MY FIRST MISSION WITH MSF

Introduction

My name is Kalyan Velivala. Let me tell you a bit about how I came to know about MSF. I had been working in India in the field of Internal medicine and in ICU’s .My family wanted me to pursue a specialization .Therefore I applied for a ‘Masters in International Health’ and a Diploma in Tropical medicine and Public Health’.

I received the ‘Erasmus Mundus’ European scholarship and thus pursued my specialization. During my years of specialization I met people who had worked for MSF and had faced the challenges of the work for years and survived it with a smile. ‘My first introduction to “realtime” humanitarian work.’ I decided to learn about MSF and understood the role of MSF as a primary health provider and intervener during outbreaks and disasters.

What is MSF?

After intensive research I had come to understand that it would be a satisfying journey to work with that MSF is a politically neutral, medical humanitarian organisation and is well known for voicing its own opinion. MSF does not discriminate between caste, creed, sex or colour and works in places of natural and manmade disasters. Thus I applied to work with MSF.

Preparation

After a thorough screening process, I was informed about my first mission with MSF at Nasir, Southern Sudan. I prepared myself to undergo PPD – Primary Pre Departure Training in Amsterdam. When MSF called me for the training I had a vague picture of my assignment at Nasir and was apprehensive about the conflict and security there. At the PPD, I met 38 people from diverse backgrounds who were extremely enthusiastic about working with MSF .The drill was fun, interactive and gave complete knowledge and information about the major health problems, situation and security concerns. This gave me an insight and a broader view on the MSF mission and purpose.

About Nasir

Nasir is a Southern Sudanese town on the Sobat River in Upper Nile near the Ethiopian border state. The town has lush green planes and rich water resources and unpolluted natural beauty. The Sudanese people call it a small town but my eyes only saw a small village with no infrastructure, one or two buildings and a small market. The presence of MSF and its air-strip is why the natives call this place a town .MSF started their hospital in Nasir in 2004 and in Southern Sudan since 1988. The Sudan mission of MSF is an NGO which provides primary and secondary health care in the region. A large inpatient occupancy and number of OPD consultations explains it. My job responsibilities were larger than I had thought. I was responsible for inpatients ward, paediatric ward, and tuberculosis. Kala-Azar, leprosy and HIV/AIDS. I had a large number of national staffs and my responsibilities included training and motivating them for the challenges of the place.

Team

After receiving a handover and briefing from the previous doctor, I took charge of activities of the mission. The first few weeks were challenging. I made myself familiar with the hospital and the national staff. I also understood he guidelines and the protocols applied in the region clearly. The team support and spirit was extraordinary. This helped me immensely. I felt not only could I survive under these trying conditions but also continue to stay and work here for many more years.

After I returned from my first holiday back to my mission project, I met my new team. With that came new ideas, challenges, crisis and confusion. Soon the issues were smoothened out.

Medical Action

Kala-Azar Assessment

According to sources, we came to know about a large number of Kala- Azar and related deaths in a place called ‘Longichokioo’, a small town which is a 10 hour drive from Nasir.There were no active partners or intervening organisation.MSF thus decide to assess the situation and act on it. A team constituting two medics (Trees and Me) and our data collector Isaac set out for the task. We took with us an estimated number of test kits, drugs, tents and food supplies for our team incase we needed to stay on. We reached the site and assessed the local staff and did rapid diagnostic tests.

Kala-Azar Patients waiting for Injections, MSFH, KA Mission,
PAGIL, South Sudan

We noticed a few proven cases of Kala- Azar .The staff skill and knowledge being elementary, we continued with our operations. We gave the patients primary treatment and referral to MSF Hospital for further treatment and management of complications. Some of the patients actually showed up for treatment and were cured. It added to my experience to address a situation during an assessment.

Paguil mission

In February, we were sent for 10 days for Kala- Azar intervention to a remote isolated place called‘Paguil’ in the UNITY state. Outbreaks of Kala- Azar occur every 6-8 cycles in these regions. The Acacia tree forests, large scale cattle camps, socio-economic factors and seasonal influence contribute to such outbreaks. As the Ministry of Health (MoH) did not have the capacity to intervene, MSF took the initiative to diagnose, treat patients and reduce mortality.An expat team of ( two – three in numbers) were working since three months and had already diagnosed and treated around 250 cases.

My presence was to support the team (i.e. to fill the gap during rotation for a period of 10 days) with the diagnosis and treatment. Though it was for a short period, I adapted and carried on my tasks well. It boosted my confidence and skills in treating patients in such remote areas.

Though it was for a short period, I was able to adapt and carry on my tasks well.It boosted my self confidence and skills in treating patients in such remote settings. This was one the best times in my mission.A voice within me said- “I would be among the very few who have stepped on this land, staying here and treating the people.

When I returned to my project, there were escalations and suspicions of meningitis outbreak/ epidemic during 2009 to 2010-2011.Adding to it is the hot- dry season which favors outbreaks.

Acting on this, I got involved in training natives and staff on the clinical features, diagnosis and treatment of suspected meningitis. Personally, I was involved in lumbar punctures on suspected cases for identification of the organism and the subsequent treatment. I gained immense experience as I performed LP’son small children.

HIV/AIDS INITIATIVE

I was involved in the HIV/AIDS component with my dear friend and project implementer Daniela. I supported her on analyzing the case files and scaling up the HIV activities. I did a lot of research and reading on the subject.

We took up intensive measures to counsel people on drug adherence issues and a disclosure approach was carried out from VCT counsellor.Our effort fructified in April when the HIV component was restarted, and I initiated ARV’s on five patients after fulfilling the criteria. It was one of the major achievements for me on my first mission.

End for a new future

As I returned from my second holiday, the rest of my time spent at the mission was very quick. Before I could imagine, my replacement was in the field. As I handed over, I remembered the days spent and explained the insight of the mission and gave relevant information. The memories and smiles of the children, the people and the place will always be with me.

In conclusion my first mission with MSF was great, and I learnt a lot professionally and personally. Thanks to MSF, its presence and its work with the less privileged people, I received the opportunity to serve them on behalf of MSF.

My future plans now lay in working for MSF and for the cause. Till then Bye…