Medicine at the frontier

Outdoor chess set in the garden

So, having completed my first month on site at the end of last week, I can truly say that I was tired in body and mind. Luckily, MSF recognises that working in a project like this can wear people down pretty quickly and thus makes it possible for staff to take regular breaks outside the “hot zone”. And this is how I came to spend this past weekend enjoying some serious chillage in Islamabad, the capital.

The MSF co-ordination team for all our projects in Pakistan is based in the capital and so I was able to stay in the expat house with some of the more senior staff, which was a good opportunity to build relationships and share news and info from the field. It was also a good opportunity to enjoy the wonders of air conditioning (I don’t think I have appreciated a modern convenience as much in my entire life!), eat some different food (though our usual diet on the project is tasty and appreciated, it does border on monotony at times…) and to see and experience a more open and relaxed side of Pakistan.

Skyline silhouette in the jinnah park Islamabad

In Islamabad, the security situation is far more relaxed than in NWFP, which means we have a much greater freedom of movement. It was a real pleasure to be able to visit some of the markets and browse idly in books shops (this is one of my favourite things to do and I was very impressed with what was available). We were also able to go out at night and enjoyed some excellent hospitality at several of the cities many restaurants. But the highlight of the weekend for me was an afternoon stroll in the park. It was wonderfully freeing to be able to enjoy such a wide-open space and to feel like I was really “in” the place (since our usual restricted environment makes us quite apart from it all at times). Along with Fabio, a Brazilian expat doctor who is coming to the end of his time in Pakistan, I made an invigorating circuit of the very beautiful Jinnah Park, which is just over the road from the MSF office. We saw children at play, watched locals enjoying games of soccer and cricket and generally appreciated the normality of things here compared to our usual set up. It was an afternoon well spent and I will look forward to my next weekend off very much – they tell me there is a swimming pool and that sounds quite marvellous!

 

My life and work in Pakistan’s North-West Frontier Province has a certain rhythm: 6am wake-up, breakfast, into the transport, do the inpatient ward round, spend time in the ER, then home for lunch and repeat in the afternoon aiming to get home by 4pm (but usually around 6pm or 7pm!).

Due to security concerns, we are not usually allowed out of our residential compound, except to go to work and then only in the vehicle and only before dark. And so, we spend a lot of time indoors. Though we have an exercise bike, some weights and a punching bag (very necessary for exorcising frustration!) exercise options are severely restricted.

sunrise in NWFP

As a keen hiker, this has been a bit of an adjustment for me, especially since we are in sight of some spectacular local mountains where I would love to stretch my legs. In the last few days, however, this established routine underwent an unexpected and refreshing change.

Due to a relative stabilisation of the security situation in the Swat valley to our north, people displaced from the area in the past are being actively encouraged to return. As our town is on the main route to Swat, we have witnessed this procession growing from a trickle into a steady stream of trucks, buses and private cars since the beginning of last week.

Now, while this situation comes with its own frustrations for our project (particularly the daily military curfew which restricts our movements and has led to some very long days at work), it has offered the opportunity for a rare and special experience: a proper walk…outside…on the street!
You see, because of the curfew, the usual access roads for our transport to reach our residence are blocked and so, for the last few mornings, waking extra early to ensure we are moving before curfew begins, we have had the chance to take a short walk to our nearby office where the vehicles can collect us.

This probably seems a strange thing to write home about, but in the cool quiet just before sunrise this is, despite the many challenges, a very special and beautiful place, and a stroll in the fresh morning air does wonders for ones state of mind.

So for all those of you who are able, I strongly recommend you take a walk today. Preferably somewhere scenic, perhaps with someone special. It is a rare pleasure when properly appreciated and a free gift to yourself. ENJOY!

The reason that MSF is working in the North-West Frontier Province (NWFP) of Pakistan is that there is a clear medical need.

Patients who, in places with more advanced resources, would recover from their illnesses and return to their lives sadly do not always survive here. This is particularly true of unwell newborns, and it was here where we were recently able to make a decisive difference.

On the 10th of July twin girls were delivered at the MSF-run MCH (mother and child health unit). They we premature (only 28 weeks old) and each weighed only 1 kilogram.

At birth, they were pale, cold and unresponsive. After initial resuscitation by the midwives, they were brought to the nearby MSF emergency room. And, thanks to the skill and knowledge of our nursing staff and the availability of the necessary equipment and medication provided by our project, these two new arrivals were stabilised and were soon exclaiming their appreciation at the top of their little lungs. They were later transferred by ambulance to the nearest paediatric unit, and we have been receiving updates of their ongoing good progress over the last few days.

There are a lot of frustrations and difficulties to working here. Things often go wrong despite our best efforts. But, due to the sustained commitment of our excellent team (both clinical and support personnel), things are going right more and more often, and that makes it all worthwhile!

I hope you will all join me in welcoming these two tiny new arrivals to this sometimes strange and often wonderful world of ours.

It isn’t easy getting from Cape Town in South Africa to the North West Frontier Province of Pakistan.

To do so means spending a lot of time in airports: Cape Town to Johannesburg, then to Zurich, Brussels and finally, Islamabad. The rest of the way is by rough road and only with the permission of the military at several checkpoints.

But this is not just a journey of distance and time, it is also one of mindset. To work for Doctors Without Borders (MSF) – as I will be doing here for the next 6 months – is to agree to represent an organisation that aims to reach out to those in need in some of the most challenging and complex environments on earth. It means to adopt a code of impartiality, advocacy and the giving of assistance irrespective of race, gender or political/religious ideology.

Joe with friends

I am an emergency room doctor and I arrived here to join a team of doctors, nurses and support personal currently bolstering the standard of healthcare in a region that has suffered a great deal in recent years. In the week since we stepped into the exhausting 50 ^oCelsius (122 F) heat, it has become very clear to me that the needs of the people here are great.

As an international organisation that has its origins in the western world, it has not been easy for MSF to be accepted here, but the high standard and dedication of local and international staff has opened the way and we are now welcomed and appreciated.

Looking ahead, it is clear that this is going to be one of the most challenging jobs of my life. But, I am proud to be working for an organisation that changes lives and I feel immensely privileged to have the opportunity to help people in what is, metaphorically speaking, an axis for one of the turning points in the history of the modern world.

I look forward to sharing my experiences with you here over the coming weeks and months.

Joe Starke

Jonathan (Joe) Starke is a South African doctor with a keen interest in emergency medicine. He is currently on his first mission with MSF and is working in an emergency room and inpatient department in Pakistan’s North-West Frontier Province. So far he has encountered cholera, endured sweltering heat, monsoon rains and survived a bout of dysentery. He finds the entire experience exhilarating and this is his blog…

“Working with MSF has been a long standing dream for me. In many ways, the previous jobs I have chosen to do have been, in part, a preparation for going on an MSF mission.

The time I spent practicing emergency medicine has prepared me well for my current position, but even more important has been my Remote Site experience. I spent 15 months on mainland Antarctica and a total of 12 months on two sub-Antarctic islands, (Marion Island and Gough Island) over the past few years doing medical support for the researchers of the South African National Antarctic Expedition.

The challenges of the isolation and restricted living environment in those beautiful places have prepared me rather well for the isolation and restriction that we face in Pakistan’s North-West Frontier Province. But it also prepared me for the vital role that team work plays in all MSF projects.

Outside of medicine, my interests orbit mostly around questions of the future of humanity and what role the individual has within the unfolding of this challenge.

I like to read, enjoy writing and find great pleasure in spending time in nature – something that it is a little difficult at the moment, but which I look forward to finding time for as soon as possible.”