My first time

My first journey to Africa was on 8th May, the plane landed safely in Nairobi international airport after 10 hours flight from Brussels. The next morning, I took another flight to Juba, the capital in South Sudan. The plane flew through a huge piece of green flat land of South Sudan. Sudan is the biggest country in Africa. The climate in North is like the one in desert. The climate in South is hot and humid. I was amazed by the view. The following day was even more daunting. It took 4 hours to drive from Juba to the field, Bor. The road was muddy and bumpy. When I got off from car, my hair, my face and my white MSF T-shirt were completely covered with mud and dust. This is my first mission. I feel so excited when I arrived Bor even I was in a bad dirty shape. The compound in Bor is shocking to me. It is a small compound, however there are 25 expats and regional staff living in it. Every thing there is new to me, the African hot climate, living in a tent, mosquito net, VIP (ventilation improved pit) latrines. I could hardly sleep the first night because it was so hot and humid. I didn’t remember if I could breathe at all. The first question for me the next morning was “can you sleep?” I said I can’t. Then I realized it was quite "normal" for new comer to be “insomniac” on the first few nights. The hospital is just opposite to the compound. It is supposed to be a secondary referral hospital in Jonglei state of South Sudan. Bor is a town in Jonglei state. After the comprehensive peace agreement between North and South, more and more Sudanese coming back to their homeland. The hospital buildings are partially collapsed due to war and earthquake. Basically, there is no infrastructure in Bor. There is no drainage system, no water supply, no electricity, no airport, and roads are difficult. The objectives of the project are to rehabilitate hospital building as well as to manage the hospital services. Hospital services include obstetrics, emergency surgery, ER, paediatrics and internal medicine. The maternity ward, isolation ward and Operating theatre are all operated in big tents. Outpatient department and in-patient wards are in rehabilitated buildings. I started my first working day on a beautiful sunny Saturday morning. I could hardly see anything in first few minutes in the in-patient ward because there are only 2 light bulbs. We almost worked in dark environment. We have to bring the child out of the ward to look for jaundice or other skin lesions. Most of children in ward are malnourished and have developmental delay. After the treatment of their illness which are mostly diarrhea and pneumonia, they stay in the hospital for supplementary feeding treatment until they reach the targeted body weight. All babies are very tiny. A 2 year old boy can weigh only 6kg. When the child is in hospital, the mother brings all her children, cooking utensils, clothes etc to the hospital. The mother needs to continue breastfeeding the sick child and other children she has. She also needs to cook for herself. We provide additional milk to babies, and high protein high caloric food to bigger malnourished children. In the afternoon, a 20ish lady came in with gunshot wound in the abdomen with faecal matter coming out from the “abdominal hole”. We brought her to our operation theatre which is a nice inflatable tent. I have to put in a intravenous access before operation. The OT was dark, her skin was dark, I could hardly see any veins on her arms. Finally I found one by feeling it rather than seeing it, I put in my first intravenous catheter in my first African patient. We found 6 holes in her large bowel and a lot of blood in her abdomen. Like most places in Africa, there is no blood bank in our hospital. When blood transfusion is needed, family member or village people are called for blood donation. They won’t accept blood from or donating blood to people they don’t know. We operated on her for 3 hours and managed to save her. During our operation, I saw a wandering fly in OT tent, I just hope it won't land on the open abdomen. When I walked out of the dark operating theatre, I saw beautiful sunset.

Hong Kong doctor Carmen HO joined MSF in 2007, she worked in Bor in South Sudan to provide basic health care service.