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South Sudan. MSF doctor checking the heartrate of a child in intensive care. Photo: Olga Overbeek
More than 170,000 refugees have crossed from South Kordofan and Blue Nile states in Sudan, and are gathered in five camps in remote and inaccessible areas of South Sudan. Many of the refugees arrived in a very weak condition after weeks of walking, and the health situation in the camps has varied from bad to disastrous in the past months.
In Batil camp, in South Sudan’s Upper Nile State, mortality was more than double the emergency threshold, according to MSF data from July. Up to half of children under two years old in the camp were malnourished, and MSF declared the health situation catastrophic in August.
MSF’s Dr Roberto Scaini offers an insight into a typical night shift working at MSF’s field hospital in Batil refugee camp:
Night time is a critical moment in the field hospital here
"We start with ward rounds so the day shift doctors can tell me about their patients. Last night, we started with a man in the inpatient department who had just been brought in with suspected meningitis. We did a lumbar puncture, taking a spinal fluid sample. The result was cloudy, which meant we needed to send it off for further laboratory tests. He was in a critical condition.
"The other place I need to know about is the severely malnourished intensive care ward. Last night, all the patients were stable apart from one girl who was extremely dehydrated and having constant diarrhoea. We have to give her a special fluid to replace what she’s losing with the diarrhoea and vomiting. We weigh her hourly because we are giving her a lot of this fluid but need to make certain that we are not overloading her system as that can be very dangerous. These children are so weak that we give them this fluid extremely slowly with a syringe. You have to do this carefully all through the night: Give fluid, check weight, wait. Give fluid, check weight again…
"We always have some patients who are very ill, who can go from just about stable to seriously sick in seconds. The other day a child we were treating for severe cerebral malaria started having convulsions - that was two hours of intense activity. When a child goes into seizure…you have to stop the seizure immediately as the shortage of oxygen can lead to brain damage. We followed the usual emergency protocol for seizures, but then she stopped breathing. So we had to start manual respiration with a breathing aid, but this was difficult as she was having really bad convulsions, shaking and writhing on the bed. Through all this, we were ventilating her manually because if you stop ventilating for two or three minutes, the patient could die.
"The drug to stop the seizures has a side-effect of lowering a patient’s breathing rate. We had to stop the seizure, so we needed to keep giving her the drug, even though it was affecting her breathing badly. After about 25 minutes, we managed to stop the seizure, but this is really long for a seizure and the risk of brain damage was high.
Sometimes we are lucky
"At one point I started thinking that this child is eight years old, the same age as my daughter. I think this somehow helped me to keep going, and I kept ventilating the child for 40 or 45 minutes, which is really exhausting. Then suddenly, her chest started to move...and she was half-breathing. I continued to support her breathing for a while and, little by little, she started breathing by herself. Throughout the rest of the night she was unconscious but stable.
"The next evening, when I came back at six o’clock, she was sitting and drinking. She stopped and smiled at me. She must have recognised me from the previous night. So I did some quick examinations and yes, her life was saved and it seems without any obvious brain damage. I don’t believe in miracles, but sometimes we are lucky."