Beyond the frontline

Ruby wrote this and the following blog posts in January and February 2016.

Ruby wrote this and the following blog posts in January and February 2016.

I’m beyond the frontline! I can’t believe it. This is my fourth visit to the Bentiu emergency and this is the first time I’ve visited Bentiu town. Before the conflict that ripped apart Unity state, MSF ran a routine hospital-based programme in Bentiu town. Compared to now, it was a calmer, more carefree time. We had the stability to focus on more chronic diseases like HIV and TB and had a large cohort that we were treating.

But then the country descended into civil war in December 2013 and within months MSF had to evacuate Bentiu town and our hospital was ransacked. Bentiu became the new frontline and we were rarely permitted to cross.

Now two years later, we have tentative peace, and MSF has returned to the town. Not in the same hospital building but in a clinic down the road. The town is quite a sight. In some ways it’s a bit of a ghost town. It’s clearly been a battlefield. There are destroyed buildings, burnt-out cars and rubble-strewn streets. Even my room, in our very basic MSF accommodation, is covered with bullet holes and has major cracks across the wall.

Bentiu town

A scene from Bentiu town © Ruby Siddiqui / MSF

Yet people are starting to return to this ghost town. There’s now a bustling market that’s expanding, there are cows wandering through the streets and music blasting from all over. We’re driving through the market when we get a flat tyre. This is slightly unnerving. I’m unsure how we’ll be perceived in a setting where there’s still much suspicion. But people soon surround us and a few men step in to help. The kids start pushing and prodding the ‘Nu Kowai’ (white girl, which I’m not!). It’s a relief. We’re a curiosity, not a threat.

Its early days for this new project but the team is ambitious. We have started health clinics and plan to re-start TB treatment programmes. We also wish to focus on sexual and gender-based violence; an issue that we know has been a prevailing theme of the recent conflict.

But first we want to set up community surveillance. We really need a sense of the true population size and the rate at which people are returning; and we need to understand the key diseases affecting the population. We have identified 22 community health workers that will perform this work and I chat to two of them, Rebecca and Paulino.

Rebecca is a no-nonsense woman who just seems to have the right advice for every woman we visit. I want her to adopt me! And Paulino is so knowledgeable about the town. He takes us to the key water points and we realise the water and sanitation situation in Bentiu town is dire. There are no latrines, few working water points, no hand-wash points and no soap distributions. Women are collecting and drinking untreated water from the river. There is open defecation everywhere. Conditions are ripe for a hepatitis E outbreak, a disease that recently hit the nearby Protection of Civilians camp.

And, worryingly, we have started to see patients with one of the main symptoms, jaundice (‘yellow eyes’). Our team carries out a mobile clinic in the two neighbourhoods where we have seen most of these cases. Six people are positive for hepatitis E. We ran out of tests so cannot test two pregnant women that have arrived.

Hepatitis E is particularly serious in pregnant women with up to 25% case fatality. We brace ourselves for some strong lobbying. The water and sanitation situation needs to be improved in Bentiu town, and fast.