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Myanmar: On going, a part of me.

Going through my journal entries I reflect my time working at the Kutupalong, Myanmar, clinic a months back. The clinic is the largest MSF facility in the area providing emergency, outpatient, maternity, mental health and inpatient care for the Rohingya and local population.

Before the influx, there were three international staff doctor working at the clinic, one which I replaced. I am in admiration of how he managed to cope in the job single-handed. There are two of us now, but today the other two doctor went on a trip to visit the MSF health posts that provide primary health care in the camp, so I was left to my own devices!

When you are by yourself in the clinic, you spend your day here, there and everywhere. You are called to review patients in all departments, make decisions and support the Bangladeshi staff. These are some of the patients I saw today:

1.      A boy with a fracture to his femur having fallen in a drain.

2.      A girl who was shot in the eye and was well following surgery. She had a simple case of conjunctivitis and could go home.

3.      A 20-year-old woman who fled Myanmar one month ago and has since had seizures. She has had 15 episodes this month alone.

4.      A man who had cut the tendons in his hand with a knife whilst working. We referred him to a surgical department for repair.

5.      A child with an acute asthma attack.

6.      A baby with low oxygen levels and likely congenital heart disease who we will discharge with advice as we have no treatment available.

7.      A lady who has been taking HIV treatment for approximately 10 years. She ran out of medication whilst crossing the border. Her son is also HIV positive. We will arrange for them both to restart treatment.

8.      A 70-year-old man who had a stroke one month ago, he had weakness of the right arm and leg. We will arrange physiotherapy.

9.      A young boy with a badly fractured wrist with the bones no longer in line.  

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10.  Lots of patients with chronic lung disease; women from cooking on open fires without ventilation and men from smoking and open fires. Some required oxygen.

11.  An 18-year-old woman who had fallen on the cooking pot and burnt a large area on her chest.

12.  A five-year-old boy with Henoch Schonlein Purpura (an autoimmune disease) who was now improving having developed a very badly infected rash. He is receiving antibiotics and sitting under a mosquito net to protect the wounds.

13.  A family of four children and their mum. One of the children had fallen and hurt her jaw whilst crossing the border. She had been referred by an MSF mobile border clinic as she was unable to eat. She was now running around the ward with her sisters waiting for discharge to the UNHCR (the United Nations' refugee agency) registration point where hopefully someone will help them find shelter.

14.  A 15-year-old boy who looked like he was six having not grown since then. He was withdrawn and not socialising. We offered counselling to support his mental health.

15.  A boy with recurrent nose bleeds and a low haemoglobin who needed a blood transfusion. His family accompanied him to see if they could donate blood.

16.  A one-day-old baby with low blood sugar and an infection.

17.  Many patients looking fed up with their measles in the isolation tent.  

18.  An 18-year-old girl with heart failure. Who knows why? We will never know.

19.  A drowsy child with watery diarrhoea and dehydration.

20.  A one-year-old boy with malnutrition and a chest infection who was breathing rapidly and requiring oxygen. He was given antibiotics and admitted for the feeding programme.  

21.  A patient with a longstanding cough and weight loss. We suspect TB and will investigate.

22.  A 35-year-old man who had a pelvic fracture when he was hit by a car. Although it was repaired, he now walks with a Zimmer frame. He was admitted with pain and was distressed as he has nowhere to go and no family to help.

I saw an array of other patients, too long to list. It puts my normal job in the US in perspective; I imagine I may be a more relaxed doctor when I get home.. 

The poor conditions that most Rohingyas live in have a direct impact on their health. At one point we received 13 people who had been bitten by a rabid dog that had run through the settlement. There’s no end to their suffering. When I am sitting at home and it starts raining heavily, it’s hard knowing they are trying to sleep outside under the rain. I don’t even know if it’s worse when it’s raining, or when it’s burning hot and they have no clean water.

This is not the only conflict in the world, but it's very frustrating seeing the suffering with your own eyes, and then seeing what's considered important back home. 515,000 might seem like an abstract number, but as a doctor here you see what that actually means. People are in profound need of help. Currently still working on the Obstetrics to Midwife program so that one day midwives in Myanmar will be ok with out the presence of MSF. Looking forward to returning to what feels like my 2nd home. 

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BANGLADESH: Hear me out

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BANGLADESH: Hear me out

I struggle a lot sometimes with these blogs... trying to figure out the best way to talk about what is going on, give an accurate picture, represent somehow the reality of where we work. i want to be honest and say what i know of the people we are serving, but still avoid the pitfalls and traps of speaking 'for' people. so really, all i can do is say what i see.

I've been trying for days to put into words what I've seen and been told about individuals, humans just like you and I, who have been forced using unimaginable violence to be uprooted from their homes, their own country. Here are just some of the images from just entering camp about an hours drive  from Cox Bazaar, the everyday evening sun in Kutupalong refugee camp, and encountering an interesting and unexpected  community radio. I commend everyone here truly making the most of what they have, for instance the mighty creative vehicles constructed by a 9 y/o. 

The clinic was consistently busy, with around 350 patients a day in the outpatient department and around 200 admitted patients a month. The people had run out of money and their health deteriorated.

We saw more and more people with severe malnutrition, particularly children under five years old. At one point we had 20 patients a day with severe measles in our isolation tent. We received a lot of trauma, and lots of accidents involving children, tetanus, rabies, and other cases I wasn’t used to seeing at home. At the facility we rarely see a newborn that weighs more than 2,500 grams (around five and a half pounds). The mothers are usually malnourished, so the babies don’t have a very good start.

But even then, there are some things i will never talk about explicitly in this blog. the survivors that come to the clinic have stories that are not mine to tell, and would never be appropriate for this forum. but i could give you glimpses perhaps from what i read in the papers, stories that are printed every day of young women assaulted by people they know, or women attacked as they walk home in the night, in the day... really it doesn't appear to matter when they are walking...

and there will never be photos of our beneficiaries. i will show pictures of the clinic when empty, and from that, you will have to imagine a monday, when every bench is occupied by women and their family, women and their friends, women and those who support them/ depend on them.

i want to tell you all a story about people working so hard to fight back against the injustice of violence. i've met so many people who, whether survivors or allies, are committed to ending sexual and domestic violence in png. i could introduce you to high level politicians, to women i meet on the street, to volunteers i talk to in meetings... and i want you to hear that story while i explain the reality of violence here, the scope of it.

and i can tell you our little story, as msf. our story of medical support. of a small act in the midst of this struggle. while it rages on, we say very simply, we are here, you deserve medical treatment, you deserve your health, it is not negated by someone else's violence.

that is what i can tell you.

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BANGLADESH: First impression

A tremendous electrical storm woke me from sleep with a terrifying show of lightning, accompanied by driving rain. It lasted more than an hour. When I got out of bed the next morning, I stepped into a puddle. At first I thought that window frames were not water-tight, but then I realized the toilet had leaked into the bedroom. Backflush.

 Petee The Goat. I was told not to start naming animals because I'll end up getting attached and want to take them home...

Petee The Goat. I was told not to start naming animals because I'll end up getting attached and want to take them home...

The minivan arrived at 7:15 to take us to work. I began to regret having eaten a greasy omelette for breakfast. We made good progress driving north, despite dozens of goats on the road. To our left, semilunar fishing boats were beached, ready to be launched at high tide. To the right were prawn hatcheries. 

We hit traffic driving south on the main road, National Highway 1. All traffic was at a standstill. But patience is not a virtue held by Bangladeshi autorickshaw drivers and after a couple of minutes, they came buzzing past, horns blaring, belting down the wrong side of the road. Someone asked our driver what was the cause of the holdup. He slowly and deliberately said, “It…is…a…traffic…jam.”

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We thought that there may have been an accident and I considered getting out of the van to see if my services were needed, as a medical Good Samaritan. My colleagues advised me against it. Discretion prevailed, but imagine the newspaper headlines, “Expat medical team remains cosseted in their air-conditioned vehicle while Bangladeshis perish in road crash.”

In front of us, a truckload of Bangladesh Signals soldiers in rather fetching camouflage uniforms climbed down onto the tarmac. Their officer looked efficient. He had a row of pens and pencils tucked into a pocket on the sleeve of his uniform. He strolled down the road past the stationary vehicles, looking into the ditch. I wondered out loud if he was considering whether it could be possible for a truck to bypass the obstruction by going off-road. “No, he’s just looking for a place to pee,” said one of the Water & Sanitation engineers in the minivan. 

When we started moving forward, the drivers behind us became irritable and parped their horns if we didn’t immediately drive closer to the vehicle in front. We overtook the source of the blockage, a massive earthmoving machine mounted on a low-loader. At last other agencies were responding by supporting infrastructure. I guessed that the machine would be leveling ground for the new Red Cross/Red Crescent hospital by the side of the road at the Rubber Garden. It was far too big to tackle the muddy tracks inside the camp itself.

The hospital is muddy and miserable when it is raining. Rain pelting on a corrugated iron roof makes such a racket that taking a history is almost impossible. The consulting rooms and wards have concrete floors, but the tents have flooring made from plastic sheeting. People find it difficult to get to the hospital because the paths in the camp have turned to muddy streams. Old people who venture out run the risk of sliding and slipping in the mud, fracturing their wrists and hips. More work for us.

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