Fieldset
Water is life: a day in Palorinya refugee settlement
There are now some one million refugees in northern Uganda who have fled the violence in South Sudan. They are living in four refugee settlements, where MSF is one of the few organisations present working alongside the Ugandan Ministry of Health. In June, Chris was working as a nurse manager, overseeing the activities of two of the five clinics run by MSF in the Palorinya refugee settlement which provides home to some 170,000 people...
 
The night before had been a very stormy one with thunder, lightning and torrential rain lashing our living compound. I was lucky that my hut kept me dry, so even with disturbed sleep I felt ready for what might come on the day ahead.
 
My days here are varied, travelling between two Médecins Sans Frontières / Doctors Without Borders (MSF) clinics in Palorinya settlement. It can involve giving informal training on clinical matters based on MSF’s guidelines, following up with staff on triaging and consultations, pharmacy management, clinic hygiene and general trouble shooting.
 
As I travelled by car to the first clinic with my medical colleagues, some five miles into the Palorinya settlement, we passed hundreds of improvised shelters made of plastic sheeting and branches stripped from neighbouring trees. These serve as home to the refugees. I wondered how these shelters weathered last night’s storm.
 
It certainly hadn’t dampened the spirits of the many children who waved excitedly seeing us pass by. Despite seeing us twice a day, six days a week, they nevertheless gleefully wave, dance and call out to us, providing a continual chorus all the way to the clinic.
 
 
Photo: Chris Peskett / MSF
 
The night’s rains had turned stretches of the dirt roads into virtual quagmires, adding time to our journey.
 
The mud is incredibly slippery, as I recently learnt, finding myself strewn in a mud bath as I slipped when stepping out of our Land Cruiser. At least my fall provided considerable amusement for the children standing nearby.
 

With just one more night of heavy rain the clinic floor could be fully submerged”

Eventually arriving at the clinic, thanks to the mastery of our driver weaving through the mud, we began by assessing the level of flooding. Items in the clinic already sit high on tables and benches – it is now normal practice to keep everything off the ground, anticipating the worst. Thankfully only the outside areas had been affected though: with just one more night of heavy rain the clinic floor could be fully submerged.
 
 

Photo: Chris Peskett / MSF

 
Many of our staff are themselves refugees and one of our nurses tells me that her plot of land has been submerged. She had done all that she could to move her possessions away from the reach of the rising water at least for today and says that for now she prefers to remain at work, caring for those who manage to reach the clinic. Her presence makes a difference; she and her colleagues assess all patients, fast-tracking those in critical condition.
 
The rains bring many dangers to health. Children in particular are now at an even higher risk of acute watery diarrhoea than previously, as the flooding is entering the open pit latrines. Without treatment, this can easily result in death. My nurse colleagues quickly identified and referred for consultation children with such tell-tale signs as dry mouth, sunken eyes and skin that does not return to its normal appearance after being given a gentle pinch.

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A crowded tent serves as an MSF clinic
One of the MSF clinics in the settlement.
Before I left to visit the second clinic, our guard asked for permission to return home, his family having sent news that his home is now being submerged by rising waters. An understanding staff member quickly volunteers to take his place to enable him to go home quickly.
 
The second clinic is some three miles away and, together with the surrounding population, is situated on an area of high land. It was unaffected by the flooding, but the many small pools of standing water left by the rains mean that many patients there are presenting with malaria. Staff here are concerned that the number of malnourished children is going to increase - malaria often causes vomiting and diarrhoea in children which can lead to poor food intake and hence malnutrition.
 
I spend the afternoon working with our hardworking nursing team, being called in to advise on any complicated cases. There is an incredible team spirit, working for the betterment of so many vulnerable people, a spirit which will continue with me long after I have left.

Water is life

As I make my journey back to base we see water tankers returning from supplying some of the water tanks put up by MSF around the camp. Though the rain brings many health problems, a truck emblazoned with the words ‘Water is Life’ reminds me of the huge need for water.
 

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Children fill up a container from a leak in a water tank that's got stuck in the mud in Palorinya refugee settlement. 
Children fill up a container from a leak in a water tank that's got stuck in the mud in Palorinya refugee settlement. 
Located near the Nile, MSF has set up a water processing plant near Palorinya settlement which is capable of producing some 2 million litres of drinkable water a day, ready to be distributed throughout the camp by a fleet of 34 tankers. It is a major operation, providing 80% of the population’s drinkable water. However rain, again, is a mixed blessing as the worsening state of the roads is making the daily water haulage an ever more challenging undertaking.
 

 
Driving back to our base at the end of the afternoon things look a little drier due to strong sun during the day. However, this is only a very temporary respite as I remember that the rains have not yet begun in earnest.
As we again pass by the temporary shelters affected by flooding, I cannot help thinking of their inhabitants who have not only been forced to flee their homeland but are now facing the prospect of having to uproot yet again, now forced to abandon the precious crops that they have been labouring to grow. These thoughts continue long after I return to our comfortable compound.