Sunday, April 25, 2021

We had to leave Nyankunde

So it’s been a week since we fled Nyankunde. I have not written about the experience, mostly because I didn’t know what to say.  Most importantly, we are fine.  We are safe.  I am in Bunia.  Lindsey and Emmanuel are in Aru, and plan to travel to Adi tomorrow. This is in the Northeastern corner of the country. It is a safe and calm place to be.  


Things in Nyankunde had been heating up for a while. The military presence had become more visible.  There had been skirmishes with the militia.  Without getting into all the details, things got dramatically worse.  We endured several days of heavy fighting in and around the town.  The population panicked and fled to any location that seemed “safer”.  At one point we had around 50 people huddled in our living room.  When there was a lull, they simply disappeared into the countryside.  


The interesting thing about such an experience is simply how little you know what is going on.  Rumors fly around, but there are few hard facts.  All you know for sure is sounds.  Little booms, big booms, closer and further away. You hear single shots, and bursts...and you wonder what they can be possibly shooting at!  At a certain point you head for the shower and hunker down.  At several points I heard bullets whizzing over, but at no point did I see a person firing a gun!  I don’t know how many were killed or injured. I don’t know who “won”.  All I know for sure is that they used a lot of bullets.  


Lindsey and Emmanuel did great under the circumstances. It was stressful. My impulse is always to try to be reassuring.  “Things are fine.  It’s still far enough away.”  Keep a calm voice and demeanor.  At a certain point it just doesn’t seem to work. What worked for Emmanuel was simply to let him watch videos on the iPad.  At one point he figured this out.  He could hear gunfire in the distance and would say “I’m scared...I think I need to watch a movie.”  It is hard to describe the emotions you feel in such an event.  There is a very visceral reaction to the sound of close gunfire.  Frankly it is terrifying. We also felt our  hearts breaking for the suffering of the people. 


We stuck it out for a while, hoping that things would settle down.  On Sunday, the noise of fighting and the large explosions had intensified.  It was pretty clear that it was time to leave.  When there was a lull, we put our bags in the car and drove out.  We stopped at MAF and we learned that they had made the same decision to evacuate their staff, planes and vehicles.  We drove down the airstrip and took the shortcut that leads out to the main road.  This shortcut is a path that I usually run in the morning.  It is a little path which goes over a small bridge, through a little village, over another little river and up to the main road.  It effectively took us well away from the region of conflict.  Everything went well, until we crossed the bridge. At this point we were met by a group of militia.  It was a ragtag group of young men.  There were around 30 of them and they looked like they were headed into battle.  Lindsey and Emmanuel crouched down.  I started waving, smiling, and giving them the thumbs up.  I told them that I couldn’t stop, and they let me drive past.  We turned onto the main road and drove towards Bunia. 


So much has happened in the past week, that it’s hard to reconstruct it.  We initially attempted to arrange some sort of UN cooperation to evacuate the remaining staff from the hospital.  This was not successful.  Perhaps there are situations in which the UN peacekeepers might protect the staff of a hospital, but this was not one of them.  In the meantime, the hospital continued to function.  They treated a number of wounded militia and provided medical care to civilians and the patients who remained.  I am intensely proud to say that the hospital never shut, never ceased to care for people and is still functioning today.  They find themselves in a region which is now controlled by the militia. We do not know what the future holds, but the fighting has died down.  We are hopeful that some sort of negotiations might be possible. 


I have made two trips back and forth to Nyankunde. On the first trip we brought food and supplies.  I operated on two patients with grave injuries.  Since then one has died.  I went up to our house and retrieved our parrot. He was a bit unsettled but seemed ok.  I managed to get him in the cage and put it in the car.  The dog was nowhere to be found. I recovered some of the more valuable hospital equipment and left without incident. 





The next day I took Lindsey, Emanuel and the Stafford family to the airport. They flew to Aru and will soon travel to Adi. After what they had been through, it seemed better to get them to a peaceful place.  Bunia itself is also a kind of chaotic place these days. In the afternoon, I went around pleading for assistance. This paid off big. I was able to get an emergency medical “kit” from the ICRC.  This was 19 boxes of the basic supplies we would need to keep the hospital running. I also spoke with Samaritan’s Purse, who generously contributed food and fuel.  I was able to leave the next day with a Land Cruiser full of essential supplies.  



The next day I went back to Nyankunde. This time I did not hear any gunfire or explosions. It actually seemed quite peaceful. I rounded with the doctor who stayed behind.  I helped them to sterilize some instruments.  No one is interested in learning how the autoclave works, until you don’t have anyone else to run it!  Luckily I was very familiar with it. I went around to various houses, trying to retrieve valuable items which had been left behind.  At our house, I was met by our dog, looking a bit worse for the wear, but alive and VERY happy to see me.  Turns out this dog really does not like the sound of gunfire. I got him into a cage which I secured to the roof rack. We loaded up the care with patients and caretakers who wished to leave. We stopped by MAF to get some valuables, and drove back to Bunia. The hardest thing of the trip, by far, was that one of the patients had a broken leg.  He was in agony for the entire trip and each bump of the road resulted in moaning.  There are a lot of bumps in that road.  Despite trying to go as slowly and gently as I possibly could, it was an agonizing experience for everyone in the vehicle. 


Anyway, that’s more or less the situation. I am hoping to go back tomorrow. The situation is calmer and I desperately want to help the hospital to continue to function.  By the grace of God and the courage of the staff who stayed, this hospital is still functioning.  A sense of normalcy is returning. It is not possible to predict what will happen in the coming days, but I pray and hope and believe that we will return and continue to serve.





 

Tuesday, April 6, 2021

Troubles of Childbirth

April 6, 2021




Maternity 


This is a serious post from a heartbroken pediatrician.  I know the statistics: neonatal deaths account for 40% of deaths in children <5years of life.  Most neonatal deaths occur at home within the first 28days of life, especially in Sub-Saharan Africa and Southeast Asia.  Midwives are critical in decreasing death rates.  Check, check, and check.  Now what can we actually DO in a low-resource area with insecurity, to really make a difference?


Imagine that you simply did not have access to prenatal care as a first-time mother.  Imagine now that you feared for your safety to simply travel 10km to get help.  You go into labor at home, at night, without a midwife, an epidural, or a birth plan.  Labor does not progress and you are in severe pain, unable to walk.  You can’t travel at night due to insecurity.  The next morning the baby is not moving and you travel by motorcycle to the nearest referral hospital.  The nurses receive you with care and compassion, but the baby doesn’t have a heartbeat.  


We see this almost EVERYDAY!  Many babies are dying before they have a chance to be born in OUR HEALTH ZONE!  We are seeing the reality of women coming to the hospital with obstructed labor and babies in distress or already dead.  If the hospital doesn’t respond in a timely way(and even if they do), we see babies die in our hospital as well.  These last few months our Nyankunde Hospital’s maternity department saw upwards of 10 fetal deaths.  In previous years the number of fetal deaths was 1-2/month, so this current crisis is truly a public health emergency.


Insecurity and violence have long-standing effects on a community.  There are obvious sequelae of violence: death, displacement, children don’t attend school, families break apart, roads close, and people sell/move valuables.  Then there are less obvious effects of violence:  negligence of children, psychological trauma, not to mention the inability to farm rural areas, and lack of access to health care.  Violence always affects the most vulnerable among us:  pregnant women and children.  


At present there are only 4 of 12 health centers functioning for prenatal care and uncomplicated deliveries in our health zone.  The other 8 health centers are closed due to insecurity.  This means that women are probably not getting any prenatal care.  Many of them are going into labor and delivering at home because they come from insecure areas.  Women are not traveling due to insecurity of the roads and they simply are not arriving in time.  Babies are dying at home.  


This is the worst that I have seen fetal and neonatal mortality since we arrived in 2013.  It is sad.  We have decided that it is time to re-open a ward for antenatal care from insecure areas around Nyankunde.  The facilities aren’t much to speak of, but adequate.  It is a room close to the maternity ward with beds, mattresses, mosquito nets, and access to clean water and washrooms.  Ideally women with higher risk pregnancies would come 2-3weeks prior to delivery, as well as first-time mothers, women with repeat caesarian sections, or women from insecure areas lacking a midwife.  We plan to consult these antenatal cases when they arrive 2-3 weeks prior to delivery.  We will be making public health radio announcements welcoming women from these outlying areas with little/no access to care, first-time mothers, and anyone who needs a safe place to live for the weeks preceding delivery.  We may need to use the hospital vehicle to pick up these women on certain days at disclosed locations.  These women will need to be promptly evaluated and determine what their needs are.  There is a precedence for this kind of intervention in this area, but we have no idea what the community response will be.  The response could be tremendous. 


-Pray for us as we see the breakdown of insecurity in our area, to not lose HOPE for the future.  

-Pray for our maternity department as they desperately need more experienced nurses.  We have lost a lot of good nurses due to insecurity and decreased salaries.

-Pray for the physicians working with pregnant women in this high risk environment.

-Pray for the message to get out to more isolated areas and for women to be willing to come.  

-Pray that we would find the right support person(s) to support this effort.



Thank you for your interest and support.

Lindsey