‘Just do what you can’: Diaries of a doctor in South Sudan
Dr Ryan McHenry kept a diary during his three months working in the MSF team in Lankien, a remote town in South Sudan.
In this edited version of the diary he movingly confronts the challenges he faced and shares his in-the-moment feelings and reflections.
About Lankien
Lankien is a town of approximately 19,000 people in Jonglei State in the east of South Sudan. MSF has been operating a hospital there for 30 years, serving the town and people living in the wider community.
The hospital offers in-patient and out-patient care, including paediatrics, maternity and ICU. In 2024, the team welcomed more than 1,600 newborn babies to the world.
"The old UN helicopter kicks up dust on Lankien airstrip, and we're out, rotors running, into the heat. Some of the local community come out to see the spectacle.
***
Emergency call to the procedure room to assist a brisk arterial bleed. The bullet has crossed his jaw, coming out and hitting him again in the shoulder. We peer deep into the hole in his face, tie off a couple of bleeding arteries, but struggle to get the exposure to the deepest.
Doing what we can, where it's needed, with scant resources. I remember Juan's advice before I started this assignment. You go as a doctor, not a specialist, not a paediatrician or whatever. Just do what you can.
***
The diarrhoea I’ve had for weeks has been replaced by vomiting, so it's not going well. Another 24 hours of fever, so weak that I can't even stand, before it breaks. Every few weeks, this is the cycle. Another day where it feels like South Sudan is trying to kill me.
***
Tuberculosis, so much measles, malnutrition and the whooping cough which has been eliminated elsewhere for decades, polio. Polio.
Even when you know a lot about this, it's hard to comprehend how hard things are in this region. The hunger gap when food supplies run short between the start of the rains and the first harvest. The children dying from preventable diseases.
***
Medical care where it's needed most
Help us care for people caught in the world's worst healthcare crises.
I struggle to hold back the tears at the ward round. Ten months old and barely the weight of a newborn.
***
Shots again ring out at night. Scattering the birds, so the shit drops heavy on the tin tukul roof. The egrets white and flocking against the dark sky. I go to check on the ICU.
***
I'm tired, though I don't like to admit it. Six weeks, every day.
***
"I have the easy job, I only need to resuscitate the child, if it ever arrives"
Every medic in Lankien is in our delivery room. Three doctors, the clinical lead, and Shabana, our midwife. The mother has been carried here for hours from home, on foot, after a day or more of unsuccessful care by a traditional birth attendant.
The evidence of the efforts are clear, the blood and mucous on the sheets and the failed vacuum instruments on the metal trolley. In another setting, this patient would be having an emergency c-section, but we're over an hour's flight from the nearest surgeon, and even that requires days for the flooded landing strip to dry.
I have the easy job, I only need to resuscitate the child, if it ever arrives.
I put the rubber apron over Shabana’s head and tie the waist as she goes for another look.
She takes the scissors, and makes the cut of the now-inevitable episiotomy, and soon hands me the child. I scoop him to our hard workbench, which is masquerading as a neonatal resuscitation area.
Somehow, after a dry, the baby screams, becomes pink and fierce, and I get to say again, hello young man.
Over my shoulder Shabana, at 5ft-nothing stands solidly at the end of the bed. Under her headscarf, sweat runs down her brow as she puts in the sutures to close the cut. I love my job, my dear, she says. And there's no doubt her skills, alongside the massive effort the family made to get here, have saved two lives.
***
These kids are so sick. Less than a month of my assignment to go now, and always feeling like you haven't done enough.
***
Soph asks if the patients that make it at least feel good. I don't think they do. They maybe make it feel worthwhile, but more than that it's the relief that we got them through it.
Just relief.
But the privilege to still, always, everywhere, be the place where people turn when they have nowhere else to go. The real power of medicine, and medical humanitarianism. In this hard place, people do know that we care, and caring feels like that most profound thing anyone can do.
***
My last day. I walk together to the helicopter with Tommy, the hospital coordinator. Tommy started with MSF in his native Sierra Leone, but it seems there's nowhere he hasn't been, Afghanistan, DRC, and here, over many assignments and many years. In the past months he’s been gently encouraging as I grapple with the problems we have here, letting me run with it, and learn the lessons.
Tommy tells me that I've seen it all now. And I tell him he's my hero, and whatever he's doing, to keep it up.
***
Thank you for the work that you do. A French woman in Istanbul airport. A reminder that people really value the work that we might not value ourselves. And wondering if it's too easy to be pessimistic when you're pressing and pushing to try to do it well, and so often feel like you are failing.
She tells me that the problem isn't that people don't have enough to eat, not now, in the 21st century.
I tell her that it is."
MSF and South Sudan
Médecins Sans Frontières / Doctors Without Borders (MSF) works in hospitals and clinics throughout South Sudan, where we run some of our biggest programmes worldwide.
As well as providing basic and specialised healthcare, our teams respond to emergencies and disease outbreaks affecting isolated communities, internally displaced people and refugees from Sudan.