A night shift in a refugee camp in South Sudan
Oct 19, 2012
More than 170,000 refugees have crossed from South Kordofan and Blue Nile states in Sudan and are gathered in five camps in remote and inaccessible areas of South Sudan. Many of the refugees arrived in a very weak condition after weeks of walking, and the health situation in the camps has varied from bad to disastrous over the past months.
In Batil camp mortality was measured in July at more than double the emergency threshold, up to half the children under two years old in the camp were malnourished and MSF declared in August that the health situation was catastrophic.
Since the first refugees arrived in November last year, MSF has been the main provider of healthcare in these camps. As the situation worsened the MSF team made a ‘surge’ emergency response, focused on the most urgent life-saving activities. This intervention has helped to significantly reduce the number of deaths in Batil camp. But this is still very much an emergency as the refugees are 100% dependent on humanitarian assistance. The work to keep saving lives continues round the clock.
MSF’s Dr Roberto SCAINI offers an insight in to a typical night shift working at MSF’s field hospital in Batil refugee camp:
The night time is considered a critical moment in the field hospital here.
We start with a round of the wards so the doctors on the day shift can tell me about their patients. Last night we started with a man in the in-patient department who had just been brought in with suspect meningitis. We did a lumbar puncture, taking a sample of the spinal fluid, and the result was cloudy, which meant we needed to send off for further laboratory tests. He was in a really critical condition.
Non-stop care
The other place I need to know about is the severely malnourished intensive care ward. Last night all the patients were stable apart from one girl who was extremely dehydrated and was having constant diarrhoea. We have to give her a special fluid to replace what she’s losing with the diarrhoea and vomiting. And we need to weigh her every hour because we are giving her a lot of this fluid, but we need to make certain that we are not overloading her system as that can be very dangerous. These children are so weak that we need to give them this fluid extremely slowly with a syringe. And you have to do this carefully all through the night, give fluid, check weight, wait, give fluid, check weight again…
You have to remain focused
The patients who are not stable often become critically ill during the night. And that can be difficult. You need to keep totally focused on the most critical cases. If you leave a weak patient for too long, they can become really unstable and die.
In a way you get much more of a connection with your patients and the medical staff during the night shift. For me it’s a strange and rather magical time; everything is quiet after the rush and noise of the day, just the sound of the generator and the falling rain, and you get to pause for a minute and drink some coffee with your Sudanese and South Sudanese colleagues. In between emergencies you get to stop and think.
Sudden emergencies
But we always have some patients who are very ill and who can go from just about stable to seriously sick in just a few seconds. The other day a child we were treating for severe cerebral malaria started having convulsions. That was two hours of intense activity. When a child goes into seizure it can bring on a respiratory repression and so you have to stop the seizure immediately as the shortage of oxygen can bring about cerebral damage. We followed the usual emergency protocol for seizures, but then she stopped breathing. So we had to start manual respiration with a breathing aid, but this was difficult as she was having really bad convulsions, shaking and writhing around on the bed.
Hard decisions
It was a hard decision to make because the drug to stop the seizures has a side-effect of lowering the breathing rate of the patient. We had to stop the seizure so we needed to keep giving the drug, even though it was having a bad effect on her breathing. After about 25 minutes we managed to stop the seizure, but this is really long for a seizure and the risk of cerebral damage was high. And throughout all this we were ventilating manually because if you stop ventilating for 2 or 3 minutes the patient could die.
Sometimes we are lucky
At one point I started thinking that this child is eight years old, the same age as my daughter. I think this somehow helped me to keep going, and I kept ventilating the child for 40 or 45 minutes, which is really exhausting. And then suddenly her chest started to move and so I stopped and she was half-breathing. So I continued to support her breathing for a while and little by little she started breathing by herself. Throughout the rest of the night she was unconscious but stable.
The next evening, when I came back at 6 o’clock, she was sitting and drinking. She stopped and smiled at me. She must have recognised me from the previous night. So I did some quick examinations and yes, her life was saved and it seems without any obvious cerebral damage. I don’t believe in miracles, but sometimes we are lucky.
In Batil camp mortality was measured in July at more than double the emergency threshold, up to half the children under two years old in the camp were malnourished and MSF declared in August that the health situation was catastrophic.
Since the first refugees arrived in November last year, MSF has been the main provider of healthcare in these camps. As the situation worsened the MSF team made a ‘surge’ emergency response, focused on the most urgent life-saving activities. This intervention has helped to significantly reduce the number of deaths in Batil camp. But this is still very much an emergency as the refugees are 100% dependent on humanitarian assistance. The work to keep saving lives continues round the clock.
MSF’s Dr Roberto SCAINI offers an insight in to a typical night shift working at MSF’s field hospital in Batil refugee camp:
The night time is considered a critical moment in the field hospital here.
We start with a round of the wards so the doctors on the day shift can tell me about their patients. Last night we started with a man in the in-patient department who had just been brought in with suspect meningitis. We did a lumbar puncture, taking a sample of the spinal fluid, and the result was cloudy, which meant we needed to send off for further laboratory tests. He was in a really critical condition.
Non-stop care
The other place I need to know about is the severely malnourished intensive care ward. Last night all the patients were stable apart from one girl who was extremely dehydrated and was having constant diarrhoea. We have to give her a special fluid to replace what she’s losing with the diarrhoea and vomiting. And we need to weigh her every hour because we are giving her a lot of this fluid, but we need to make certain that we are not overloading her system as that can be very dangerous. These children are so weak that we need to give them this fluid extremely slowly with a syringe. And you have to do this carefully all through the night, give fluid, check weight, wait, give fluid, check weight again…
You have to remain focused
The patients who are not stable often become critically ill during the night. And that can be difficult. You need to keep totally focused on the most critical cases. If you leave a weak patient for too long, they can become really unstable and die.
In a way you get much more of a connection with your patients and the medical staff during the night shift. For me it’s a strange and rather magical time; everything is quiet after the rush and noise of the day, just the sound of the generator and the falling rain, and you get to pause for a minute and drink some coffee with your Sudanese and South Sudanese colleagues. In between emergencies you get to stop and think.
Sudden emergencies
But we always have some patients who are very ill and who can go from just about stable to seriously sick in just a few seconds. The other day a child we were treating for severe cerebral malaria started having convulsions. That was two hours of intense activity. When a child goes into seizure it can bring on a respiratory repression and so you have to stop the seizure immediately as the shortage of oxygen can bring about cerebral damage. We followed the usual emergency protocol for seizures, but then she stopped breathing. So we had to start manual respiration with a breathing aid, but this was difficult as she was having really bad convulsions, shaking and writhing around on the bed.
Hard decisions
It was a hard decision to make because the drug to stop the seizures has a side-effect of lowering the breathing rate of the patient. We had to stop the seizure so we needed to keep giving the drug, even though it was having a bad effect on her breathing. After about 25 minutes we managed to stop the seizure, but this is really long for a seizure and the risk of cerebral damage was high. And throughout all this we were ventilating manually because if you stop ventilating for 2 or 3 minutes the patient could die.
Sometimes we are lucky
At one point I started thinking that this child is eight years old, the same age as my daughter. I think this somehow helped me to keep going, and I kept ventilating the child for 40 or 45 minutes, which is really exhausting. And then suddenly her chest started to move and so I stopped and she was half-breathing. So I continued to support her breathing for a while and little by little she started breathing by herself. Throughout the rest of the night she was unconscious but stable.
The next evening, when I came back at 6 o’clock, she was sitting and drinking. She stopped and smiled at me. She must have recognised me from the previous night. So I did some quick examinations and yes, her life was saved and it seems without any obvious cerebral damage. I don’t believe in miracles, but sometimes we are lucky.
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