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Inside a field hospital

How do you provide emergency medical care in a conflict zone? We join Mike Denison and a Red Cross surgical team in South Sudan.

Photo: Jacob Zocherman/ICRC

As a biomedical engineer, I have worked with the International Committee of the Red Cross (ICRC) for six years in various countries, but never before in a mobile field hospital. So I was full of anticipation as I flew to South Sudan for a two-month assignment.

When conflict broke out in the world's newest nation in December 2013, thousands of combatants and civilians were injured across the country. The ICRC had been supporting a teaching hospital in the north but was forced to evacuate during the conflict. So the next option was to form mobile surgical teams, which could be deployed at short notice wherever the injured required emergency assistance.

Mobile surgical teams comprise an anaesthetist, a surgeon, an operating nurse and a ward nurse. These are supported at times by a laboratory specialist, a physiotherapist, a water and sanitation engineer, and occasionally a biomedical engineer like myself. South Sudan Red Cross volunteers are always involved, and an enormous asset to the team.

South Sudan is large and flat, with a prolonged wet season that leaves much of the country flooded. Four-wheel drives churn the wet soil into a thick, clinging mud. Roads become impassable, so teams are flown in, either in a light plane or a helicopter if the plane cannot land.

Teams are dispatched with a kit of drugs, bandages and surgical equipment; as well as tents, food, water and a small electrical generator. In the field, we sleep on air mattresses in tents or small mud huts called tukuls. In these malaria-prone areas, mosquito nets are essential.

Photo: Jacob Zocherman/ICRC

War surgery is brutal. Bullets tear flesh and break bones. Wounds invariably become infected and amputations are common. The equipment in a field hospital's operating theatre is quite basic: an operating table (or bench) to place the patient; a light so the surgeon can see their work; a suction machine to remove blood and secretions from the wound; a machine to measure oxygen in the blood and another to produce oxygen if the patient needs it. There is always an autoclave to ensure surgical instruments and bandages are sterile before use.

My job was to ensure that medical equipment was working as it should, and repair broken items: whether by tightening a few bolts, replacing a part or ordering a replacement. Sometimes I taught local staff how to use a piece of equipment or how to repair it when it breaks.

Some mobile teams operate in semi-permanent facilities such as a community health centre. Other teams are flown in after a particular battle, where injured people have no other access to treatment. They may stay a few days before flying back to base, sometimes taking patients who need follow-up care.

There were times when there was little to do but wait for someone or something to arrive, and other times when a crisis demanded long hours of frantic activity without rest. I found it important to keep a good sense of humour, as well as a sense of perspective about my individual contribution within the scheme of things.

South Sudan will certainly need support and patience from the international community as its proud people establish the society and services they deserve. I find it incredibly rewarding to contribute to this, even in a small way, alongside the amazing individuals in the Red Cross Red Crescent Movement.

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