Fieldset
Finding my feet

It’s Saturday here in Hangu. Came as a surprise to me, as I could have sworn it was Friday when I woke up. The perks of being on call 24/7; rather disorientating. But it was a welcome surprise, as the pace of life is somehow a little slower on the weekends.

It’s Saturday here in Hangu. Came as a surprise to me, as I could have sworn it was Friday when I woke up. The perks of being on call 24/7; rather disorientating. But it was a welcome surprise, as the pace of life is somehow a little slower on the weekends.

I’m sitting here in our backyard and it’s rather idyllic. There are birds chirping and flitting amongst the trees. The sweet perfume of roses in full bloom lingers on the gentle breeze. There are mulberries on the trees whose branches hang over the garden, staining our feet purple as they are squashed underfoot. Being the weekend, the general sounds of daily life are hushed. And being early afternoon, it is quieter still. The lunchtime call to prayer has come and gone and now even the children’s laughter and playful banter has quietened as everyone seems to take time in the afternoon to rest. I too relish the afternoon ebb in the flow of patients to the emergency department, giving me this moment of quiet reprieve.

This is my first mission with MSF, and despite sounding clichéd, it truly is a dream come true. And when asked, is it what I thought it would be? I can’t help but feel it is everything and more.

I am here in Hangu, in the Khyber Pakhtunkhwa (KPK) region located in central-west Pakistan, surrounded by three Federally Administered Tribal Areas (FATA), near the Afghan border. The MSF project comprises an emergency department and an operating theatre. These are all located within a Ministry of Health run complex with a maternal and child health (MCH) facility (also run by MSF midwives).

I don’t even know where to begin to share my story of life here in Hangu. Three weeks has already felt like a lifetime. Not because the days drag on: quite the reverse. Each day is so full. Too much happens, too much to remember, too much to tell.

My role here in the Hangu project is to oversee the functioning of the emergency department and newborn unit (NBU), which for those of you who know me, is pretty much my dream job! Back in Australia, I am an emergency medicine trainee with a newfound passion for paediatric and neonatal intensive care; there’s not too many places you get to combine the two.

Within days of arriving here, I was reminded of what a colleague told me when I was in Islamabad: that Pakistan had chosen her, rather than her choosing Pakistan. I think if I was asked the same question, I’d have to say Hangu has chosen me. However, the idea of overseeing a department was probably my greatest source of anxiety before arriving, as I am yet to have such a senior role in my career back home, and was feeling rather apprehensive about my ability to fulfil the job description. I know I’m using past tense, which might imply that I have managed to achieve this – which is hardly the case. But I am slowly finding my feet.

The emergency department and NBU are staffed by an amazing crew of Pakistani nurses and doctors who are all incredibly competent, knowledgeable, efficient and skilful. Every day I am learning new things from each of them. The department obviously runs 24 hours a day, but like anywhere, there are busy and quiet times. In some ways the department is resource-rich, having many of the drugs and resources I would regularly utilise at home. It greatly impressed me on my arrival. However, in many other respects we operate with very limited resources.

We have off-site x-rays of variable quality, ECG and rapid diagnostic tests for haemaglobin and malaria (vivax and falciparum), but no other pathology. We do, however, have a bedside ultrasound machine, which I am using on everything I can think of and slowly learning to make sense of the differing shades of grey!

One of the things that most struck me when I first arrived was the impact of investigations on patient flow. How much quicker we are able to see patients, make clinical decisions and achieve disposition* when we aren’t waiting for tests, results, images, etc…. to shape our diagnosis and management plans. It is a striking contrast to the way we practise medicine these days in Australia: where we are increasingly over-investigating and treating patients to achieve such little gains in clinical care and at such exorbitant costs.

*Disposition refers to the management plan which determines where the patient needs to go – whether they should be admitted, discharged or referred to another centre.