Treating refugees in Tanzania: Perspective

Saschveen has recently returned from assignment with Médecins Sans Frontières / Doctors Without Borders (MSF) in Nduta, Tanzania, where she was providing vital healthcare to the many Burundian refugees there. Although the team has limited resources, today she reflects on just how much they have been able to achieve...

On some days, of course, things get you down.

I've found that one of the hardest things in my role is trying to help refugees gain access to essential surgery. We don’t have an operating theatre or a surgeon here, and rely entirely on external service providers (non-MSF hospitals, outside of the camp) to try to get our patients the surgery that they need. 

The resources at the nearest hospitals, and at other NGOs that coordinate these surgical transfers, are severely limited and hence it is exceedingly difficult for people to access the surgery that they need. 

It is amazing how much is still able to be done right here in our hospital, even with all the constraints on time, resources and people power

Our wards are often populated with many patients needing treatment for deep bone infections, abdominal masses, various suspected cancers and other debilitating or disfiguring tumours or conditions. 
Often people either wait on very long waiting lists just in order to be able to go for a surgical opinion, and due to the situation worsening over the recent months, many of our patients aren’t able to access diagnostic or surgical care in a timely fashion. 
We advocate for our patients and do everything that we can within our hospital to provide the best standard of care, but it can be quite overwhelming at times when what happens outside of our fences is completely beyond your control.  
Sunlight breaks over the trees in Nduta refugee camp, Tanzania
Sun breaks over the trees in Nduta camp. Photo: Saschveen Singh / MSF.
One of the things I do in these moments to help keep things in perspective, is to take a few moments to walk around the health facilities we have here. I remind myself to focus on all the things that we CAN actually do, and that do make a huge difference. 
It is amazing how much is still able to be done right here in our hospital, even with all the constraints on time, resources and people power.
At these short stitches in time I just marvel at all the activities that are happening simultaneously at any one moment: you can walk past the emergency room where people are resuscitated and brought back to life with emergency treatments, then past the out-patient clinics and see patients receiving life-changing mental health counselling and support for the terrible traumas they have endured. 
The clinical officer checks on four infants in the newborn ward
Clinical officer Jesto cares for babies on the neonates ward. Photo: Saschveen Singh / MSF
Then you can into the maternity department where an incredible 500 or so babies are born per month, and make a stop into the malnutrition ward where at least some of the children, who were admitted in the days before, gaunt and lifeless from a severe lack of nutrients, could now even be seen sitting upright with their mothers and finally playing again (maybe even smiling, just as all kids all over the world should have the right to do). 
You can walk into the adult ward and find your amazing team of nurses and clinical officers and doctors at the bedside providing compassionate care to someone with a debilitating or terminal illness, and then visit the isolation ward where your patient with multi-drug resistant tuberculosis is making good progress on her very long and arduous treatment course, with the help of so many hard health care workers on the ward to support her.  
You can stop in at the training tent and see a new generation of dedicated nurses and clinical officers participating so attentively in learning sessions to improve their clinical skills and knowledge, wanting to provide the best standard of care to their patients. 
Group shot of MSF's adult ward team in Nduta camp, Tanzania
Saschveen with Dr Simon Masanja (front right), the medical doctor of the adult ward in Nduta, and some of the dedicated team of nurses, clinical officers and translators. Photo: MSF
You can then wander past the infant and toddler ward to see a row of babies splashing in buckets under the trees, where the health promotion team are teaching the mothers how to bathe their precious babies safely to ensure good hygiene and prevent at least the avoidable infections. 
You can even leave the hospital grounds and attend one of the six peripheral health posts that are dotted around the vast camp where you will see mothers proudly lining up in the clinic to have their babies vaccinated. Needless to say, there is no “anti-vaxxers movement” here, as these mothers see first-hand the devastation that infectious diseases cause in their vulnerable community: sadly many mothers lose at least one child in their lifetime due to severe, and often very preventable, childhood infectious diseases. 
All these activities are ALL possible to see within just a few hours of a single day, on any day, even over the weekend. And then you start to understand what exactly you had heard people talking about, not only this concept of the “huge MSF machine” in all its far-reaching impact, but more simply expressed: this is the quintessential example of how teamwork unites us for humanity.
And it totally rules!