Emergency epidemiology

Day 30 – leaving South Sudan

Posted on July 20, 2012 by Ruby Siddiqui

Randra or Suby? The team are trying to decide what acronym they should use for me and Sandra, along the lines of Brangelina and Tomkat. Sandra and I have been inseparable. We work together, we share the same tent, we’re basically with each other 24/7. I find myself looking for her when she’s not around. And I’m going to miss her now that I’m leaving. It’s been great working with her. She cares about the refugees and our outreach teams just as much as me. She could discuss the challenges, debate the limitations and problem-solve our activities and although we have very different styles (she’s much more patient, gentle and diplomatic than me), I think our combination worked well for our outreach workers too. I feel a bit out of sorts.

Leaving a mission is always hard but this is particularly difficult. There’s so much more to do. This crisis is far from over. We’re just starting to scratch the surface of the true extent of health morbidities in this population, we’re starting to identify patients before its too late and we’re catching patients before they drop out of our programmes. But there’s still more that we could do.

We had to remove the pregnant women component of the MUAC surveillance due to the staff strike. We still need to investigate the main diseases affecting this population and we need to do more qualitative research (semi-structured interviews, focus groups and non-participant observation) to understand the refugees’ attitudes, perceptions and behaviours around water and hygiene. So maybe it’s appropriate that my boss is coming to replace me. I am joking with Tara, the emergency coordinator, also leaving the mission (and with whom I would work again in a heartbeat), about how we’re both being replaced by our bosses. Clearly we’ve set the bar so high only the highest level of MSF is qualified to take over (ignoring the fact that it’s the summer so finding staff is a lot more difficult!). But Phil is an infectious disease expert with years of field experience in MSF. I’m relieved to be handing the project over to someone that can move it on to the next level.

And I leave behind a team of fantastic people. The large Kenyan contingent like Johnstone the WatSan technician and all-round flirt, Janet the shy midwife, Soloman and Steven the supply logisticians that never complained about my demands and Peter my favourite OPD nurse who never looked phased when we brought in lots of patients from the camp and always prioritised their care. And the Sierre Leone posy; Daniel the outreach nurse that would travel through hell and high water to get to his patients, John the passionate nutrition nurse who was just as determined as us to trace every defaulter from the nutrition programme to ensure they were not forgotten and Sheik, the medical team leader with a gentle but determined approach who has been without his luggage for almost a month and hasn’t complained once. And the rest of the team; Richard, Andrew, Neil and Robin, the dependable logisticians; Estoban and Joachim, the coordinators that I last met in Haiti, shortly after the devastating earthquake of January 2010; Laura, Sabrina, Katherine and Erna, the medical staff that care about every patient. And Martha, Matt and Rink, our formidable WatSan team, still battling to supply enough water to the camp.

I put my bags in the car and suddenly Jilail appears at my shoulder. Jilail is the eldest of the Outreach team and I’ve always looked out for him, worried that all this walking might be too much for him, making sure his team support him. He lost six members of his family in the Blue Nile bombings. Six. I think he’s telling me to hurry back, in his quiet gentle way. I don’t know how to tell him I’m not coming back so I nod OK and quickly turn away. A huge lump in my throat.

And as our car pulls away Vanessa, our medical coordinator, suddenly appears, running after the car. I feel the most guilt about leaving her. I’ve known her remotely for a few years, supporting her from my office desk in London. But this is the first time we’ve worked alongside each other and I’ve loved watching this dynamic woman motivate her teams, having advice and an opinion on everything. We have used each other as sounding boards, bouncing ideas off each other to address the health needs of this population. It’s a bad time to leave but she gives me the biggest hug and I know I’m forgiven.

And then I see Rink, our star WatSan technician, running after the car. We arrived together. He was the one that re-routed the MSF plane over river beds and unused runways, igniting the adrenalin in all of us for our important missions. We became fast friends and I’m sad that I might never see him again. And then Anur comes running after the car, one of our lovely translators. We’ve decided to make him and Timoty outreach supervisors. They’ve accompanied me and Sandra every step of the way and know exactly what needs to be done to maintain a robust community surveillance system. The project is in safe hands until Phil arrives. And hopefully the small increase in salary means they can go back and complete college one day.

I’m now a blubbering wreck and the journalists and other expats leaving the mission are tired of stopping the car, keen to get out of this camp. But I see it differently. As we drive away in the morning light I only see the beauty of the Ingassana, a proud mountain people suddenly finding themselves living in a swamp. The change must be such a shock, but they are stoic, and determined to survive this hideous chapter in their lives.

And our MSF team, living beside them, demanding that their voices are heard, and doing what we do best, mounting a response in that critical early phase of an emergency while others debate what to do and providing medical care to people at their most vulnerable. I can’t think of anything more worthy.

The MSF plane Photo ©Ruby Siddiqui/MSF

Posted in Crisis management, Epidemiologist, South Sudan | Tagged crisis, Jamam, Refugee | 4 Comments

Day 29 – the things you remember

Posted on July 16, 2012 by Ruby Siddiqui

She wrapped her arms round my neck and I never wanted to let go. This little girl, as light as a feather, dressed in her best frock.

It’s my last day. I have been bumped off countless flights but tomorrow I will be on a flight out of here. And it seems apt that I’m working in Pudurubel, the village where we started the mortality surveillance 4 weeks ago. I’ve come full circle.

I’m working with Team 4. Benjamin the carpenter, Asha the nurse, Amna the cleaner and Daniel the dispute resolver! Sandra has been chatting to each of the outreach workers individually to find out more about their skills and experience and what they would like to do. We want to ensure we are maximising their skills and capacity-building as much as possible. So Asha and all the former nurses will be talking to Sheik, our medical team leader, tomorrow. Amna will talk to Laura, our Irish nurse, who is also managing the hospital. Benjamin will hopefully join Richard or Robin, our construction logisticians, and cheeky Daniel will stay with us, his skills best suited to working in the community.

The staff strike is over. At the same time as asking them to work incredibly hard for us during this refugee crisis, we suddenly stopped the staff shuttles that brought them from Jamam Town to work, about an hour’s walk. We simply didn’t have enough cars and it was impacting on our activities. So they walked out. After a couple of days, the situation was resolved and we agreed to morning and evening shuttles but would no longer do the lunchtime shuttles. That was a tough couple of days for our teams, especially the hospital staff, but many of our local staff had actually started trickling back anyway, realising that the shuttles didn’t affect them.

So now we could restart the MUAC surveillance. And we are finding so many children in Pudurubel with red MUAC plus an infection. We need to get them to the hospital. Why is it that even when you are telling a mother that her child is seriously unwell, she still has to spend ages getting ready? This is a trip out of the village and they need to look their best. One woman decides to have her hair braided, another gives her little boy a bath and the final one needs to find a pretty dress for both her little girl and her new baby. We often see children become malnourished when a new baby comes long, the mother’s attention being focussed on the new arrival. Hence this little girl, standing in her pretty dress, severely malnourished with a fever. I scoop her into my arms and she rests her head on my shoulder, two mud stains on my thighs where her little shoes gently tap them. But other patients are presenting themselves to us. The old lady with probable malaria, the young teenager with vomiting and diarrhoea and the little boy with jaundice. We will have to do two trips.

And it’s such a fantastic feeling to find the little girl later, gobbling up a packet of plumpynut, the peanut-based high-calorie food supplement that we give to malnourished children. Children with red MUACs have often lost their appetite and we have to try more drastic means to re-nourish them. But this little girl is sticking her finger into the packet, trying to pull out every last dreg. I want to give her a big hug, relieved that she’s going to be OK, as long as she stays in the programme.

Girl with Plumpy Nut, a peanut-based high-calorie food supplement that MSF give to malnourished children. Photo © Ruby Siddique/MSF

Girl with Plumpy Nut, the peanut-based high-calorie food supplement that MSF give to malnourished children. Photo © Ruby Siddiqui/MSF

We pile everyone back in the car to drive them home, all of them diagnosed and receiving the appropriate treatment. I notice the little boy with red MUAC was supposed to receive a bednet. We give bednets to all pregnant women and children under the age of five that attend OPD as they are more likely to suffer the severe consequences of malaria. But his medical card says we’re out of stock. I remember I’d requested a new bednet after breaking mine. I’d actually fixed it (in a lopsided fashion) so I rushed back to find the spare bednet. The mother looked surprised and grateful that I’d gone to such effort.

Field work is exhausting, tensions can rise in such a large team trying to share tents, bathroom facilities and the internet. I can’t remember the last time I had fruit or vegetables and I’d do anything for a bottle of coke.

But you never remember that stuff. You remember days like this, days when your surveillance has picked up sick people, days when you might have saved a life. Its days like these that give you the biggest high.

Posted in Crisis management, Epidemiologist, South Sudan | Tagged crisis, Jamam, malnutrition, MUAC, plumpy nut, Refugee | 4 Comments

Day 28 – pressure

Posted on July 14, 2012 by Ruby Siddiqui

Maram* is not the answer to everything. We can use it to build new roads, to create stands for bladder tanks (huge 10,000L water distribution vessels) and even to absorb swampy lakes outside tents (!) but it can’t be used to build water towers, as can be demonstrated by the collapsed rubble at the end of our shower stands. We all stare in wonder at what on Earth that person was thinking! Then we go back to our queues.

Our team has expanded to over 60 people (+visitors and journalists). This creates some pressure on our 2 shower stands and 2 toilets. Every morning I queue for the toilet, then for a bucket (what’s happened to all of our buckets?), then the tap to fill the bucket, and then the shower stands to take my bucket shower. Then it’s a mad scramble for whatever is available for breakfast (less and less each day) and then the usual bedlam around the cars.

Everything we do is dependent on the availability of cars. If we need to set up a clinic, we need a car, supply ORS points, we need a car, drill for water, we need a car and supervise our outreach teams… we need a car. And of course, all of us think our work is important. So it’s down to Cool as a Cucumber Canadian Andrew to satisfy our automobile needs. He’s just been handed this job (I suspect because nobody wanted it and he was the newest). The poor guy doesn’t flap easily but after 4 days, he looks like he’s had enough.

And this is made no easier by the fact our staff have walked out, disgruntled that MSF has stopped the staff shuttles morning, lunchtime and evening to Jamam town. Suddenly we had few drivers, no radio room staff, no guards and worst of all, hardly any hospital staff.

How were we going to run our hospital wards, OPD clinics, feeding programmes, 3 mobile clinics and 15 ORS points with no staff? We stared despondently at the stream of patients flowing in, soon becoming the usual sea of faces and the 3 expats that would have to handle this alone.

*Maram is a type of grass

Posted in Crisis management, Epidemiologist, South Sudan | Tagged crisis, Jamam, Refugee | 2 Comments

Day 27 – silent children

Posted on July 12, 2012 by Ruby Siddiqui

It’s the silent ones that you notice. In an outpatient’s department (OPD) full of people and screaming children you notice the ones that are quiet. It might mean something’s seriously wrong. The hospital is seriously swamped after we start our nutrition screening in the camp. All of our teams are referring children based on MUAC (mid-upper arm circumference). MSF has created special bracelets, colour-coded green (for safe), yellow (for pay attention), orange (for moderately malnourished) and red (for severely malnourished). Anybody can be trained to wrap this bracelet round the arm of a child and assess the severity of malnutrition.

A red mid upper arm circumference measurement indicates that a child is severely malnourished Photo © Ruby Siddiqui/MSF

And our outreach teams have been finding a lot of malnourished children. The OPD has become a sea of children’s faces, each carrying a white outreach referral slip. The hospital staff are blaming me. But I know they’re just as pleased as me that we’re identifying these kids before they’re beyond medical care. And our outreach workers are enjoying helping kids to live rather than asking families about who died.

But as I wander around OPD, tears come to my eyes. I have never seen children this skinny and weak. Imagine an upper arm, so far in the red zone that it’s basically just a bone, wrapped in skin. It’s heartbreaking to see children suffering this way, a shadow of their former selves, unable to muster a smile. And on top of that some of them are hot to the touch or incredibly dehydrated. Malnutrition makes the child more susceptible to infections such as respiratory tract infections or diarrhoeal diseases (that can lead to dehydration). How much more can a child take?

So we have to be super-vigilant in triage and pay particular attention to those kids that are not responding. And it’s such a relief to hear a child cry. It means they’ve still got some fight left in them.

Posted in Crisis management, Epidemiologist, South Sudan | Tagged children, crisis, malnutrition, MUAC, Refugee | 4 Comments

Day 24 – Happy Independence Day

Posted on July 11, 2012 by Ruby Siddiqui

Happy Independence Day South Sudan! And what festivities there were, even in Jamam camp full of non-citizens. There was music and laughter until the early hours and a military procession along the only road passable at the moment. We of course were in lock-down. Familiar enough in recent days with the unpredictability of drunken soldiers. But it was great to see our national staff looking so happy and proud, watching their soldiers pass.

So yesterday we took advantage of our last day of movements to drive around the camp and take geographical coordinates. With all this rain, the villages are moving around, looking for higher ground, which makes all of our maps out of date. And we were on our way back when we noticed a cluster of tents that we hadn’t seen before. Eager to find out more we trundled towards them. And our driver Joseph thought he was being clever by avoiding the water-logged road and heading into the grass. Within seconds we had sunk. The law of averages meant it was our turn to get stuck in the mud.

So the village came to us! Some of the local men came to dig us out. Turns out they had only been there a couple of weeks. They had split from the village Soda to form a new village called Soda Amol. They invited me to meet the new sheikh. So I left Joseph and Sandra to wait for the rescue vehicle (Sandra weirdly knows far too much about 4-wheel drives) and waded through the mud, to squeals of laughter from the local children, and sat with the village elders.

The Ingassana people are organised into 4 tribes (Soda, Bau, Kukur and Kulak), each having 2-3 sub-tribes led by umdas. Each umda leads 5-25 sheikh villages. The refugees have naturally reformed these structures here in Jamam camp, assisted by ACTED’s policy of ‘Organic camping’-encouraging the refugees to decide how and where they will live. However the hierarchy made these decisions before the recent rains and the tribes have ended up becoming dispersed, fragmented and even separating with some animosity.

But maybe they will all come together again. UNHCR have responded to calls from several corners and announced that some of the tribes will be moved out of the Jamam swamp and transferred to Batil refugee camp. It’s a relief to the storm-battered refugees. And the move will happen one tribe at a time.

Posted in Crisis management, Epidemiologist, South Sudan | Tagged Batil, camp, crisis, independence day, Jamam, mud, Refugee | 1 Comment

Day 22 – standing in line

Posted on July 7, 2012 by Ruby Siddiqui

Kowaja! Kowaja! Kowaja! Or the mouse shuffling round the tent at night. Or the dahl every…single…day! I’m trying to list all the things I WON’T miss about Jamam. It will make leaving easier. It somehow feels like you’re abandoning a project when you leave it but in reality I’m no longer needed. I came to carry out the mortality surveys and to set up community surveillance.

Now the international media are quoting the results of these surveys and, thanks largely to Channel 4, this crisis is finally getting the international attention it deserves. And Sandra is more than capable of taking full control of the epi component of this mission. In fact she’s turning into a great asset.

And even the outreach teams are sick of saying goodbye to me. Half suspecting they’ll see me again a couple of days later. We trained them for another ambitious project today, screening every child in Jamam camp for malnutrition. We plan to carry this out in only 1 week and really get on top of what we suspect is a large-scale problem in Jamam. We’re even going to include the pregnant women in the screening after anecdotal evidence that some of these women are malnourished. If an adult is malnourished, it indicates the severity of the food security situation as adults usually have natural coping mechanisms so it takes a long time to become malnourished. And if pregnant women are malnourished that can have extreme consequences to the developing foetus. I’m really pleased that we’re including pregnant women and I’m gutted I won’t be here to support that part of the survey.

So I’m back to making my list. But it’s a bit of a struggle. I could talk about the lake outside my tent every time it rains but Richard, one of the logisticians, has piled maram around that part of the compound so any water is almost completely absorbed. It feels a bit weird, like walking on the moon, but better than wading knee deep through swamp water.

And to be honest I love the kids shouting out Kowaja (‘white person’) to us. It’s so cute. I’m not white but there’s no point in arguing the point. Actually the kids have made up a song about how getting the ‘Kowaja’ water means standing in line, getting the ‘Kowaja’ food means standing in line, getting any ‘Kowaja’ stuff means standing in line. Hilarious.

Line for food distributions © Ruby Siddiqui/MSF

And I love dahl. It’s the one food I could eat every day. This one could do with a bit of spicing up though.

But the mouse is doing my head in. It appears every night and scurries around the tent. I immediately wake up, flash on my torch and spend the next hour looking for it but at the same time frantically ensuring my bed net is tucked in. I’m so paranoid that it will crawl all over me I can’t sleep. It even managed to get past our ingenious taping of any tiny gap in the tent’s zips. I’m desperate for a good night’s sleep, yet Sandra manages to sleep through the whole thing, oblivious to this tiny monster. How does she do it?

Posted in Crisis management, Epidemiologist, South Sudan | Tagged community, crisis, Jamam, malnutrition, mortality, Refugee | 1 Comment

Day 20 – rollercoaster

Posted on July 6, 2012 by Ruby Siddiqui

Bit of a rollercoaster of a day.

All the refugees have been transferred to Batil camp from T3. When we pass the site, we wonder whether we must have imagined there were 10,000 refugees there. It’s so empty. Yet great to know they have completed their journey.

But then we hear a message on the radio. Rink, one of our star WatSan guys has gone up to K18 to check that the water supply can be reactivated. He’s discovered about 100 families that must have arrived in recent days from the border. He asks for medical support and Erna, our top medic that has been here since the start of this refugee crisis, from the initial discovery of weak, exhausted refugees that were beyond medical care to the erection of a clinic at K18 to the transfer of all refugees to T3 and finally Batil, grabs her kit and jumps in a car, cancelling the first day off she’s had in a month.

Meanwhile, after ensuring everyone has water at K18, Rink heads further up to K43 and discovers more refugees. Maybe the influx of new refugees from Blue Nile State, expected any day now, has started.

Meanwhile we are taking all 46 outreach workers for an Ethiopian lunch. Today is my last day in Jamam and Sandra, the field epi, and I are pooling the last of our per diems to treat the teams and say a huge thank you for their efforts. This is not straight forward as the biggest restaurant is a straw shack with a capacity of 20 and not enough plates! So we divide ourselves between 3 restaurants. Not quite the communal get together we hoped for but everyone is having a good time, wolfing down the delicious injera and tibs in minutes and falling about laughing when they poke fun at me and my comical Arabic.

Team Epidemiology - outreach workers © Ruby Siddiqui/MSF

But then the heavens opened and the restaurant roofs were soon leaking. And we hear on the radio that the cars are stuck at K18 and K43 and the car sent to rescue them is also stuck. This is a job for Max our burly logistician. Max heads over there with not one but two tractors to rescue our teams who are unprepared for a night in the rain.
Later we discover that two of the outreach workers have been pretending they have been working. They have turned up to the relevant meetings and then disappeared. We have no choice but to sack them. Not a pleasant task, particularly after having such a fond farewell in the restaurant.

Then we hear that another MSF car has reversed into a tree. Somehow a drunk soldier managed to get into the empty car and rear-ended it. We’re all scratching our heads.

Then I’m told all flights have been cancelled for the next 4 days because of South Sudan’s first anniversary of Independence. They’re going to make a weekend of it but that means I can’t leave Jamam for another week. I’d had mixed feelings about leaving but, like most MSFers at the end of their missions, had mentally started the withdrawal. Now I was unsure how I felt. But the outreach teams were happy and I was secretly chuffed to be staying a few days longer.

And then we see Erna, Rink and Estoban, our project coordinator, roll into the compound, minutes before sundown. It’s a relief to see their muddy faces and Max’s huge smile.

What a bizarre day.

Posted in Crisis management, Epidemiologist, South Sudan | Tagged Batil, camp, crisis, Jamam, Refugee, sanitation, T3, water | Leave a comment

Day 16 – camels

Posted on July 3, 2012 by Ruby Siddiqui

The oddest sight is all the camels, cows and goats. You expect people to only carry the clothes on their backs and a few belongings when fleeing attacks, but some refugees brought their cattle. And I guess you can understand it. This is their livelihood, currency, a means of trading. This is how their families will eat and their children will marry.

Everyone has been moved out of KM18. The weather held and the remaining 800 refugees, newly arrived from the border at El Fuj were transferred to the transit camp (T3). Our medical team at K18 stayed until the last of the refugees had been transferred, dismantled the clinic and transported everything back to Jamam camp. And the Channel 4 team were there to film it. We have a lot of journalists passing through. And we understand that some of these crises would never reach the general public without their important work. But at the same time we do feel protective of our patients. I always feel the anger levels rise when some journalist pushes a camera lens into a refugee’s face, having no respect for that person’s privacy and dignity. So we are a bit naughty and accidentally on purpose block their shot. But we all loved the Channel 4 crew. They got it. They wanted to tell the story of these refugees with as much dignity and respect as possible. They seemed to care and we appreciated that.

It’s the end of a chapter in this acute emergency but certainly not the end of the crisis. These refugees that have endured bombings, violence, dehydration, exhaustion, malnutrition and illness and have lost family members in the bombings or have had to abandon family members during this arduous journey, too weak or sick to continue, must still make the final journey to Batil refugee camp.

And all agencies there, already overwhelmed by the needs of the existing refugees must ensure that a second emergency does not unfold at the camp where the water, food, shelter and medical needs of the refugees are not met and mortality rates increase.

This seems to have occurred at Jamam camp. Our mortality surveillance has revealed unacceptably high mortality rates, above the emergency thresholds. These are mainly due to diarrhoea (70%) so we need to ensure that the population has access to clean water (still below the recommended 15L per person per day), prioritises hygienic practices and has access to oral rehydration solution (ORS) before the diarrhoea becomes serious. MSF has therefore initiated decentralised ORS points throughout Jamam camp such that the population can access this life-saving treatment easily, our outreach teams have started educating the population in how to protect themselves from diarrhoeal diseases and our WatSan teams continue to work closely with OXFAM to increase the water supply to Jamam camp.

And we must be ready to reopen the clinic at KM18 at short notice. There are reports that another 15,000-20,000 refugees are expected to cross the border any day now, desperately trying to cross the border before the frontlines and the rain prevent further movement.

Posted in Crisis management, Epidemiologist, South Sudan | Tagged channel 4, diarrhoea, emergency, Jamam, Refugee, water | 6 Comments

Day 14 – motivation

Posted on June 30, 2012 by Ruby Siddiqui

We interviewed every family at T3 today (the new transit camp where most of the refugees from KM18 have now been transferred). I still can’t believe this band of hardy outreach workers managed to carry out about 2000 interviews in one day. They are so motivated. Half of them come from Blue Nile state and fled the same violence.

They want to be here, to help in some way. And the other half of the team, made up of local residents, want to be here too. Over the last few days we’ve been taking well-deserved breaks together, drinking the local spicy coffee at the market and sharing stories. We discovered that we have 3 doctors on the team; Mohammed Issa with the claw foot, Jilail the eldest in the group and Mr Cool, Abdul Aziz. But of course they don’t have their certificates or any kind of proof so have to take any work they can. Also Abdul Aziz is a bit of a musician and is in a band that we’re hoping will perform on my last day here.

But the most poignant moments have been when the teams have talked about fleeing Blue Nile state. Arun talked about losing his father and now becoming the man of the house, so much responsiblity for someone so young. Khamisa talked about leaving her husband and family behind, not knowing what’s become of them. Osman and Abueila and Hasson Mohammed talked about the day the bombings started, the second day of Ramadan. Even shy Asha and super-shy Amna became animated when everyone talked about that day. And the local team members have asked lots of questions, keen to know what had happened. I didn’t understand much of what was said. They all speak a mix of Arabic, Ingassana, Magajan and other more obscure languages. Yet they are all translating for each other, ensuring nobody is left out.

It was exhausting work today. T3 looks like a major village now. About 7000 refugees were transported in 1 day yesterday. Astonishing as usually the maximum was 2000. But again there was a storm last night and half of T3 became a swamp. People had moved to higher ground which meant we were walking large distances to find them. It also meant they were moving a long way from the latrines and water points. Almost everyone was collecting dirty swampy water into jerry cans. No wonder we are seeing so much diarrhoea. But what choice did they have? Walk for miles carrying heavy jerry cans from the nearest water point, or collect water from outside the tent?

Posted in Crisis management, Epidemiologist, South Sudan | Tagged diarrhoea, doctors, Refugee, water | 3 Comments

Day 12 – Triage

Posted on June 28, 2012 by Ruby Siddiqui

I grabbed the baby and started running. But where was the mother? She was still in the truck, way behind the throngs of people spilling out of the truck that had just brought them from KM18. I stopped and waited. I had been handed the baby and asked to get him over to the clinic.

We were trying to triage everyone as they were coming off the truck, identifying the sickest and taking them to our clinical staff at the newly erected MSF clinic at T3. This is our name for the transit point at the junction of the main Jamam-Doro road and the road to KM18. After all the rain and storms of recent days, our contingency plan has kicked in. UNICEF and ACTED are now prioritising moving all the refugees out of KM18. Each time it rains, the KM18 road becomes impassable and they have to wait for the road to dry.

Yet each day that passes, this group of refugees become weaker and more vulnerable. By bringing them to T3 we can move more people in a day and have them all out of KM18 in 2-3 days (if the weather holds). Also Batil is inundated. Up to 2000 refugees are being trucked there every day but UNHCR can only put up 500 tents per day. They can’t keep up with demand. It makes sense to hold people at T3 for a few days. Then the transport to Batil refugee camp will be straightforward as the Jamam-Doro road (that leads to Batil) is made of maram and always passable.

So MSF has constructed a clinic, pharmacy and observation tent in a few hours. We are ready with a NFI (non-food item) distribution so that each family can set up new temporary shelter. OXFAM have already constructed latrines and water points. Each time a truck arrives we naturally form a semi-circle around each truck, the medics at the front and the logisticians at the rear. I’m at the wing, also watching the refugees climbing over the side of the truck.

Our medical coordinator finds a child with severe pneumonia. They manage to stabilise her and get her in the ambulance to our Jamam hospital. All of our teams are finding severely malnourished children, elderly people that are dehydrated, children with ulcers and lots of people with conjunctivitis. I find the mother and we rush over to the clinic. The child is hot but has stopped crying, puzzled that a non-African woman is carrying him.

It’s intense and overwhelming at times but it feels great to be gelling as a team and to be doing something positive for these refugees. But the last truck arrives at dusk. They could only fit in the women and children and the men had to walk. They will be walking for hours in the dark. Each time there’s a high it’s quickly followed by a low.

Posted in Crisis management, Epidemiologist, South Sudan | Tagged crisis, Doro, Jamam, malnutrition, pneumonia, Refugee, triage, water | 5 Comments