The contrast was stark and inescapable.
Dr. Lanice Jones was resting in her accommodations in Mweso, a village in the Democratic Republic of Congo (DRC) after a difficult day. One patient, a young boy, was suffering from rabies, his body thrown into spasms, shaking and screaming in pain.
“Rabies is a dreadful disease,” Jones said. “We could only offer medications to break the spasm, to calm his muscles. The disease had progressed too far to be cured with medications.”
Then she was paged to help a woman in labour. She grabbed her first aid basket, and accompanied by a Canadian nurse, ran from the hospital compound into darkness under a tropical downpour.
“We found the woman just outside our gate, about to deliver in the mud, the running water and the dark,” Jones described. “We had time to toss down a cloth, shove our hands in gloves, and the babe slid out onto the cloth.”
While the nurse cared for the newborn, Jones delivered the placenta while preventing hemorrhage – the biggest killer of delivering women in that part of Africa. Moments later a truck transported mother and baby into the hospital. While feeling grateful to have saved both mother and newborn, she couldn’t forget the young boy, dying from a disease rarely seen in developed countries.
“The sadness of the father’s eyes looking at his dying son, the gentle joy in the mother’s eyes, cuddling her newborn son,” Jones said. “I have so many experiences that I look upon with joy and awe, tinged with sadness.”
The Canmore resident was in DRC for six months in 2018 on assignment with Doctors Without Borders/Médecins Sans Frontières Canada (MSF). Her fourth MSF assignment, she’d previously worked in Pakistan; in South Sudan at a refugee camp of 50,000 fleeing bombing of their homes by their government; and as a midwife in Chad. In DRC, she worked as midwife and doctor in an MSF maternity clinic at a full-service hospital. Partnered with the Congolese health authority, the hospital sees 2,000 patients each month. Outreach centres treat children with malaria, diarrhea and respiratory illnesses, the biggest killer of children under five.
“We were very busy, with 350 to 400 deliveries a month, with three delivery beds, seven beds for labour and observation, and 10 nurses a day shift,” Jones said. Fifty women shared 30 beds in the “welcome village” for higher risk pregnancies.
While fifteen Congolese doctors covered most of the hospital work, Jones shared instruction on managing labour complications, while the Congolese midwife supervisor shared knowledge of birthing twins and breach babies, helping lower caesarean and maternal mortality rates.
Having first learned of MSF while in medical school, Jones signed on after her three children were grown.
“What keeps me going back is that I thrive on the challenge of living in a tough context, in providing the best care possible in remote and resource-poor settings, and in being a part of a team that collectively is saving lives not only every day, but hourly,” she said.
On her last day in DRC, she watched the Congolese staff skillfully save a woman who was bleeding heavily post-delivery.
“I felt as if my entire six months of work had been validated by seeing how well the team responded,” she said.
She’s not alone among Canmore physicians working with MSF in less-developed, less politically stable countries than Canada.
Dr. Simon Bryant recently completed a nine-month assignment in Lashkargāh, the capital city of Afghanistan’s Helmand province. A traditional area in the conservative Islamic country, current estimates place the Taliban controlling 55 per cent, and rising, of the country. Ongoing conflict contributes to filling hospital beds.
Despite that, Bryant felt safe. Like all MSF assignments – his first was for six months in 2015 aboard a search and rescue ship rescuing and treating migrants desperately trying to cross the Mediterranean from northern Africa to Europe – Bryant’s posting involved extensive communication, preparation and safety protocols.
“There’s risk every day, in life. (With MSF) the risk is well managed. It’s all we can do. People have a lot of misconceptions; they are more fearful than realistic,” he said.
Once there, Bryant understood how, since the hospital provides a great service to everyone in the area, the locals – including Taliban – are appreciative.
“MSF is impartial and neutral,” he said. “Any human being in need is eligible for treatment at no charge. There’s good communication with the locals, so there’s no motivation to interfere with us. We provide a valuable resource.”
By the same token, MSF personnel, medical or non-medical, must act appropriately – no snapping photos, no cameras pointed out a moving vehicle. He and 11 other MSF staff lived in three Afghan mud-walled, yet still modern houses, each with their own room. Their walled compound was guarded by unarmed watchmen. Two male cooks prepared daily meals. In summer temperatures rose to 50 C, which air conditioning helped alleviate. They rode in Land Cruisers clearly marked as MSF to the hospital and back daily. He took two short, mandatory vacations.
“We couldn’t leave the compound and walk around,” Bryant described. “You can’t walk in the street. It didn’t chafe on me, but it was great to go to Istanbul and enjoy a beer. There’s no alcohol in daily life in Afghanistan, we had to respect the local traditions.”
Only once they visited another compound, a Red Cross prosthesis facility.
“They do fantastic work,” Bryant said. “A lot of people are injured in the ongoing conflict. Some motor vehicle accidents too, but a lot of conflict injuries. Our gardener at the compound rode a hand tricycle, with two fingers, a thumb and one arm.”
Working with a full-time translator to communicate with patients and hospital staff, Bryant learned a few words of Pashtun. He oversaw emergency and intensive care departments in a 378-bed MSF hospital operated in partnership with the Afghan ministry of health. Of 500 daily visitors, 100 were admitted. Eight-hundred staff comprised of a combination of MSF and national employees, including 12 to 24 ex-pats. Like other MSF facilities, its hands-on staff members oversee training and supervising.
“It took me months to really get a feel for how things are done,” Bryant admitted. “There’s a hierarchy, lots of discussion. It’s been a tribal country as long as history has been recorded, and those considerations are still there.”
Illiteracy persists too. A survey revealed that 92 per cent of caregivers of pediatric patients are illiterate, many of them women. War has persisted for decades.
“You see a lot of trauma,” Bryant said. “A lot of suffering people, severely malnourished infants, or children dying from lack of measles immunization. There, it’s not a benign disease like it is here. Fifteen per cent of people die from it over there.”
Violence doesn’t help. In an election right before he left, two candidates were assassinated by bombs. The registration facility was bombed. Only 50,000 of 300,000 who registered to vote did, fearing violence.
“Violence and death hangs over the society,” Bryant said. “It makes me wonder what it’s going to take for everybody to get the basics in place – immunization, clean water, reasonable level of security. And no more armed conflict – there or in other places.”
Witnessing daily violence effects MSF workers too, in the form of second-hand trauma, a consideration that’s openly discussed.
“One of the personal benefits one comes back to Canmore with is that you’re on a slightly different level,” Bryant said. “Your priorities are different. Working with MSF is an option – including elements of adventure and challenge. I have this good fortune to be in the position to have the skills to share. It’s easy to talk and think and care, genuinely, but actions make a difference, often.”
For his part, Bryant has decided 16 months with MSF is enough. He’s moving on to new challenges, including returning to work in remote Nunavut hospitals, where his partner, Paula Duncan works as a nurse.
“You don’t have to go far from home to find opportunities to be helpful,” Bryant said. “People are in need there.”
While Jones enjoys subbing for Canmore doctors on vacation or leave, she too embraces working in Nunavut.
“MSF has taught me how to manage in remote areas, working as a team with limited resources, and that is an experience I am deeply grateful for,” she said.
“It’s not for everyone, but I am grateful for every mission that I have been able to work with MSF. I hope I have an opportunity for one more mission yet.”
