Cannot use Hong Kong standard to judge southern Sudan

Let me tell you some more about our colleagues and the hospital. Our Field coordinator, again, is a beautiful French nurse. Perhaps it's the tactic MSF uses to attract so many young people to the mission. She is very smart and has lots of experience. She works throughout the day and night, almost non-stop. We just finished our general meeting. She is having a discussion with the other nurse already. I remember being called back to hospital on the first night. We forgot to inform her. She immediately caught up with us at the gate. She is the in-charge of our security. Maiwenn, another French nurse, is our nutrition programme leader. She had a few MSF missions before, Uganda, Congo. The knowledge about the nutrition programme was from her teaching to Jayne. Jayne is an English girl living in Australia. It's her first mission with MSF. She had joined another organisation's  programme in India once. Abdul is our anaesthetist. He is an Indian Australian with family in Adelaide. Stephane is our operating theatre (OT)/ Sterilization Nurse. Antonne is our pharmacist. Both are from France. All three of them are retired. They all have multiple MSF experiences. Abdul and Antonne had worked in Mamba Point Hospital in Liberia as I did before. We all enjoyed working there and regretted that it was closed. Everyone is nice. Stephane is a typical French old man, strict OT standard nurse. He can speak little English. The Field Coordinator always asks us to push him to speak more English.  As Abdul, Jayne and I speak with him in English, he has become less shy. I like him very much. Altogether, we now have total 13 international staff. Most are from France. Some more are coming. It is a big project. The project has shifted from original support to obstetric service to main nutrition support programme. The number of beneficiaries, the staff and resources input have increased very much. The fate of surgical service will probably be determined in this weekend. The Head of mission and the Medical Coordinator will come to discuss with our team.      The Aweil City Hospital is operated by the Ministry of Health (MOH). MSF started coming in after an assessment last October. MSF found that the mother and baby death rate in the maternity unit was very high. Later on, there expected more clashes going on during the nomadic migration season. MSF would like to see whether there is a role for surgical service. That's the reason I am here. The hospital has two surgical, one medical, one paediatric, one maternity and one emergency ward. The staff is mainly Africans, most of the doctors are Arabs. All the documents are in Arabic. Facilities in the hospital are so scarce. There is no water in the ward, and no formal hospital records,  not even proper papers. There are rooms for a laboratory, blood bank and x-ray but they are all are empty and no people operating them. We need to diagnose fractures without an X-ray. Today I had the first experience. I have to rely all on my clinical knowledge. Surgical emergency patients will be admitted as MSF patients. We have to provide all the treatment and medications. The OT and pharmacy electricity are supported by MSF. Our generator works only during the time we are having an operation. On the night we had the emergency operation, I found that there were only a few dim lights on in the wards and along the corridors, which was switched off after midnight. The hospital was completely dark. There are number of patients with gun shot wounds and road traffic accidents. Most have lower limb injuries. They have to stay on those old metal frame beds which we would have thrown away long time ago. For example, one young man admitted one month ago with a large muscle abscess already developed a bed sore as he has been lying in bed for so long. I found that there are some brand-new adjustable beds in the emergency ward that may have been donated by some NGOs, but no one uses them. I discussed with the Medical superintendent and had some beds changed. We made our own monkey pulleys so the patient could exercise in bed. I asked our logistician to make me some walking frames for early mobilization. Working here, the idea is not "We cannot do it" but always "What we can do and how we can do it?" We come here because we think the local standards of health care are not satisfactory or at the level of modern society. In fact, some of them have quite good clinical sense. Like the doctor who called us to see the twin baby one night--he had made the exact diagnosis and right decision. Another aspect is the culture, belief and knowledge of the people, and the resources available here. In the same twin case, the family first refused operation at the beginning because they were worried that the women would not be able to have another child. I suspect that they were worried that we would remove the uterus as in most of obstructed labour cases with ruptured uterus. The other example is treating the fractured femur, they do not have the orthopaedic equipment and they do not know how to use it. They use their traditional method.  The fracture would heal, although with some deformity. That's the way they can work here. If we are given the same level of resources, I wonder how many of us can survive here without talking about the service. Sometimes, we may need to give credit to those with the ability and opportunity to leave, but decide to stay in this kind of working environment for whatever reasons. We cannot use the same measurement that we use in our society.. Au Yiu Kai