LETTER FROM THE FIELD: Vanessa Naidoo, Afghanistan

Vanessa Naidoo, aged 27, is an anaesthetist from Cape Town who left South Africa for her first assignment with MSF in February 2012. Initially she was sent to Khost province in southeast Afghanistan to work in MSF’s new maternity hospital for six months but after bomb blast at the hospital she and her colleagues were temporarily transferred out of Afghanistan. Until safety assurances for patients and MSF staff at the Khost hospital are being negotiated Vanessa is working in the MSF supported Timugara hospital in northwestern Pakistan.

Tell us about the new maternity project you were working with in Afghanistan.
In March MSF opened a specialised 56-bed maternity hospital in Khost province, which borders Pakistan. The aim was to provide free maternal healthcare – including deliveries, obstetric care, pre- and post natal care – in a region which has seen intense fighting since 2001 and where women's healthcare has been neglected.When I arrived in February, the construction and renovation work on the old hospital building was still ongoing – the despite the hospital being weeks from opening. It was my first experience of helping to set up a hospital from scratch:  in three weeks, we had to hire and train local midwives, develop all the hospital guidelines and systems, receive and store the drugs and equipment, and assemble the beds and trolleys.
What were the biggest challenges that you and your team faced in Khost?
The maternity hospital is a strictly women-only environment, which means all the medical staff had to be female. However, we really struggled to find qualified female staff locally, as there are far fewer education and training opportunities for women in these parts. We ended up recruiting midwives from a local midwifery school where they only had 18 months of experience and having to provide on the job training for them. I was training six midwives who had never been in an operating theatre (OT) before! They learned really quickly, but it meant everything took longer to implement. Maintaining hygiene procedures and keeping things sterile in the OT needs to be done properly and would take longer to do.Training would continue throughout the day, and if things were quiet, we would also give English classes. It became a very positive, engaging environment to work in.
Was the hospital busy?
At first tings were slow. In March on the opening day, we had no patients. On the second day we had one patient – a complicated case that required a caesarian section. However very quickly we saw an increase in the number of patients: in the first two weeks of April we did more operations than in the whole of February combined at the maternity. We also started receiving more patients in a serious condition, patients who were traveling from neighbouring provinces, and referrals from private clinics. By April, I was doing four surgical procedures a day – mainly caesarian sections – which is a lot, if you consider that everything took longer to do there. By the time MSF suspended activities on 17 April after an explosion at the hospital, we had performed more than 600 deliveries and helped 100 women who had complications during their pregnancies.  
What were you doing on the day that the hospital had be closed temporarily?
On the morning of the 17 April I was doing some paperwork in the adjacent MSF office. We suddenly heard a blast coming from the hospital area and we felt shockwave seconds thereafter. We quickly realised a bomb had detonated in the outside hospital toilet. We rushed over to see if anyone had been hurt; fortunately, no one was killed and there were only a few injured. I stayed very calm, probably because I was thinking like a medical professional, and was making sure everyone was okay. By day-end, our Field Coordinator had taken the difficult decision for us to leave Khost, and most of us had left by the following morning. We transferred all our patients to a nearby hospital so they were still able to receive care. It was incredibly frustrating to leave – the hospital was full and there were many patients waiting to be seen. But to stay at that moment, was to put ours and their lives in danger.
What will happen now and will you be going back to the project?
MSF and local authorities are conducting and investigation into what happened, and MSF is working with local community leaders and others get safety assurances to prevent similar incidents from occurring. Until this happens, we can’t go back. By mid-July we should know what the outcome is. Most of the international staff working on the project have decided they want to go back to Khost. We feel responsible for our patients and the local staff we were training. MSF has found many of us temporary positions in the meantime, which is why I’m currently filling in for an anaethetist in Timugara hospital in Pakistan. I’m trying to stay positive, because I know the healthcare needs in Khost remain, and that even within the short space of time we were working there we made a big difference.