Fieldset
COVID-19 in South Sudan: Waiting for the wave - Part 2

As the pandemic disrupts medical supplies and staff, doctor Ayla Emmink is relocated from her rural project to a vast UN displacement camp – where our teams are racing to prepare for the arrival of COVID-19

Read the first part of Ayla’s blog, here

The fact remains that here in Bentiu camp we do not, and will not, have any option to mechanically ventilate a patient. The best we have are oxygen concentrators – machines that separate oxygen and nitrogen from the air to support patients with breathing difficulties.

This means that we won’t be able to treat any of the patients who need more than that. If they struggle to breathe, we won’t be able to do anything about it. Possibly we won’t even be able to offer them much palliative treatment if we are already short on beds and equipment, medicine and staff.

Once the virus breaks out in the camp, it is possible the medical team will have to use triage to decide who is most likely to recover if given treatment and who we will let go. Unless we are lucky and for some reason the impact of the virus isn't as bad as we fear. At the moment we understand too little of how the virus will affect the people here.

Preparing patients

Due to the gaps in the team, my colleagues have been on call every other night for the past few weeks.

While nobody pushes me, I try my very best to get familiar in this new setting and do my share of the nights on call I become the supervising clinician of the paediatric ward, the neonatology department and later also the nutritional ward.

I am grateful for the unexpected moments of joy that relieve the pressure

In preparation for COVID-19, we must reduce the number of patients staying in the hospital for other conditions. That means, we try to reduce in-patient admissions and proceed to discharge as many people as possible without compromising the quality of their care.

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A newborn delivered in the operating theatre at MSF's hospital in Bentiu
A newborn delivered in the operating theatre at MSF's hospital in Bentiu

Most wards have decreasing numbers of patients every day, but in the paediatric departments, the turnover seems to remain high as ever.

Acute watery diarrhoea is the biggest challenge of the dry season, while young patients with respiratory infections, meningitis and other infectious diseases fill the rest of the ward. Sometimes there are complicated by other illnesses such as malnutrition, HIV or tuberculosis (TB).

Good and bad days

Some days are peaceful.

I make balloons out of gloves to entertain the children on the nutrition ward, I teach children how to use a stethoscope and feel relieved when newborns are carried away in their mothers' arms after days or weeks in critical condition.

It’s as if we could all see an enormous tidal wave approaching in slow motion

Other days, I hardly know how to remain positive.

When the morning starts with the realisation that the treatment we have to save a young life isn't enough. When the afternoon is marked by counselling a girl who recently gave birth to a baby with severe congenital disorders. And, when the night brings one or more resuscitations that I need to end, calling the death because we tried everything yet it was not enough.

Despite all of that, I am grateful for the unexpected moments of joy that relieve the pressure:

The meerkats running ahead of us during our morning run; a malnourished girl finally strong enough to walk; a sunset volleyball match with my colleagues; the older kids in the ward teaching me Nuer; sharing spoonfulls of Nutella with my friend the midwife when we return from the hospital together after midnight.

The tidal wave

In the coming weeks we expect to see significant increases in the numbers of patients at the hospital. The first rains have fallen and the mosquitos are multiplying daily, soon malaria will dominate all the wards.

We will need to open extra beds and extra wards to host all the patients. The likelihood of malaria season and COVID-19 hitting at the same time is an unpleasant thought.

Unfortunately, this fear becomes more and more realistic. We receive the first positive COVID-19 test result from one of our patients, shortly after the rains begin

The first case

The good news is that the patient is completely stable. The bad news is that he hasn’t left the camp for months. This suggests that transmission on is already happening at a local level before we can take further measures.

We activate all the plans we'd prepared with adjustments where needed. We trace and test the patient’s contacts, ask them to self-isolate, and try as pragmatically as possible to continue our normal activities,

But, underneath the surface, all of us are slightly paralysed by the surreal situation we are in. It’s as if we could all see an enormous tidal wave approaching in slow motion. Now, as starts to fall onto us we are dragged under, so we can’t understand where we’re going and how deep it could be.

“Corona, corona”

Surprisingly, the first confrontations with COVID-19 aren’t medical.

The restricted rules of the UN now block staff from passing through the base from their homes in the camp to their work in the hospital. Nor can staff go to the market for lunch, while the patients are no longer allowed to receive food from outside.

The weekly movie nights previously put on for children and parents are postponed until further notice, which is especially sad for the long-term young patients.

However, since the pre-screening for COVID-19 happens before people reach the ER, and the isolation units are entirely separate from the hospital, it is almost as if nothing changed on the wards I'm working on.

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A market inside a Protection of Civilians camp
A market inside a Protection of Civilians camp

Only indirectly do we see a difference.

Some staff are now moved from their normal work and dedicated only to the COVID-19 isolation area. As the government asks people to wear masks, we see more staff wearing them every day. In front of the only shortcut to the isolation area, a fence and an extra guard are placed. The amount of water taps and hand washing points are increased (the number of people actually using them increased as well at first).

I wonder how long this silence before the storm will continue

At the market, people have changed what they call out to the “western-looking” staff. It used to be “kawaja” (meaning white missionary), but now it's “corona, corona”. This brings extra security restrictions which ground us to the hospital compound and UN base.

Meanwhile, the work continues, asthmatic children, dehydrated toddlers and premature newborns keep being admitted. And, while I adjust the oxygen flow for a patient short of breath, I wonder how long this silence before the storm will continue.

In this together

Despite all uncertainties of the situation we are in – the workload, the number and severity of cases, how quickly the virus will spread, the continuity of our supply chain, how long lockdown will last – there is one thing we know for sure.

One thing we all cling on to, against all impossibilities and discouraging developments the last months, weeks and days, is that we all choose to stay.

While others choose to leave, we decided that for us it was not yet time to go. We are still too much attached to our tasks and responsibilities here and we will continue performing them as much as the situation allows us.

This binds us all together. In the happy moments and in the stressful times, we are in this together.

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