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Barry Suckling – Medical doctor in Akuem, Sudan
In response to severe food shortages caused by the long running civil war and years of drought, MSF first entered Akuem in 1999 providing food and setting up a therapeutic feeding clinic. Since then, it has set up a primary health care centre in the remote town of Akuem in Bahr El Ghazal province. At this centre two expatriate doctors oversee a team of local ‘clinical officers’, providing a range of primary health services. The team carry out up to 1200 outpatient consultations each week. The hospital has about 80 inpatient beds, and there is also a tuberculosis (TB) unit and a therapeutic feeding unit for treating malnourished children.
Since it’s the only medical facility of its kind for miles around, Akuem receives a wide variety of medical conditions. Consequently, Barry Suckling found the mission and the variety of work interesting and challenging. “You’re exposed to a broad range of problems: the main serious conditions in children are malaria, diarrhoea, and pneumonia, but meningitis and trauma, especially burns, are common,” says Barry. Following the cease-fire in 2002 and the subsequent peace negotiations, the region has been relatively stable. As a result, people are starting to return from the north, and travelling is much easier for internally displaced persons (IDPs). This has led to an increase in the number of people gaining access to treatment at the centre. In this remote part of the world, however, patients can spend one or two days – sometimes longer – on foot to reach the hospital in Akuem. “To say to a mother ‘your baby’s fine, now you can go home’ and see her just pick up her baby and leave, faced with a three day walk home, is astonishing. All she has is her baby. No food, belongings, or means of transport,” Barry says.
Typically, Barry and the medical staff in Akuem start at 7.30am and do triage of the 50 to 100 patients who may have arrived overnight. “First we look for the most urgent cases, children with convulsions, for example. Next, we see children with high fever or severe diarrhoea. Following that, we check for other urgent child cases before moving onto women and men. During the day we help the clinical assistants with the outpatient consultations, and with the ward work. One doctor assists in the TB ward, and the other in the feeding centre.” When new patients are admitted with TB, a visit to their home is arranged. “They must have caught it from someone, and the most likely source is a family member,” explains Barry. “A home visit allows the source person to be treated. This way we can prevent TB in other family members, and prevent reinfection of the patient on return home.” To prevent the spread of this highly contagious disease, the TB ward in the Akuem facility is separated from the rest of the hospital. Because the treatment can take up to eight months, treating people with TB is very challenging. “I remember one instance in the TB ward,” recalls Barry, “where there were two mothers with TB – both with children – lying next to each other. When one of the mothers died, the other mother simply took the newly orphaned child and began breastfeeding it. It was virtually a spontaneous adoption, a natural, warm, automatic reaction that was wonderful to see.” MSF’s pioneering experience in the area of TB has paved the way for other organizations to set up similar programs elsewhere in the country.
Another part of Barry’s work in Akuem involved training local staff. “I see education as an integral aspect of what MSF has to offer”, Barry says. “Much of the time we were encouraging the clinical officers to do the work in order to develop their skills. The local staff are very keen to learn and though they learn from us, we also learn a lot from them. They have grown up seeing illnesses which we in wealthier countries have only read about. “One of our TB nurses (all nurses are male) was the only child who escaped when his school was raided by the military, to abduct children to become soldiers. He was 10 years old. He hid for two days before going home. When he arrived home, all his family had been killed. He left and walked east to Ethiopia – a two-week walk. There he was in a refugee camp and received an education in English and simple arithmetic. He returned to this area two years ago, and because of his education, was employed as a nurse. He had two-week on-the-job training, and was then a ‘qualified’ nurse.” It’s heartening to know that since the peace agreement people can travel greater distances more safely. Subsequently, the numbers getting access to medical care is steadily increasing. “The way people here accept what life brings is truly amazing,” Barry says. “There is no sense of blame, just an acceptance of today and a hope for tomorrow.” Lex Hall
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