Fieldset
Bullets wounds, bumpy roads and bats in the bed

UK doctor Bethany Sampson is on the road to Pieri in South Sudan, where the medical team are preparing for mass casualty events

MSF landcruisers ready to depart towards Pieri

I’m standing by the hospital car gate watching the preparations for departure as bags are loaded and the final checks take place.

A slight dampness from my MSF jacket soaks slowly through my t-shirt. I had to wash it this morning to get the blood off the front and it isn’t dry yet. I've been up since 3am helping the team in maternity treat a patient with severe bleeding after giving birth.

I flap my jacket a bit in the morning air. It’s still cool but as the sun continues to rise it will soon be burning hot. My jacket will be dry in less than half an hour.

We’re taking the first overnight visit of the year from our main hospital in Lankien to our primary healthcare centre in Pieri, some 58 kilometres and a three-hour drive to the south.

We have a briefing for our journey. There are contingencies for all eventualities, and I’ve prepared a medical bag containing equipment to stabilise someone with a severe illness or injury.

Eventually, everything is prepared and we set off, passing out of Lankien and into the countryside beyond.

The journey goes smoothly as we bump our way down the dirt road, the car jolting up and down the ruts and tilting from side to side as we cross dried streams and riverbeds. The only drama comes half an hour in when one of our colleagues, reacting to the uneven route, has to get out and vomit in the grass.

Full of life

From the air when you fly over this area looks almost deserted. A dense scrubland with areas of swamp where water has been left standing after the heavy floods of the rainy season.

Close up though, it’s full of life.

She’s unconscious and starting to have a seizure. Our staff quickly spring into action...

We screech through an overgrown section of track with thorny branches hitting the car and leaving scratches in the paintwork on both sides. Then we’re out into an open glade where a startling tree stands with deep red bark and tiny, bright yellow flowers in bloom. We surprise a cloud of small white butterflies which jump into the air all at once, scattering in the sunlight.

A tukul is a form of local architecture with earthen walls and a thatched roof. We pass a number of small homes with large tukuls for the cattle and smaller tukuls with decorative entrances for the families to live in.  

Groups of children run out and race after the car as we pass. David, one of our experienced local staff who is coming to help with carpentry and repairs, tells me that the smoking bundles the children carry means they’re out hunting today, for bees and honey.

The plans for Pieri

The journey takes us through a number of other small habitations before we finally arrive in Pieri. We’re all pleased to be able to clamber out, stretch our legs, and get a breath of air with less dust in it.

The team in Pieri have been waiting for us. They swing into action, providing tea and something to eat whilst also confirming the plans for the rest of the day.

Our outreach staff will travel onwards this afternoon to review our community-based medical care sites. Our carpenters will head off to repair the ward ceiling. And, I’ll stay here with the team in Pieri to help develop their contingency plan for treating large numbers of injured patients, known as a 'mass casualty' plan.

In the dry season, fighting often flares up between different groups and raids where young men attempt to capture cattle are much more common. This meant that last year the facility was so full of injured patients after an episode of fighting that some were sleeping outside on the ground. A helicopter was a common sight, travelling back and forth picking up the severely injured patients needing surgery.

Teamwork

The team here are extremely dedicated and hard-working. They see a large number of patients from the surrounding area and although they have quite limited resources available to them, they are able to provide care for a wide range of conditions. These include injuries, chronic diseases like high blood pressure and infections, which can be severe.

It’s nice for us to spend some time working together more closely. Most of my contact with the staff here is restricted to conversations over the temperamental satellite phone. This might be when the team need advice about patients with severe or complicated conditions, or to make arrangements to transport them by plane or helicopter for emergency care or surgery.

pieri_-yien_james_icon_and_i.jpeg

Bethany with teammates Yien, James and Icon
Bethany with teammates Yien, James and Icon

As we’re talking, a new patient is brought in – a two-year-old girl with severe malaria.

She’s unconscious and starting to have a seizure. The team quickly springs into action, replacing her glucose, rehydrating her and giving her injected medication for malaria.

Her mother holds her tightly as the team get the treatment started around her.

The bats

We sit in the evening having a cold drink from the market, watching as the birds settle into the trees to roost and the stars come out. There’s no electricity here, no phone signal, no internet. It feels peaceful.

As I go to the room where we’re staying, I frighten the bats from where they’ve been sleeping and they stream out from the underside of the bed frame and up into the ceiling.

Around midnight they call me on the radio – the injured patients have arrived

As I drift off to sleep, I remember I had been warned to put a sheet on top of my mosquito net to protect me from the bats in the night… but I’m too tired to get up to organise it now. I’ll have to take my chances.

Incoming emergency

My eyes are barely closed when the supervisor comes to tell me that we have received an emergency call.

We’re expecting patients from a nearby area where there’s been fighting. Someone had called ahead to tell us they’re on their way, their conditions sound severe and we don’t know exactly how many people are injured. Still, it will take some hours before they reach us along the uneven roads.  

Around midnight they call me on the radio – the injured patients have arrived.

The medical staff on-call have moved the patients inside and I join the team in the small clinic room. There are two patients; one with a gunshot injury to his thigh and one with a gunshot to the abdomen. The team quickly get their vitals and assess the injuries.

We have one torch and as we wrap the bandages, I discover that I can use both hands and the light from my phone (no electricity remember) if I perch it in my jacket pocket facing out.

Thankfully enough both patients are relatively stable. The bullets had missed their most critical organs and we get them admitted and started on intravenous antibiotics and fluids. Their relatives are hovering anxiously by their beds.

I leave the on-call medic to continue their treatment and head back to bed for a few more hours of sleep.

The return road

In the morning, there’s a cool bucket shower and some breakfast before I join the clinical team to start the day’s work and review the patients.

The patients with injuries are doing well, although I’m worried about the man with a gunshot injury to his abdomen. We arrange to urgently transport both of them by plane for surgery.

After lunch it’s time for us to start our journey back to Lankien; we have to be back before dark.

pieri_compound_3.jpg

The MSF compound in Pieri
The MSF compound in Pieri

As we set off, I pass the child with malaria, she’s sat up munching happily on a biscuit her brother has given her. She’s likely to make a full recovery.

Then we’re on the road again, bumping and jolting our way back north kicking up a trail of dust behind us.

Halfway through the journey, I’m nearly frightened out of my skin by a loud noise from under my seat. I peer under to find an enormous chicken staring back at me.

The guys find my fright hilarious and continue to laugh as the unfortunate chicken and I both squawk when we pass over the larger bumps. David proudly informs me it is his purchase and promises to be very delicious.

We arrive back, absolutely covered in the dust from the road, but the trip has been a success. Hopefully, the first of many as we try and support our remote sites before the rains come and the roads again become impassable.

Our water and sanitation expert insists I take a shower before I can come into the kitchen and eat. I’ll need to wash my jacket again to have it clean, ready again for tomorrow.

--

Read more: Stories from South Sudan

South Sudan: Plumpy'Nut and messy smiles
The hymn: A young life in the balance in the ICU