It’s still pitch black out when I wake up to a siren-like alarm. I’m disoriented and it takes me a moment to remember where I am and why on earth there is a siren going off. I look at my phone. It’s 4:34 am and I remember that I am aboard MSF’s rescue vessel the Dignity 1. The alarm means that we have received a distress call from one or more boats who left in the night to attempt to cross the Mediterranean from Libya to Italy. It is telling us we have about 20 minutes to get to our stations in order to respond to the distress call. I scramble to get dressed, put on my safety gear and splash water on my face. This is my first rescue ever and I am so nervous thinking about everything that could go wrong that I think I may vomit. I receive a reassuring smile from the logistician, who grins and says “This is it. This is why we are here”. And I know he is right. We are well stocked, organized, and prepared for a safe rescue.
I am told that the flimsy white rugby boat I can barely make out in the distance has over a hundred people in it and that there are several more in the vicinity. I feel unexpectedly overwhelmed with emotion when I see the refugees perched, without life jackets on their dinghy. I have seen so many pictures of these boats that I didn’t think it would hit me this hard. It is so dark, all it would take is one stray wave and the entire boatload of people would be swept into the sea; the only proof that they were ever there, being some white plastic and floating water bottles. It’s truly a terrifying thought and I feel much more at ease when I see our sailors distributing life jackets to everyone and bringing the first group onboard.
The men are lining up to be registered and receive provisions, a few weak or near fainting when they first board, but no one seriously ill. The sun is coming up by the time they are all aboard. During a lull I strike up a conversation with one of our new passengers. When we first visualized their boat, it appeared to be driving away from us. I asked him if they were trying to avoid our boat and why. He responds:
“Some of us, we were so scared. We thought you were going to shoot us. We didn’t know what to do. We were so scared”.
Hearing this, it becomes very clear to me why people collapse upon boarding our boat- they have just gone from abject terror to relief and that is a lot for a malnourished, dehydrated, sea sick, heat exhausted person to process and accept. He goes on to tell me, that he had left his country a year ago to escape a difficult life there. When he arrived in the new country he had his papers confiscated and was put to work in slave like conditions. He shows me the scars he has from abuse at his previous “job”. Is it still considered a job when you are being kept against your will and only paid sporadically? I ask myself. The fact he feared we were going to shoot them makes a lot of sense to me now.
We arrive at another 100 plus passenger boat and this one has over 20 women and children. The women start to board our boat and my job at this stage is to register them and identify any unaccompanied minors or passengers needing medical attention. I try to smile and make eye contact with each woman and child as I register them- I can see that many are still scared or unsure and I want them to know they don’t have to be. A woman collapses as she enters the women’s waiting area and my colleague helps her to sit up and eat and drink a little bit. We place a white bracelet on her wrist signalling that we need to do a more thorough assessment as soon as everyone has boarded. The next woman enters and is cradling something tiny. My heart beats faster; if the men arriving on the boat are collapsing, what condition will we find this baby in? I uncover the baby’s face to see she is breathing and responding normally and I feel a wave of relief. The little babe is ten days old and already on quite the journey.
The process of loading 4 more boat loads of people onto the Dignity 1 continues all morning while the medical team (a doctor, another nurse, and I) are in the hospital seeing urgent patients. By noon, our final passenger count is 466 people. My colleague Antonia and I complete a general health check for all passengers aboard and send urgent cases to the hospital to be seen by our doctor, Pierre, immediately. This means that we have taken the temperature, spoken with and performed triage on each passenger on-board. After the general check, we join Pierre in the clinic and start to see patients as well.
Today there is a lot of emotional distress, dehydration, skin conditions, and sea sickness, but luckily, no one is in too critical of condition to be treated by our team, in our very limited medical setting. I came across a patient that I triaged earlier with somewhat vague symptoms, but a temperature of 38.5. The doctor invited him to lie down and he struggleed to do so. We can see he is in pain. The patient speaks French, and even though we are speaking to him in French, it seems like the patient either does not understand what we are saying or understands but cannot express what is wrong. He points all over his body when asked where the pain is, but can’t seem to verbalize anything further. Suddenly this young man breaks down sobbing and the truth pours out. He tells us that he had been held captive and forced to work in Libya for the last several months. He had been tortured during this time and shows us many scars. The most recent beating has left him with severe bilateral rib pain (likely a combination of fractured ribs, pneumonia, and a hemothorax- blood pooling in the lungs) and is in complete emotional and physical agony, and from the looks of it, I cannot tell which is troubling him more. This is the first time he has had medical attention for his condition. I watch, extremely impressed as our doctor, Pierre manages to soothe this young man while also doing a complete assessment, preparing medications and listening to his story. He walks out of our hospital looking more hopeful than he came in.
We continue seeing patients throughout the rest of the day and into the evening as the seas grow rougher and rougher. I make a round with anti-nausea medications before I go to bed myself and can tell that we are all (staff and passengers included) feeling relieved that the day is over with no deaths or major emergencies, but very ready for sleep.
The next morning I do a round in the women’s waiting area and everyone seems to be doing well. I stop to chat with a woman who has a 4 month old baby with her. He is healthy and bright and I gush to this mama how beautiful her little boy is. She smiles- she is well aware. She pulls me in closer to her and whispers “Il etait jumeau...”. “He WAS a twin? What happened to his brother?”, I ask automatically. She shakes her head and I see tears rolling down her cheeks. She doesn’t want to talk about it, but she says she hopes her remaining son has more of a chance than the one who passed away. I hope he does too.
Later that morning I have a woman approach me who states she thinks she is pregnant. We give her a test and Pierre informs her that she is not pregnant. She seems very relieved to get this news and she reveals to him that she did not want to be pregnant because it would have been the product of a rape. I sit down with her and record the aspects of her rape in a medical certificate that she may use as she likes, either to attempt to press charges against the person who raped her (unlikely as her country is currently embroiled in an ugly civil war) or to show to mental health workers in Italy in order to get some psychological support if available. As part of the care we provide to victims of rape, we provide treatment for sexually transmitted infections (STIs). I treat her empirically for common STIs and explain the importance of an HIV test. She nervously offers her finger for me to obtain a blood sample from and sits emotionless while we wait for the HIV results. After 20 minutes I am able to share the good news with her. Her test is negative and given the fact that the “window period” for HIV to become testable has passed, she can consider herself HIV free. A wide grin spreads across her face and she jumps up shaking my hands in joy. Her joy is infectious. She starts to jump up and down and I can't help but join her. She throws her arms around me and gives me a beautiful, heartfelt hug. Is this really my life, I think? Do I seriously get the honour of doing this for a living?
We continue to see patients, many of whom seem to be dealing with as much psychological pain, as physical complaints. The stories of trauma seem to bubble over in our patients unlike anything I have ever experienced. Seeing a patient for a simple skin infection turns into a story about how the patient saw his brother get shot in front of him in Libya. He said he knew it would be hard to make a life there -his brother warned him. His brother also said it was possible to get by if you worked really hard. When he used his savings to get to Libya and join his brother, it was just in time to see him get shot and killed by men he couldn’t identify. He just kept repeating to me “I didn’t know them; I don’t know why they did it. I don’t know why they shot my brother”. I could treat his skin condition, but aside from giving him the space and time to talk, there is not much more I can do for the grieving man.
The seas have been rough through the night and morning, but are getting worse now and the boat rocks incessantly. Waves are as high as 2-3 metres. Our passengers are sea sick. We are sea sick. The hospital is over 40 degrees with no airflow (joys of working on an old shipping boat!). The need to stay hydrated easily pales in comparison with the need to have nothing in my stomach. My colleague Antonia, looks green, vomits over the side of the ship and admirably, somehow, returns to work. I have to keep leaving the room to get air to keep from getting sick myself. We are not working at maximum efficacy to say the least, but we have dealt with all the urgent cases, pre-natals, and children and decide to do a round on all decks with anti-nausea medications before taking a break ourselves.
We take turns doing watch shifts in the evening so the sailors who have slept little and worked constantly throughout the last two days can finally get some rest and most of us get to bed late that evening. Early the next morning we arrive at the port in Sicily. The Red Cross tents are waiting for us, along with other NGO’s, Italian government officials and a medical team. The disembarkation of our passengers takes several hours and the atmosphere is a little impatient, a little nervous, but joyous. The women sing and play with their children. The passengers exchange contact information and joke and talk like they have known each other for years. Finally our last passenger disembarks and we set to the task of cleaning the ship. We are tired, but happy. Every one of our 466 passengers has made it to shore alive.