Thread by @DrChristou

For the past few weeks, I joined @MSF_SouthSudan to work in our hospital in IDP camp.
I met amazing colleagues, had happy & challenging moments, as well as experiences & emotions I’d like to share with you.
Not a short thread, but stick with me:

This wasn't my first time in #SouthSudan. I was in Gogrial in 2013, operating in an inflatable tent.
This time, I joined 500+ South Sudanese colleagues & 25 staff from other countries in a hospital that provides care to 100,000+ people & is a referral center for complicated cases

I worked in the Operating Theatre (OT) of our hospital, which also has an intensive therapeutic feeding centre, paediatrics, an inpatient department, surgical, maternity, and isolation wards as well as a delivery room.

During the first two weeks, I operated on victims of violence - especially gunshot wounds - almost every night.
Most of the injuries were to limbs, but there were also severe abdominal and chest traumas. Keeping these patients alive is always a challenge.

There are so many guns in South Sudan these days. Just in the last 10 years we've lost 24 @MSF colleagues to violence and over the same period at least 176 humanitarian workers have been killed.
Such insecurity becomes a trigger for even more violence & fosters a "gun culture."

During my stay I was also confronted with sexual & gender-based violence, which continues to be of grave concern.
Stigmatization & other cultural & gender barriers block survivors from seeking care. Survivors are often invisible, shying away from seeking medical care.

I saw patients who had to walk for days to reach our facilities.
One night a midwife woke me up, because a pregnant woman arrived with massive bleeding. We did a C-Section and saved her life but unfortunately the baby was already dead.

Another day, a boy arrived in ER in very bad condition after 2 days of walking from his village.
I thought he had appendicitis but in theatre I was confronted w/ perforated bowel & severe peritonitis bc of typhoid.
The boy is now discharged back to his village, healthy & happy.

I operated young kids w/ snakebites. I remember in 2013, how challenging these cases were since we didn’t have antivenom, and many victims had to undergo amputations.
Now, we do have “weapons in our armoury”. They just need to be given on time, which isn't always the case.

Many of my snakebite patients managed to go back home quickly, but a few of them had to undergo major and painful operations because, again, there was no facility close to their villages to provide first aid.

The last weeks, we noticed a worrisome trend of water-borne diseases & rising cases of malaria.
My colleagues shared that water & sanitation conditions in the camp had dramatically deteriorated the last months & actors-in-charge don't have enough funds to respond adequately.

People living in IDP camp are now being encouraged to leave. But why do so many of them prefer to continue to live in inhumane conditions, behind barbed wire fences?

Community leaders told me: “There are three things that we need, so we can go back and start our lives again: peace, education, and health. And none of them exist out there.”

South Sudan is both the world’s youngest nation & also one with some of the worst health indicators.
It has one of the highest rates of maternal mortality & preventable conditions like malaria, diarrhoea & pneumonia continue to be leading causes of death for children under five.

An ineffective disease-surveillance system, poor vaccination coverage, & limited provision of clean water & sanitation services put vulnerable populations at risk of preventable diseases and outbreaks.
After decades of conflict, mental health disorders are also prevalent.

Health infrastructures, incl. hospitals, have been destroyed or badly damaged over years of conflict in #SouthSudan. Among ~1,500 health facilities, 75% need minor, major or complete renovation.
Primary health facilities often lack supplies, drugs & health staff.

Healthcare delivery is mainly dependent on humanitarian organisations & in remote areas int'l medical actors are usually the only ones ensuring specialised healthcare. Referrals of patients in need of surgical care remain a huge challenge w/ heavy costs & logistics constraints.

At this 10-year anniversary of the country’s independence there is nothing to celebrate but much to reflect on & a lot of work to be done.
Work to bring peace, to invest in education, and to build capacity for an accessible & robust primary health system.

https://twitter.com/MSF_SouthSudan/status/1416049281841180676?s=20

To all the amazing MSF colleagues I met in South Sudan and those I read and heard amazing stories about, thank you for your brave and incredible work!

To end, I invite you to read the “South Sudan at 10” report - a record of the human toll of violence since independence, as seen through our staff & patients.
A report dedicated to the 24 colleagues who were killed here over the course of these ten years.
msf.org/10-years-indep…