to the baby straightaway, even though she was still notbreathing. For the next few hours wehad to take it in turns to operate a small‘ambubag’ – essentially a hand-operatedventilator which was breathing for her.Shortly before midnight, we asked themother to give another unit of blood. Assoon as we gave it to the baby, she startedto breath for herself. It was incredible.

Back from the brinkLess than an hour later, this tiny baby, whohad spent the past four hours on the cuspof death, opened her eyes. I can’t begin toexpress how shocked we were; even hermother couldn’t believe it. By 2 am she wasbreastfeeding. She really brings meaning tothe phrase ‘back from the brink’.

Her story is so special to me because manyof the other children I treated weren’t solucky. In those first few months, we hadseveral babies and children who started tobreathe, and we got our hopes up, only forthem to die a few hours later.

In the morning, we started the little girl onintensive feeding and malaria treatment.She stayed with us on the ward for a fewweeks and, by the time she left, she’dput on a lot of weight. She looked like adifferent child.

When things went well, children wereusually out of the ward within a fewdays. When you think about it, that’spretty remarkable. A child is carried intoour ward completely unconscious andconvulsing – but, with a blood transfusionand an IV, they are often running aroundand playing within two days.

Returning to BentiuFast forward a few months and, onceagain, it’s rainy season. I left Bentiu inApril, but now I’m back. I returned to thishospital expecting more of the same, butcan’t believe how different things are.

Before this rainy season had even begun,spraying was underway to kill mosquitoes,which spread malaria. MSF helpeddistribute thousands of mosquito nets andestablished ‘malaria points’ in partnershipwith other medical organisations. Notonly does this mean that people can accesshealthcare much faster, but also that weare catching malaria cases long before theybecome serious.

In September 2015, we had treated 30,312people with malaria so far that year.This year, we have treated 18,414 in theexact same period. When you comparethese figures, it is truly remarkable –almost 12,000 fewer patients, despite theprotection of civilians site being the busiestit’s ever been.

It’s clear that this proactive and relentlessapproach to preventing malaria in Bentiuis saving thousands of lives. When I walkthrough the hospital now, there are emptybeds in almost every ward, and that reallyis a great feeling. Let’s hope that this timenext year we have empty wards too.”

Read more of Lucy’s blog at blogs.msf.org

Médecins Sans Frontières/Doctors Without Borders (MSF) is a leading independenthumanitarian organisation for emergency medical aid. In more than 60 countries worldwide,MSF provides relief to the victims of war, natural disasters and epidemics irrespective of race,religion, gender or political affiliation. MSF was awarded the 1999 Nobel Peace Prize.

YOUR SUPPORT | www.msf.org.uk/support

“An hour later, she opened her eyes”