I arrived in South Sudan six weeks ago now. I'm working with a team from all over the world; Netherlands, Kenya, South Sudan, Sudan, Finland, Ethiopia, America, Canada and I'm currently the only Brit.
The hospital compound consists of an Accident and Emergency unit, paediatric ward, maternity, gynae, pharmacy (which is the most popular place as it has air conditioning!), a mental health service, services available for childhood nutrition and we currently have an isolation building for measles.
I'm working as a midwife in a temporary tent which has three labour beds, two assessment beds, eight postnatal beds, and eight gynae beds. We have approximately 30-40 births a month, and mainly from the Sudanese refugee camp across the road from us, although some live in neighbouring villages and arrive via donkey cart. One lady walked for seven hours to get treatment for her malaria. It's 40°C plus here... I can't even contemplate how hard that journey must have been.
I left a busy London NHS trust to work with a much smaller intake of women. But with six midwives and 10 maternity support workers we keep ourselves very busy. We see a lot of STI's (sexually transmitted infections) here and therefore also have to treat and follow-up with the husbands and co-wives. We also treat a lot of malaria cases, but as we are now in the dry season this should eventually drop. We also offer medical and emotional care to women who are miscarrying, which is a new skill for me. Usually doctors offer this at home but I have been well trained by the midwives here. And sadly we also see women who have suffered sexual and gender based violence. We have a private confidential room for women to be offered screening, family planning, medical exam and emotional support. The mental health officer here has set up a support group for the women every Friday, which I will help run when she leaves this week.
Because our maternity unit is run by midwives there is no operating theatre, so if women need to be transferred to the local hospital (30 min drive away) for a Caesarean section or ultrasound the decision has to be prompt.
Unlike the UK, husbands here are never present, and women usually have with them a caretaker. Caretakers are female companions for the women in labour which could be a mother, sister, aunt or friend. The caretaker feeds, washes and helps with breastfeeding. In return we feed them!
My first official day was definitely one I won't forget. We started the day with handover from the night staff. A mother had just given birth to her 11th baby, something very common here. All was well and she was breastfeeding her babe in the postnatal tent. The women accessing care at the MSF hospital are recommended to come in if it is their first birth, if they have any complications or have had three previous labours.
A first time mum had arrived via donkey cart in premature labour, at approximately 25 weeks during the handover. One fetal heart was heard with the pinard - a horn type tool without batteries that enables you to hear the heartbeat - and consent was gained to check the stage of labour. She was fully dilated and feet were presenting, called footling breech, which in a western context usually means involving an obstetrician and possible need for emergency surgery. As the baby was 25 weeks, and also the ladies first pregnancy, we attempted a vaginal birth. Manoeuvres were used to birth the baby safely and the baby was given to the mum to say goodbye. Babies born this early here have little to no chance of survival due to lack of specialist care.
Soon after this the women complained of further strong contractions and a hand appeared. This was an obstructed labour and was now an emergency. I could not feel the head to turn the baby so the decision was made to transfer her to the emergency hospital where further medical/surgical support is available. On route to the hospital in the bumpy 4x4 I kept hoping the mother would be able to birth this second baby naturally. To have a Caesarean section for her first pregnancy would be devastating as most women here have 6+ babies. Also having a healing wound in the camps would put her at increased risk of infection, not to mention the psychological impact of already losing both her babies but to also have surgery.
On arrival the woman was admitted and I, with the help of our translator, wished her well. I had to go back to camp but didn't want to leave her. Once I arrived back at camp I was greeted at the gate. A baby born earlier that morning had stopped breathing. I needed to return to the hospital with this baby as they were querying obstructed nasal bone. I was given the baby and I continued to resuscitate for what seemed like the longest car journey of my life. The baby was then handed over to the paediatric team where they intubated the baby. I again gave my condolences to the family and wished them well. I was able to visit the lady I had left only one hour ago to find she had birthed the second twin and was recovering well. She would return to us in a few days for continued postnatal care.
I got back in the MSF car and cried the whole way back. I couldn't believe how useless I felt being unable to help both families further. That they had such sadness having to take their babies home to be buried. And as their religion states the babies must be buried as soon as possible, most aren't there to say goodbye. Women from the camps have escaped war, left their home and jobs in Sudan, to have further pain.
When back at the camp one of the midwives gave me a huge hug and we carried on with the shift.