The BMJ charity appeal Christmas 2017: help Médecins Sans Frontières’ volunteer doctors help the Rohingya peopleBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5926 (Published 29 December 2017) Cite this as: BMJ 2017;359:j5926
“Médecins Sans Frontières make it possible for you to do your job as a doctor, as well as you can, in the most difficult circumstances imaginable,” says Ian Cross, a retired Leicester GP and one of the first MSF doctors to respond to the recent emergency in Bangladesh as more than 600 000 Rohingya, mostly women and children, fled violence in Myanmar.
“I saw an appeal for doctors at the end of August, just as the news of the exodus was emerging,” he recalls. At the MSF health facility in Kutupalong, close to the Bangladesh border, he was one of 43 expatriate employees and volunteers organising medical facilities for refugees.
Working with another UK doctor and 12 Bangladeshi doctors, the MSF team were treating an average of 400 new outpatients a day, with 100 inpatients crammed into 80 beds.
Gunshot and landmines
“A third of the patients were children, some so malnourished that they had barely any resistance to disease. I learnt quickly how to manage gunshot wounds and landmine injuries.1 Each bed in the birthing unit was occupied 24 hours a day. The neonatal unit was filled with critically ill and premature babies with neither incubators nor ventilators. Dying patients became part of normality.”
But Cross has returned anything but defeated, acknowledging the team and MSF’s logisticians. “They did an astonishing job ensuring we had an adequate drugs supply, building two extra wards with bamboo and plastic sheeting when they were needed, constructing a new incinerator away from the inpatient wards, and working out the best places to site tube wells and latrines,” he says. As well as doctors, the team recruited extra midwives, nurses, laboratory technicians, cleaners, and crowd controllers. Another 300 Rohingya volunteer outreach workers identified health problems, educated patients, and helped with vaccine campaigns.
The MSF inpatient unit was built at Kutupalong in 2008 to serve the steady trickle of Rohingya refugees that began leaving Myanmar two decades ago, many settling in the massive refugee camp nearby. “That background enabled MSF to understand the scope of the crisis and what needed to be done quickly,” explains Cross.
What he offers MSF, he says, is, “above all, the experience of 25 years as a GP.” Working abroad, he says, is “general practice with knobs on: conditions you might see in UK practice but much more advanced and which you have to manage with fewer resources—with a bit of tropical stuff thrown in for good measure.” One thing that surprised him was the number of vaccine preventable diseases, including tetanus and measles, “because the Rohingya have been denied immunisations in Myanmar,” he says.
From Leicester to Bangladesh
Cross’s experience as a GP enabled him to take responsibility for managing six hospital wards. “I take the same approach in Bangladesh as I did in my Leicester practice. It’s a matter of being mentally and physically robust. You don’t get flustered. You get on with the job of making the best possible decision for each patient with as much information as you can muster—and then move on. You’re always dealing with the next problem while trying to keep your focus on the present.”
His evenings were spent doing “the inevitable paperwork, collecting and analysing data to give MSF the information they need to deal with the Ministry of Health and United Nations agencies.”
“Of course the work is harrowing and exhausting,” he told The BMJ. “But there’s also an exhilarating sense of achievement that comes with working for MSF. Every time someone recovers and smiles and gives a handshake, it’s the best feeling.”
But the team were clear about what they could not do. The medical facilities lack safe anaesthesia and a sterile operating theatre, so anyone needing more than basic surgery is referred to one of a handful of nearby hospitals. “Every week we refer 40 or so patients, around half with orthopaedic problems, with injuries from traffic accidents now overtaking gunshot wounds. The rest include acute abdomens, eye injuries, and caesarean sections.”
MSF pays the bill for surgery whenever necessary. “It’s money well spent and just one part of the costs that MSF faces in a place like Kutupalong. Of course, UK doctors should consider volunteering. But they can help so much by donating to this amazing charity.”
Please donate to MSF
£123 could pay for a blood transfusion for three people
£65 could buy a stretcher to help move an injured person to safety
£54 could provide antibiotics to treat 40 war wounded people
Donate online: www.msf.org.uk/bmj
Donate by phone: 0800 408 3897 (UK only)
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.