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The state of South Sudan was born in 2011 after years of violence. As a medical coordinator, Dr Kalyan Velivela was at the forefront of planning the medical aid services of Doctors Without Borders/Médecins Sans Frontières (MSF) there next year. He talks about the situation in the country, its large public health needs, and the challenges in meeting them.
My first tryst with the country, also my inaugural assignment with MSF, was in 2009 when I worked in Nasir, Upper Nile State. The learning that began during this time gained momentum with subsequent assignments. Yet I found myself in the newest state of the world again last year, when I came back to work in Juba, the country’s capital. The period was full of challenges and lots of work. Perhaps this is why it was an unforgettable experience too.
My perspective on South Sudan
Many of the problems that I grappled with as a medical coordinator arose from the absence of adequate medical services in the country. The lack of infrastructure further complicated the situation. Among my primary tasks was the supply of medicines to various MSF projects, just to cite an example, and this was not always easy.
Transporting supplies and people to our projects across the country was a huge challenge as there were hardly any road and railway networks. Chartered airplanes were employed to ferry the cargo and people, but the difficulty of the task increased manifold during the eight-month-long rainy season. Planes were sometimes unable to land on muddy airstrips and to avoid this situation, we built stocks of medicines and food in the projects. The bulk of these supplies were augmented in the dry season, where temperatures can soar to 50 degrees Celsius and above.
Trained people who can give medical expertise comprise a small pool in South Sudan, presenting another obstacle to providing healthcare. A mix of diseases assails the country: from kala azar to HIV and tuberculosis (TB). MSF offers treatment to counter these; takes care of mothers and malnourished children through its programmes too.
My team has seen cases where people have walked 12-16 hours to seek medical attention or a pregnant woman was carried on a cot through swamps to approach our centre. The deficiency of local manpower is therefore visible.
What I did
I’d like to explain my role a bit more. As a medical coordinator, I ensured that drugs reached the projects on time and in proper condition and defective ones were promptly replaced. I advised doctors in the programmes on complicated cases, both on clinical matters and the possibility of referring the patients to better healthcare facilities. Working together with the government was an essential part of my responsibilities as well.
In 2012, MSF started a treatment programme for TB and HIV patients in the town of Bentiu in collaboration with the Ministry of Health, a first-of-its-kind initiative. In the future, the hope is to handover charge of primary healthcare services to the government so that MSF focuses on meeting the need for specialist medical care.
To support the teams who look after patients, my team also established medical libraries in the projects, and standardised protocols.
The work I did in South Sudan therefore gave me satisfaction at the end of the day, while I grew as a doctor too.
My learning
I earlier thought that I only possess the clinical skills of a doctor, and not managerial abilities. Through my years at MSF, I have learnt that this is not so. I have been managing — by putting experience into practice — varied nationalities on diverse tasks. It is because of this, among other reasons, that I have developed faith in team spirit.
This is required when working in South Sudan. It helps in undertaking tasks where one has to reach out to people. For example MSF medical care givers walk at times for hours to arrive at villages and stay there over days to offer healthcare services; a demanding journey where the support of colleagues can make a difference.
It is a lot about managing limited resources, and there is also the thrill of working in a multi-cultural setting. That’s the beauty of this experience and not everyone gets a chance like that.
My introduction to MSF
I am the first doctor in my family. My motivation to join MSF came from a presentation its team gave in Berlin. The nature of their work inspired me. I chose to go to South Sudan because I wanted to explore a different context — the African setting — after having worked in India for a few years. Some people in MSF say that if your first assignment is good, then you will continue. The first time I worked with MSF was a great experience. So has been my latest assignment.
Kalyan Velivela has completed four MSF assignments in South Sudan and Uganda, with a maximum period of one year.
