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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