Nursing in Gaza: "Most of the patients we see have gunshot wounds in the legs"

South African nurse Annke recounts the first weeks after the “March of Return” demonstrations, where she joined the Médecins Sans Frontières / Doctors Without Borders (MSF) team treating patients wounded near the border between Israel and the Occupied Palestine Territories.

As I write this blog, I am sitting on the small balcony with a bird’s eye view of Gaza City. I am in one of the humanitarian hotspots of the world today. 
My career manager in the Johannesburg office contacted me on Wednesday a few weeks ago, asking me if I was interested in an urgent assignment to the Occupied Palestine Territories to treat people wounded in the “March of Return” demonstrations in Gaza. 
“Yes, I will go!” 
I had started packing my suitcase the previous weekend knowing that an assignment would come up soon, but not knowing if I would need to pack for summer or winter weather. 
A young man is rushed from the scene of the demonstration, carried by four others

A young man is wounded in the demonstrations on 14 May 2018. Photo: Laurence Geai

Once the paperwork came through, there was no time to waste, Monday evening I was on the flight and once I arrived at the MSF office, it was off to the border crossing to Gaza. 
The crossing was eerily quiet after the events of the previous day, the 14th of May. I met up with a lovely older gentleman, Bernard, a French surgeon. We crossed together and walked the long road through the “tunnel” that reminded me of a school corridor but with wire fencing on both sides, leading all the way to Gaza.
The MSF project that I’m assigned to has five wound care clinics which allow MSF to care for the growing number of patients needing post-operative care for their wounds. 
Most of the patients we see have gunshot wounds in the legs. MSF surgical teams are also placed in five hospitals in the Gaza Strip to treat patients who suffered gunshot wounds while protesting at the fence.
Annke Yssel and some of the nurses at MSF's Khan Younis Clinic in Gaza

Annke and some of the nursing team at the Khan Younis Clinic. Photo: MSF.

Each morning I take a 45-minute drive to the clinic in Khan Younis and have my daily Arabic lesson with the friendly MSF driver. I decided that on this assignment I will make much more of an effort to learn a bit the local language. After a few weeks I am fluent in greeting the staff and patients in Arabic!

The clinic is a busy place bustling with nurses, physiotherapists, doctors, stretcher bearers, drivers, watchmen and wounded people needing care.

Healing and rehabilitation from the gunshot wounds can take a long time

I work in the two clinics in the south, Khan Younis and Nuseirat. We give post-operative care to patients with gunshot injuries and also treat other trauma and burn wounds from the local community. I’m always greeted with a friendly smile and a hand wave when I assist and teach the nurse while performing a procedure.

The Palestinian nurses are friendly, compassionate, skilled and very motivated to help their people recover. Most of the patients will be in the clinic program for many months as the healing and rehabilitation from the gunshot wounds can take a long time.

I soon realized that I was not skilled in treating the patients with “ex-fix” (external fixators) in their legs. These metal rods protrude from the patient’s leg and they keep the bone fragments aligned, enabling the bone to heal straight and give the patient function in the injured limb.

I humbly asked the team to teach me how to do this specific wound care procedure. I became the student and my colleagues Subbah and Asad became my teachers.

A patient with external fixation uses crutches to approach an MSF facility in Gaza

A man who was shot in his legs during protests at the Gaza/Israel border fence enters an MSF clinic. Photo: Spencer Platt

The week of my ex-fix lesson had particularly hot weather, with temperatures up to 42 degrees Celsius! During the procedure the sweat was running rivets down my face and the nurse I was working with gently dabbed my forehead while my hands were in the sterile gloves.  

After some excellent instruction and guidance I am now confident and can do this wound care procedure. It was a good experience to be the student again!