Treating refugees in Tanzania: "The hospital is overflowing"
Katharine blogs about what happens when unexpected events threaten to overwhelm a medical project, and how MSF responds to make sure needs are met...
Hello good people. I've been slack about writing again. For the last eight weeks, I’ve been working at Nduta refugee camp. It’s also in western Tanzania near the border with Burundi and north of Nyarugusu camp. Unlike Nyarugusu project, Nduta is rapidly growing.
MSF is the main health care provider here and runs a hospital with an emergency room, adult & pediatric wards, maternity, reproductive health, and an isolation ward. With the expanding camp population, generally poor health of many newcomers, and the impressive fecundity of Burundian women, the hospital is overflowing with patients. There aren’t enough beds to hold everyone or even enough interior space to hold enough beds. When the number of admitted patients exceeds the bed capacity, people get to share a bed with a complete stranger. Maternity beds may hold two moms and their two newborns. Pediatric beds hold two sick kids, two parents, and maybe an extra kid who is too young to be away from mom. Things get confusing fast.

People wait  to be seen by MSF healthcare staff. Photo: MSF

When MSF projected their 2017 budget and goals for Nduta, they planned for a hospital serving a population of 55,000 Burundian refugees. Humanitarian crises don’t always lend themselves to accurate long-term planning. As the camp population swelled to more than 123,000 people, the result was a shortage of beds, space, medications, staffing, everything. We now have an updated & approved budget for the current camp population (yay!) and plans to expand the hospital to meet the needs.
MSF also staffs six health posts to provide primary care for the camp residents and refer emergency cases to the hospital. Each health post is staffed by 3-5 clinical officers (COs), as well as nurses, nursing assistants, a drug dispenser, health promotors, midwives, and midwife assistants. My role in Nduta is to work one-on-one with the health post COs to improve diagnosis and treatment skills. I sit with them while they're evaluating patients and we discuss the case and treatment. 
Aiding me in my work with the COs is the MSF book called Clinical Guidelines. It presents the most commonly seen medical conditions and how to treat them. When the COs are unfamiliar with how to approach a certain condition, Clinical Guidelines can direct them towards the diagnosis and treatment.