"This is why we are here": The race to save a life in South Sudan
In remote Old Fangak, a woman is in desperate need of medical treatment. But with no surgical facilities and a runway too muddy to land a plane, time is running out...
“Emergency in maternity!”
The call pierces an otherwise silent period on the MSF radio.
I head towards the ward, uncertain what I’ll find. Anything is possible in Old Fangak.
Old Fangak
First, to describe the context: Old Fangak is around 500km north of Juba, the capital of South Sudan. It's a swamp region with a population of around 50,000 people, most of whom fled to the area during the civil war because the remote location conferred relative safety.
There aren’t any roads to Old Fangak. During the rainy seasons, when the runway turns to mud, three helicopter flights and a boat trip are required to travel here from the capital.
I work at the small MSF hospital here, and today it is raining.
Blood on their shoes
Arriving at the maternity ward, I see the midwife has blood on their shoes. This isn’t wholly unusual, but I can read from their facial expression that the situation is serious.
The patient has given birth to a healthy baby girl. However, there have been complications. The patient is now haemorrhaging. There is a river of blood flowing over the front of the bed, only partially captured by a nearly full bucket below.
Within a moment of my arrival, the patient loses consciousness.
Nyame
Crammed into the tiny delivery room, the temperature must be approaching 40°C. Sweat is pouring from all staff, safety glasses fogging.
We squeeze fluid into drips in each arm and I start the mother on a potent medication that raises blood pressure. In this low resource setting I have to count the drops per minute to infer infusion rate.
Within ten minutes the patient starts to groan. She is regaining consciousness.
I call her name: Nyame.*
She desperately needs blood
Nyame’s condition requires surgical support. We don't have those facilities in Old Fangak, so a senior staff member immediately begins the process to transfer her to another hospital.
In the meantime, Nyame desperately needs blood.
I gather all of her family members urgently and explain that Nyame is in critical condition.
Their optimistic mood vanishes.
They tell me that Nyame has five children. If she doesn’t survive, what will their future be?
Rapidly I tell the family we need blood donors, and out of the many volunteers, we find three with matching blood types.
At this point we are well into the night.
Every possible avenue
Throughout the night I stay with Nyame. Her family camps in the same room. Nobody sleeps.
At the same time a team of MSF staff work to find a way to get her the surgery she desperately needs. But the runway is consumed by mud, and with planes unable to land, options are limited.
As dawn breaks, we still do not have an answer. Exhaustion is now matched with concern.
I check the clock and realise I have been in the hospital for 26 hours and with Nyame for 18. I handover to another MSF doctor and take some rest.
We will not stop
I wake to learn that Nyame's haemoglobin levels are falling. There’s no visible bleeding, so we do an ultrasound.
Nyame is haemorrhaging into her uterus.
We are now close to 24 hours post-delivery. I update the family and explain that there is a high chance that Nyame will not survive, but that we will not stop treating her.
As the sun starts to set, we hear the most amazing news.
Hope
The International Committee for the Red Cross (ICRC) will provide a helicopter to transport Nyame to Juba. In Juba, MSF will arrange and fund the surgical care.
I cannot even begin to express my gratitude. There aren’t exactly spare helicopters in South Sudan.
The earliest the helicopter can arrive is midday tomorrow.
We do not have more blood for Nyame, but we have hope on our side.
We are all invested
Early in the morning we prepare for Nyame’s departure.
A medication pack is assembled, equipment is tested. The role of medical escort is allocated to one of our brilliant South Sudanese nurses.
Guard of honour
News of Nyame’s imminent departure rapidly spreads.
Around thirty people are outside the maternity department, everyone wanting to offer a hand. It’s like a guard of honour. We are all invested.
The ICRC helicopter is waiting. I rig up a makeshift IV pole and make final adjustments to the infusions.
The doors are closed, the engine is fired and the blades of the helicopter begin to spin.
We all watch as the aircraft rises and flies towards the horizon.
A life saved
Over the coming days, we frequently refresh our emails, eagerly awaiting an update.
Eventually we learn that Nyame is recovering well. She is expected to return to Old Fangak in the coming week.
Nyame is alive and Nyame’s children still have their mother because of the commitment, passion and generosity of many. Humanitarian workers from different organisations worked together for one purpose: to reduce suffering.
This is why we are here.
*Nyame is not the patient’s real name, but a polite form of address in the local language, Nuer.
MSF in South Sudan
In July 2011, South Sudan became the world’s newest country after gaining independence from Sudan. The peace deal that led to the split also ended Africa’s longest-running civil war.
But in December 2013, South Sudan was plunged back into chaos as civil war erupted amid a power struggle between the president and his deputy.
The conflict has forced millions of people from their homes and left many without access to basic necessities, such as food, water and healthcare. 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.