Bor, South Sudan: Life, death and moving on

During the three months in Bor, I never saw a patient nor their family shed a drop of tear. 
A woman who was pregnant with her second child came to the hospital. Her condition was critical -- she had been in labour for half a day when she started to come to the hospital. When she arrived, it was already her third day in labour. She was in excruciating pain and her voice was shivering. She was hypotensive and dehydrated. She needed resuscitation and an emergency Caesarean section. Our team responded quickly and operated on her right away. We got the fuel, the instruments and everything ready in no time. When I took out the baby, everyone in the theatre frowned.  He was blue in colour and was not crying, meaning that the baby was severely lacking in oxygen. There was no intensive care unit in Bor but still we had to try our best to save the baby. The baby improved a bit after some resuscitation and both mother and child was sent to the ward. However, hours afterwards, the baby crashed. Cardiopulmonary resuscitation (CPR) was initiated and the anaesthetist Martin (from Norway) and I tried our best to get the little heart pumping by itself. Martin was yelling “Baby, baby come on come on…” After 15 minutes, there seemed to be no improvement. Just as Martin and I were going to continue the CPR, the mother grasped my hand and said in Dinka, “Stop doctor. Stop. Let him go. If the child is not meant to survive, he is not meant to survive. This is life,” she said. Minutes later, the baby boy passed away in peace in his mother’s arms. 
The case had a great impact on me. In Hong Kong, the neonatal mortality rate is extremely low. A doctor from Hong Kong like me would find it extremely difficult to believe that a neonate would die. Neonates and children have always been my weakness. These innocent little living beings are meant to be free from all kinds of stress and illnesses, let alone hunger and war. They are meant to be carefree and happy. They are meant to be overwhelmed by love and joy. Because of this, I never liked paediatrics. The feeling of watching them suffer or having to let them go breaks my heart, every single time. I was heartbroken and yet when I looked at the baby’s mom, the calmness in her eyes startled me. She did not cry nor did she shed a tear.
 South Sudan has been devastated by conflict for years. The situation remains volatile and life there is far from stable and affluent. Our driver once told me that every morning when he woke up and saw his family alive, he was already very thankful. Food for breakfast would be a luxury. “Every family in South Sudan has lost someone to the war,” he said.  Perhaps it is the hardships they have been through, and the cruelty of life that has made them so strong and resilient.  
We had once received a woman with a gunshot wound who came along with a bunch of wounded after their village was raided by another tribe. The bullet entered the anterior part of her neck and exited at the right side of her cervical spine. She was very lucky because the bullet did not injure any of the important vessels in the area and it also missed her spine. She only needed dressing to her wounds, antibiotics and painkillers. What was more devastating to her, was that she had lost her whole family. Her husband had died protecting them and her four children were abducted. A family shattered, just like this.  She did not, however, shed a tear. What she thought about was how she could move on; whom she could rely on; where she could find food……Survival, was all she had in her mind. Perhaps these shootings, abductions, life and death have always been part of the life in South Sudan. The only choice that they have is to move on.
The people there are so tall and tough both physically and mentally. They are like warriors to me, warriors of life who are never defeated by difficulties. I am full of admiration for them. 
Dr. Shannon Chan is a surgeon in a public hospital in Hong Kong. She joined MSF in 2014 and went for her first mission in Bor, South Sudan in October 2016. The mission lasted for over three months.


South Sudan