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War surgery

As the conflict in South Sudan continues into its second year, Red Cross aid worker Nola Henry reflects on what it takes to provide emergency healthcare in the midst of a conflict.

Are you sitting upright, with good lumbar support? Plenty of light to read by? Fresh cup of tea or coffee in hand?

Good. Now that you're really comfortable, picture yourself in a tent in the heart of a swamp in South Sudan. It's hot, wet, muddy, and the mosquitoes are circling. You're about to perform surgery by torchlight.

These are the conditions Red Cross health workers often work under, in field hospitals across South Sudan.

Nearly two years of armed conflict in South Sudan has left hundreds of thousands of people in desperate need of aid. The International Committee of Red Cross (ICRC) and South Sudan Red Cross are working to provide food, water and sanitation, shelter and healthcare to the most vulnerable people. Since the beginning of the current crisis in December 2013 to June 2015 the ICRC has performed nearly 5,500 surgeries, conducted more than 23,000 outpatient consultations and assisted more than 3,000 people with disabilities.

Australian Red Cross aid worker Nola Henry recently returned from two missions with the ICRC, where she worked as part of a mobile surgical team to treat weapon-wounded patients.

As ward nurse Nola supported a surgeon, anaesthetist and operating theatre nurse, all of whom work alongside local nurses and volunteers. Some teams work in more permanent places, such as a hospital within a capital city, while others need to be equipped for the field.

"It may be that we need to set something up in the middle of nowhere so our kit consists of taking everything we need to be self-sufficient: tents to set up an operating room and nurse the patients, tents that we can live in of course, and then you put up a tarpaulin under a tree so the cooks can prepare the food," Nola says.

This is medicine stripped to the core: no x-rays, scans or blood tests. But as Nola explains, there's an even harsher reality.

"You're often getting patients who have been injured weeks or months before…unfortunately nature has done a triage on many patients who are injured; if you can't get to a clinic within five days, many people have already died. So by the time we see the patients, they've survived at least five days."

Infections often take hold in the days following injury, leaving surgeons with little choice but to focus on saving limbs. Nola's role comprised everything from helping to determine which patients need to be treated first to communicating with relatives to organising treatments ordered by the surgeon or anaesthetist.

Another challenge of the role was making sure the team had adequate medical supplies.

"You can't go down to the local shop and buy some more gauze or bandages, they have nothing. So that's in fact one of the most stressful parts of it," Nola says.

For Nola, the difficult conditions in South Sudan are far from shocking. Awarded the Florence Nightingale Medal in 2015, she has completed 12 international missions: from Indonesia in the wake of the Indian Ocean tsunami, to Pakistan, Afghanistan, Libya, Kyrgyzstan and the Philippines.

She has some simple advice for healthcare workers intending to work in humanitarian aid: if you've never been camping before, now might be the time to go.

"You don't have to replicate South Sudan by camping in a swamp, in a mosquito-infested area, but make sure that you can live outside of an air-conditioned building. That you can eat most things and that you're not shocked not to have flushing toilets and a shower that goes for longer than four minutes," Nola says.

You also have to like teaching, be prepared to work around language barriers and possess plenty of patience.

"Know that you're not going to have the answers, but you can be refreshed by the fact that no-one expects you to have the answers while you're there. They're just grateful that you're there and that you're listening and that you are trying to help."

Get insights from Nola and other Red Cross aid workers in our How Aid Works podcast.


Photo: ICRC/Jacob Zocherman