Evan is an Australian doctor who has worked in emergency medicine and paediatrics. He recently returned home after working as the Medical Activity Manager in Bangladesh in response to the Rohingya crisis.
“Some race, some stride, some collapse and some must be carried.”
I gaze out the window of our MSF van, as we bump and roll away from the clinic; away from the camp and away from our work. The sun yawns with a pink glow as it slumps low behind the hills and lays down today’s last rays.
From here, a fickle cell phone signal is the only way I can support the doctor on night shift. It’s his first time with MSF as a solo doctor after hours so we speak regularly. As the hours creep toward sunrise his enthusiasm and confidence grows. He helped a mother deliver a baby. He was so proud! His contribution completes our 24-hour cycle of care for the camp.
"A crowd of muddy children fly kites. As they fade into silhouettes, the yellow, pink and green kites dance across the drowsy pink, now red, dusk"
But all that is yet to come tonight, right now I’m still staring out the window. We drive slowly – the only way to safely contend with sleepy cows, distracted pedestrians, speeding buses, lumbering lorries and the swarms of tomtoms and rickshaws on this narrow rural road. Beyond crowded shelters of yet another makeshift settlement, a bald knoll catches my eye. It’s been cleared of anything green and growing, but yet it is alive! A crowd of muddy children fly kites. As they fade into silhouettes, the yellow, pink and green kites dance across the drowsy pink, now red, dusk.
Soon, another patch of soil will surely meet more bamboo and tarpaulin as more Rohingya refugees arrive. Our mobile clinic at the entry point tells us of new arrivals coming across the channel. How many brief, but perilous boat journeys cross this channel? And how many still wait on the other side?
The channel is picturesque; postcard scenes of high-keeled fishing boats and irrepressible tropical trees lining the shores. This morning, the same sunny shore met more refugees. At the entry point some race, some stride, some collapse and some must be carried. A few are inconsolable, and most stare without any trace of expression.
Among the refugees are orphans. I saw one today who was just seven months old, adopted and breastfed by this kind mother – already with four of her own. How they came together was not a well-told story: the baby was found alone in Myanmar by someone else. Where? How? Why? The parents? It’s all unknown but it doesn’t matter, she is here now.
"Among the refugees are orphans. I saw one today who was just seven months old, adopted and breastfed by this kind mother – already with four of her own"
This mother has breastfed this feeble baby alongside her own. She is visibly very tired. Her milk has kept him alive thus far and without her I’m sure the child would have perished. His malnutrition is obvious from across the room; the empty folds of skin, the triangular head, the far too prominent ribs and distant eyes.
Some unaccompanied minors arrive at our clinic because mum is occupied tending to other siblings. That’s the case for the 10-year-old girl who I saw clutching her infant sibling in the waiting area. They were seen, received some medicine (including water and biscuit treats) and asked to come back with an adult carer. I can’t remember seeing them again. I suppose the infant must be better, or at least I hope.
I’m rudely interrupted by a loud ‘ping’ from my iPad. I ignore the intrusion and stare out the window again. I wonder whether the incredibly lush hills offer any hiking trails. The scenery is a violent contrast between beauty and grief. Neither possible to ignore, nor to reconcile, they remain a thorn in my thoughts.
“This shouldn’t feel like a normal place”
This morning’s walk to the clinic was the same as every other day, among intensely green hills and picturesque rice paddies. We are followed by a flurry of waving arms and high-pitched ‘HELLOOOO!’s from smiling youngsters. Whether it’s in sloppy, ankle deep mud with gumboots or kicking up dry dust in sandals it’s an irrepressibly beautiful way to start any day. I smile as I walk in the morning.
A smile is reliably arrested upon seeing the camp again. Is it still right to smile? I don’t know. It’s unsettling, like falling into a puddle, every morning. This shouldn’t feel like a normal place. It’s not.
"Is it still right to smile? I don’t know. It’s unsettling, like falling into a puddle, every morning. This shouldn’t feel like a normal place. It’s not"
Once inside the MSF Unchiparang clinic our staff give me that smile back by welcoming me with their own. Shouted greetings exchanged and we all laugh as I bungle simple Bangla. I’ve been to the clinic every day. There is also an outpost deeper in the camp where we provide medical advice and essential medicines to patients unable to traverse the tricky path to our crowded clinic. It also gives us extra eyes, as we monitor for potential outbreaks – cholera, measles, polio – all possible.
Twice I’ve been to the graveyard for the daily count and three times to the creek – only a few hundred metres deep into the camp. We do this to monitor the mortality levels and so that we can identify any changes that could alert us of potential outbreaks. With these expeditions spaced weeks apart I am impressed by the progress of our water and sanitation teams. The last time I walked this route I was introducing a new staff member to the setting, pointing out how good it was that we were completely free of faecal speed bumps on our narrow path.
The perspective of people within the shelters staring out is similarly distant to mine as I peer in. Shelters, squeezed together, sometimes the density of dwellings crunches a gentle walk into a crouch. From within, many people just stare but there are some smiles. And how sweet it is to reciprocate!
Children account for more than the fair share of smiles and in my mind each smile is defiance in the face of the statistical peril facing paediatric patients. Or maybe it’s just a good distraction. Children don’t know the numbers, but they know hunger. We are seeing more children wasted to the point of severe acute malnutrition (SAM). It is said that if you are a child with malnutrition, you are 10 times more likely to die from common camp afflictions, like diarrhea or respiratory infections.
"All these thoughts sit somewhere in my consciousness as I stare out the window and begin to doze off"
This worries me as I think about the spectre of malnutrition looming larger by the day. We are monitoring it and referring the ones we identify as SAM to the ambulatory malnutrition treatment centres in the camp and, eventually, referring the more severe cases to the intensive inpatient treatment centre MSF has a few kilometres north.
All these thoughts sit somewhere in my consciousness as I stare out the window and begin to doze off. Maybe I’ll have a quick nap. One mustn’t dwell too much on things beyond their control, eh? Meetings, computer work and phone calls are all waiting within our base, so I stop staring. It’s nearly dark anyway so I shut my eyes and nap the remainder of the journey away.