My name is Irena Novotna, and I am currently on my first mission with Médecins Sans Frontières (Doctors Without Borders) in South Sudan. This is a big change for me, compared to the hospital where I usually work in Hradec Králové, back home in the Czech Republic.
I arrived here at the end of June and will be spending a total of nine months here.
The journey was... adventurous.
The heavy wet season is making it very hard for any traffic on local roads. Without a tractor to tow you out of the mud, you won't get anywhere. Covering a distance of 70 km can take up to eight hours. Unbelievable, right?
When it rains, the dry land here becomes a lake and everywhere flows with water, followed by two days of mud, a dry day, and then it rains again.
The rain and the mud I can bear, but there are consequences in the form of mosquitoes and, subsequently, extensive cases of malaria.
We have many, many patients… most of them children
I am now in the north of the country at the Yida Refugee Camp. In South Sudan there is ongoing civil conflict which has included extreme violence against civilians, humanitarian aid workers and their facilities.
From a republic of almost thirteen million citizens, more than two million have been forced to flee to other countries as refugees, and a further two million have been internally displaced. There are many orphaned and abandoned children who have been left here.
Irena examines a young patient. Photo: MSF.
Yet in the north of the country, the dynamics around forced displacement are slightly different.
Here, there are actually refugees from Sudan (South Sudan’s neighbouring country to the north) who have settled here after escaping past fighting in their areas of origin.
In the project where I work, we provide health care to people in a refugee camp that has a population of 54,000. We are providing emergency hospitalisation, vaccinations, treatment of malnourished children, malaria diagnosis and medication, as well as treatment for patients with HIV and tuberculosis.
My friends and family often ask me through emails how do I live here, what do I do? There's a lot I can write about. The experiences and feelings I have to deal with are almost more than I can handle. Writing is actually a relaxation, a mental therapy for me.
When you need to monitor patient life functions, you cannot connect them to machines or monitors… we don´t have any
‘Home’ here is very modest… I'm sleeping in a tent where I have a bed, a mosquito net and a second bed on which I have most of my stuff.
Many friends back home have asked how you can actually wash here. Well, we can have a special ‘bucket shower’. It works by taking a 10 litre bucket and filling it with treated water from our borehole. Then, using a cup, you pour it on your body, and get out the soap!
Depending on the time of the day you have a view either of the tops of trees or the stars: the shower cubicles are open to the sky! We have only cold fresh water, but in the heat - who cares?
Time here runs quickly; there are very few free moments and sometimes I feel really exhausted. After a few days I found that some things are just waste of time, so I gave up on them – that includes make-up or changing clothes before I go to bed. When you have to wake up in the night for emergencies you have to be fast and ready to go.
The hospital that MSF / Doctors Without Borders operates here is very well equipped by local standards. However, compared to what we have at home, it is not at all the same and is very basic. For example, when you need to monitor patient life functions, you cannot connect them to machines or monitors… we don´t have any. You just simply sit down with the patient and do it yourself.
We have many, many patients… most of them children unfortunately.
For example, we recently admitted two malnourished boys. One of them also had malaria, but fortunately we managed to treat it. After we finished feeding him with therapeutic milk, we gave him Plumpy’Nut® - a sweet peanut-paste high-energy food for children.
The baby boy looked very happy, and he was particularly pleased when we told his mother that this is a medicine, just for the child and not for the whole family. He knew he wouldn't have to share with anyone!
You really have to find ways to stay fresh and to be able to draw energy from small joys
A young patient on the ward. Photo: Irena Novotna / MSF
A few days ago, I was woken up at eleven at night, right after I got to sleep. Emergency case!
I was sleeping fully dressed, the same as I do on night shifts at the ICU. I managed not to get tangled up in the mosquito net and started off quite quickly.
They brought in a girl with convulsions, only responding to pain, she had a pulse and was breathing: clearly, positive malaria. Judging from appearances, it also looked like meningitis. I couldn't do a lumbar puncture confirmation – we don´t have the equipment and also nobody who would be able to evaluate it anyway.
Nothing could be done for diagnosis so we started treating both illnesses. I gave her medicine and hoped she would start to improve. She started to vomit! Right after we turned her on the side, thank god she did not inhale it into her lungs.
I would very much like to have a ventilator, at least a tiny one...
Sometimes I just have to deal with patients with the equipment that is available. We have many varied cases and you never know what you are going to get through the door!
This little girl came into the hospital with bronchiolitis. For two days she could barely breathe, even on oxygen. We were all walking around her on tiptoes to avoid increasing her breathing frequency, but in the end she made a full recovery. Photo: Irena Novotna / MSF
My first day off came after six weeks of hard work! You really have to find ways to stay fresh and to be able to draw energy from small joys. I rejoice primarily from the stories of my patients who make good recoveries.
When the kids heal and we have to keep them for few extra days in the hospital, I give them a balloon made from inflated surgical gloves to keep them entertained. Sometimes they destroy them and then they are afraid they will not get new ones. So I get little notes with requests not to forget about those new balloons. But these are really beautiful worries to have.
I'm really happy about stories like this one: we had here a boy with meningitis. After I saw him I really thought he wouldn't make it. The next day I came to see him and I couldn't believe my eyes - he was sitting up in bed and wanted breakfast!
We have a lot of miracles here that make our work worthwhile and we do our best with what we have
I even got a birthday present! That girl we admitted at eleven at night - the one with malaria and meningitis – she woke up! I went check on her, but she wasn't in bed. I was afraid of the worst. But no, she was not dead, the nurses had taken her to have a shower. And what's more ... she walked there by herself and the nurses only had to give her a little support!
Successes like this make it all worthwhile.
In some ways, my new workspace is much the same as my old one in the Czech Republic. Even here, I find it hard to accept children dying. I know that it's to be expected: we see mostly children here and they are the weakest. The grief of their families isn't any less than at home, but we are confronted with it more often. However, we have a lot of miracles here that make our work worthwhile and we do our best with what we have.
In my work here I often think of the people who donate to Doctors without Borders / MSF. I am grateful for the fact that they make it possible for me to be here, and all of the patients and their families are grateful for the care that donors allow us to provide.
If you give to Doctors without Borders / MSF, please know that after you've done the best thing you can, it's our turn. We use all available means to save as many lives and alleviate as much suffering as possible. Donors are an integral part of what we do and I thank you sincerely for your contributions… it makes a huge difference believe me!