A DAY IN THE LIFE: MÉDECINS SANS FRONTIÈRES (MSF) CLINIC AT DERA MURAD JAMALI, BALOCHISTAN, PAKISTAN

South Sudan gained independence from Sudan in July 2011, becoming Africa’s first new country since Eritrea in 1993. Since then, however, hopes for the future of the young state have slowly crumbled and in 2013, as the government collapsed and intercommunal violence reached explosive levels, South Sudan edged towards civil war.

Purchaser Mohammad Aslam sees the impact of Dera Murad Jamali’s isolation every time he places an order for supplies. “We can’t buy medicines locally – we have to order them from Islamabad every three months,” he explains. “Sometimes we have a problem with international cargo and we have to ask other MSF hospitals or clinics in the country. Just this week we needed some injections and we asked Islamabad, who asked the MSF team in Chaman, who sent it to the MSF team in Quetta, and then Quetta sent it to us – it took more than two days.”

There are few options for quality healthcare in the area, with the nearest major centre of Jacobabad about 40 kilometres away, and private clinics – of which there are only a small number – charging tens of thousands of rupees for caesarean sections, for example, an impossible cost for most families. As well as being excluded from medical care, the people here have been displaced by internal conflicts and affected by social violence.
As Australian nurse David McGuinness says, there are many challenges when working for MSF in a location like Dera Murad Jamali: “Stories of loss, tales of terror, another bomb blast, another kidnapping, and children literally starving to death [but] the work being done here is invaluable and the impact it has on people is undeniable.”

Dr Raj Batra was working for a public hospital before he joined MSF. “There were poor people who couldn’t access healthcare and were being denied the proper treatment,” he said. “When I read about MSF’s independence and impartiality, I said I wanted to join.” As the medical focal person in MSF’s Dera Murad Jamali clinic, Dr Batra supports all the departments, including maternal and child health, the feeding programme for malnourished children and the mobile clinics. He explains: “The biggest challenge is that people in this area are not educated about health issues and often depend on home remedies. For example, with breastfeeding, women often avoid using the first milk from the mother. But we know how important that first milk is – with nutrition and antibodies for the baby.”

In charge of the maternal and child health departments at the clinic is midwife Gaudesia Waitherero Kimani from Kenya. She is responsible for the birthing unit, antenatal and postnatal care, and the nursery. She draws on her experience working as a midwife with MSF in South Sudan to advise co-workers on the best medical treatment.

“We have many cases of pre-eclampsia and mothers haemorrhaging, which is life-threatening. In the nursery, it takes time and you have to be patient. The prognosis of the babies is very poor, due partly to lack of hygiene in the community and because many parents don’t come to the antenatal clinic for vaccinations, which would protect the baby.”

When an emergency situation arises, the team pulls together – such as when fruit seller Shair Khan and his family were rushed to the MSF clinic with serious burns. Shair Khan had been awakened by his daughter’s shouts to find his tent engulfed by flames. His first thought was for his six children inside. “I went to the side of the tent and tore it, and took my children out,” he recalled. “Nine people, including me, were living in that tent – we were using candles for lighting.”

Once at Dera Murad Jamali hospital doctors began treatment and extra staff were called in. The mother – who had the worst burns – and one child were transferred to another hospital six hours’ drive away. Sadly the mother died but all the children were eventually discharged, and Gaudesia Waitherero Kimani still remembers the way the staff worked together that night. “Everyone still talks about it and how happy we were with the way we responded.” David McGuinness agrees, saying: “As I have seen on many occasions, the MSF staff worked through these difficulties together and committed themselves to the patients, to help achieve the best outcomes.”