South Sudan Emergency Room: 4:22 pm

ER doctor Alexander Nyman is at the start of a new assignment with Médecins Sans Frontières / Doctors Without Borders (MSF). He blogs from the remote town of Old Fangak, South Sudan...

Old Fangak 4:22 pm.

There's a call on the radio:

- ER for Camille!

- We'll be arriving at the port in five mins. The woman is giving birth right now, we need a stretcher!

- The emergency team will come to meet you!

Camile the midwife checks the woman's belly as the boat speeds towards the shore

Camille the midwife checks the patient as the boat speeds towards shore. Photo: Frederic Noy / Cosmos

The boat is approaching the riverbank at full speed. It slows down as it hits the sand. The emergency team is in place.

There they are, the whole crew is seated right on the deck of the boat. I'm overseeing the midwife who's helping the woman to deliver the child, it's in cephalic position (head first).

The baby's head is already out. The umbilical cord is wrapped around the baby’s neck; the midwife puts two forceps on it, cuts the cord with scissors and releases it as she continues the delivery, while the mother is trying to find a less awkward position in the boat.

The baby gets wrapped up in a cloth and is placed in the arms of the ER nurse and then we´re all running the 30 metres to the ER. Meanwhile we use the stretcher to transfer the mother.

The birth contractions started yesterday afternoon. The woman in labour got support from local people and friends in her home village.

In this area, you traditionally give birth with help of friends and family members. As long as there are no complications, it often goes well. This time the delivery has been going on too long, and the woman is also bleeding.

The family have been trying to seek our help since yesterday, but the journey to the hospital is both long and difficult.

When we got information about the situation the midwife, with a boat driver, travelled the 30 minute distance upriver to help and transport the patient to the hospital.

Alexander and a colleague try to resucitate the baby

Alexander and Delphine, a nurse, attend the baby. Photo: Frederic Noy / Cosmos

In the emergency room the infant is neither crying or breathing. We´re trying to resuscitate, but unfortunately without success, this time. They reached us too late.

Meanwhile, the woman's condition is critical, she's lost a lot of blood since yesterday. The haemoglobin level is 6,0 g/dl and she´s in shock. Intravenous fluids are given, but she needs blood.

Here in Old Fangak there is no blood bank. If you need to transfuse, it's usually a family member who will be the donor - if their blood group is a match, that is. Luckily a family member has the right blood group. We start the transfusion with haste, and four hours later, the woman's condition is stable.

We couldn’t save the child, but we saved the woman.

Old Fangak is a rural village with 48,000 inhabitants, surrounded by swamp and a river. No bikes, cars or road transport exist.

The access route is by boat or plane (most often helicopter).

Electricity is only via a generator. Food is difficult to find, especially during the current dry season, and particularly for most of the population who live far from the larger villages. Same for healthcare.

People who live in the smaller rural villages have sometimes travelled for days to reach the hospital, and they’re arriving by foot, sometimes canoe.

I´m in South Sudan and currently doing my third assignment for Doctors Without Borders.  I'll be here for the next three months.

You can read Alexander's posts in the original Swedish here.