THANK YOU.

MSF INTERVIEW
with Paras, Field Worker

Paras is a medical doctor from Melbourne. To date, she has been on two missions with Médecins Sans Frontières, travelling to Sudan and Ethiopia. Below she tells of her experiences....

Where was your first mission with MSF?

In August 2005, I was sent to South Sudan where I spent seven months working in a primary healthcare centre. I arrived during a post-conflict situation and was very fortunate to be there at a time when there was a semblance of stability and people could actually start to rebuild their lives. However, it wasn’t entirely secure and there was still a desperate need for medical services.

While in South Sudan, what illnesses were you seeing on a daily basis?

When I arrived, I was ostensibly the tuberculosis doctor due to my background in adult medicine and infectious diseases. At the time, there was also a large malnutrition emergency and we had about 350 children in our therapeutic feeding centre. And it was the middle of malaria season, so we were treating about 150 kids a day with suspected malaria in our outpatient malaria clinic. When I turned up to work in the TB hospital, I also found myself in charge of the outpatient malaria department.

We had a huge problem with people going to markets and getting malaria injections. This would cause terrible soft tissue infections and abscesses that we would have to treat by means of minor surgery. During one major outbreak of malaria, our inpatient ward was completely overrun, mostly with children under the age of five. Often there were two children per bed and two more on a mat between beds. There just wasn’t enough support; we were the only primary healthcare centre in that area.

Was there a particular experience that sticks in your mind?

I’ll never forget a woman in her twenties who was admitted to the inpatient ward. She was eight months pregnant, had two children and was also ill with malaria. She had been carrying a huge sack of food on her head and fell down, fracturing one of her vertebra. As a result, she became a paraplegic. And because there wasn’t a place we could refer her to, we did the best we could by treating her for malaria, providing her family with a mattress and making sure that when the time came, we’d be able to evacuate her to a referral hospital so she could deliver her child safely. It was a big lesson for us to work out the reality of what it meant to be a woman in South Sudan.

Was it frustrating not having the same level of drugs at your disposal as in Australia?

You become very pragmatic and learn to adjust. While some diseases are very easily treatable, others are more complicated. The one time I was really quite shocked was when I had a young girl with diabetes requiring insulin. While easily treatable in Australia, in South Sudan it is actually a terminal disease. We were able to get insulin in from Kenya, had the facilities to store it and it was theoretically possible to train a family member to administer it.

But the reality was that this girl lived four days away by foot from a hospital and it was just not feasible. Malignancies were another example of things we just didn’t have the capability to treat. So it was very difficult to have to tell people, who may have travelled three days by foot to your hospital and had very advanced cancers, that we just couldn’t cure their disease. Coming back to Australia, it really hit home how much people take for granted.

How did you deal with all the hardship, poverty and distress on a daily basis?

The good part about being in Sudan is that you’re able to do something and be part of a solution. And though the solution may not be perfect and you certainly can’t help everyone, you approach each day thinking you’re trying to do the best you can for the people who’ve made it to your doors. Then, of course, you’ve also got the support of your colleagues who are all in the same situation. Paradoxically, what I found most difficult was returning home and realising how lucky we are in this country to have what we have and how some people don’t seem to appreciate that.

What was your next mission after Sudan?

That was a TB project in northeastern Ethiopia, one of the hottest places on the planet. MSF had been running a TB hospital treating nomadic people for about six years. This project is fairly unique in the world, because the patients are semi-nomadic, meaning it’s very difficult for them to remain in the one place for six months, which is the minimum amount of time that we normally treat people for tuberculosis. So we had adapted a TB drug regimen whereby patients would receive treatment under directly observed therapy for four months and, barring any complications, they would go home for the last three months of their treatment.

Hopefully they’d return at the end of three months for a final assessment and to be told whether they were cured or not. The most rewarding aspect about working on the TB project was that you would get to see the visible effects of your treatment. One patient I’ll always remember was a man in his 30s with a severe case of tuberculosis of the hip. His only companion was his 8-year-old daughter who had to do everything for him – his wife had passed away. Within about four weeks of beginning the therapy, he started to make an almost miraculous recovery. But the biggest change was in his daughter, who was now able to be a kid again, playing with other children and enjoying her own life.

Was there any time when you felt scared for your own safety and wellbeing?

I went to South Sudan with a great deal of trepidation. Thankfully, MSF have been doing this for a long time and there are a lot of security precautions in place, so you quickly learn to put your trust in the hands of your support team. The short answer is: no, I didn’t really feel insecure at any stage.

Was there any major difference between Sudan and Ethiopia, particularly in terms of infrastructure?

There was a huge difference. Everything in South Sudan had to be brought in by aeroplane from Kenya. Where I was working, it was very isolated and there were no real functional roads. We were trying to rebuild a TB centre and improve our inpatient ward, so a bag of cement was worth its weight in gold.

Ethiopia, on the other hand, has had peace for quite a number of years and is much more developed with a functional health and educational system. And although they have a big problem with HIV – as is the case with most African countries – I have a lot of hope for Ethiopia.

In South Sudan, some of our nursing staff used to come to work wearing four layers of clothing. I couldn’t work out why, until I asked someone. It was because during the civil war you used to wear everything you owned in case you had to run into the bush in the middle of the night. So although there has been peace for two years, there’s a whole generation of South Sudanese who have grown up knowing nothing but war, and it will probably take some time before the people can put that behind them.