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The challenges of working in a country where the medical needs are huge

19 Apr 2016

Australian anaesthetist Michael Ward has completed his first mission with Médecins Sans Frontières. He recently returned from a six week mission in the Central African Republic (CAR) working as an anaesthetist in the capital Bangui. Here he shares his experiences working in the field with Médecins Sans Frontières.

What were your general responsibilities working in Bangui, CAR?

I was the head anaesthetist of the maternity ward for Castor maternity hospital which is a local hospital supported by Médecins Sans Frontières in Bangui. I was in charge of anaesthesia for maternity patients and I was supporting and training the national anaesthetic staff and nurses. We were performing about 800 deliveries a month however, with the increasing troubles from the civil war, the number of deliveries dropped to almost nothing as no one could move. People were literally locked down. As peace returned the number of deliveries rose sharply and we were at 550 deliveries per month by the time I left.

"with the increasing troubles from the civil war, the number of deliveries dropped to almost nothing as no one could move. People were literally locked down"

What are the challenges facing Médecins Sans Frontières in CAR?

CAR is a failed country.  One quarter of the population is displaced, none of the infrastructure is working properly and the medical needs are huge. By my understanding there are less than 30 nurses anaesthetists for the whole country. That’s a huge shortage and there is no school at the moment for anaesthesia, so they’re not training anyone. And then there’s the logistical challenge of getting supplies and equipment to the hospital as flights to Bangui happen only twice a week and there is a real possibility of convoys getting hijacked due to the unrest. I don’t know how the logisticians do it; I’m really amazed. 

What were the main medical issues coming in?

We had a lot of post-operative bleeding and post-delivery complications brought to Médecins Sans Frontières from the other referral hospitals in the area. We ended up doing 13 abdominal surgeries while I was there. There was a high risk that someone would bleed to death every day unless we operated on them.

 

Can you remember one particular patient story that really stands out?

We had a woman come into the recovery room with a massive postpartum haemorrhage and she needed an immediate operation. We had to move fast and ended up operating in the recovery room! She made it through and I have a photo of her the next day smiling. That’s what I loved about working in this hospital: every day we saw people and babies that would have died if we weren’t there.

What made you decide to do a mission with Médecins Sans Frontières?

Médecins Sans Frontières is organised and it delivers actual care in difficult places which would otherwise go without. You’ve got to make sure that you know the context you’re going into, the impact you’ll have on the local settings, and what’s going to happen after you’ve left. Médecins Sans Frontières understands the importance of this and prepares appropriately. The medical people are the minority. All the other people are actually getting water and drugs in, and administrating local staff – that’s a huge undertaking without which I couldn’t do my job. An anaesthetist is only as good as the equipment they’ve got and even getting simple equipment to the field is a huge ask. If you want to be effective in short-term missions you actually need the support service that gets you there.

 

 How do you feel about your first mission with Médecins Sans Frontières?

The placement was rewarding, and it was hard but not as hard as it could have been because the work in CAR is established. There’s a huge support network and it’s a big operation. You’re never going to be ready for every aspect of it, there’s no way you can be. It’s basically a question of going back to basics and doing simple clinical practices. In short, yes; it’s definitely worth doing.