Brett has worked for medical humanitarian aid organisation, Médecins Sans Frontières, over the past five years. In 2008 he was part of an emergency nutrition project in Ethiopia where he spent six months treating kids with severe malnutrition. What followed was a growing sense of responsibility that led him to Afghanistan, where he spent six months treating trauma patients, and more recently to South Sudan, where he worked as an emergency nurse in a refugee camp.
I became a nurse because ultimately, I was interested in people. It was a way for me to explore humanity through caring for people. I had left high school quite early on and had been working for a few years as a furniture maker. But by my early 20s I had a growing sense of responsibility and decided to go into nursing.
While I knew it wouldn’t happen initially, my aim was always to work internationally and be able to assist populations in need while exploring life in all its harshness. As you grow and you have explored the world, turning statistics into realities and numbers into individuals, you see the reality is far worse than you ever could have imagined.
It’s definitely not an experience where you come back feeling gratified, thinking, ‘I’ve done my bit and can go and drink lattes now’. That sense of responsibility just deepens. I always think I could have done more. You try to remember the ones you did help, but you always remember the ones that you didn’t.
Malnutrition in Ethiopia
By 2008, I was working for Médecins Sans Frontières. My first field placement was to Ethiopia to help in a massive nutrition crisis in the south of the country. The life balance is so precarious there. A lack of rain meant the crops weren’t big enough, so there wasn’t enough money and as result, people starved to death.
It’s mainly the kids who suffer the most. We routinely had 50-100 severely malnourished children who we were treating in the community, plus a few hundred moderately malnourished at each site. We traveled each day on four-wheel tracks getting bogged to get food to distant rural communities. Our job was to feed these starving kids and to find the really sick ones and bring them in for further treatment. These were the kids who were horrendously starving and really sick. The kids who were so small and so fragile. And there were hundreds of them.
Mostly, we would give the kids medication and food and then follow up with them each week. The reality was that all the kids in the community had swollen bellies and looked skinny. But when you see the really malnourished ones who could be dead next week, they are just so vulnerable at that stage of malnutrition. It was incredibly hard. We had criteria for admission but there are other kids who you need to consider – the ones who may not fall under those criteria, but who have lost so much weight so quickly, you’re not going to wait for them to get severely malnourished.
Sometimes they would beg. You have a mother who has nothing but an incredibly emaciated-looking child trying to kiss your feet. And you have the power to give them food, but the child isn’t malnourished enough. And the reality is, if you did, you have another 5,000 in each little town who looked exactly the same and who of course, we wanted to give food to, but we just didn’t have enough. We were only there to treat the severely malnourished, not feed a whole region. That was incredibly hard and it took me a long time to get over. There you have this crazy power to try and decide who gets something of what you have. From back here at home, you always think you can do so much. There, you realise the scope of the problem is so big. Then when you get back, you always think you could have done more. It was very hard to deal with. You try to remember the ones you did help, but you always remember the ones who you didn’t.
Conflict in Afghanistan
My second project was in Afghanistan, where I spent six months working in an intensive care department. It was interesting because we were introducing more advanced acute western medicine into the country. But in doing so, we introduced a whole lot of western medical ethical issues such as turning off ventilators and prolonging life. That was quite fascinating, but it brought up a lot of personal issues for us as well.
Médecins Sans Frontières set up a trauma centre specifically for victims of trauma from the war, but also domestic trauma from road accidents.
We were routinely seeing gunshots and lots of shrapnel wounds. There were lots of improvised explosive devices (IED) planted for specific targets, but bombs being what they are, take out whoever happens to be passing by when they go off. Unfortunately, that often involved children, who also seemed to be the ones treading on land mines and finding grenades.
There was one particular case where a little girl had come home, opened the door and a device that was planted for her father blew one leg off and severely damaged the other. She was very badly injured and had lost a lot blood. We had done everything to save her other leg but it didn’t look very good at all. It soon became obvious over the next couple of days, once she was stable, that we thought she would live but her leg wouldn’t.
During this time she was in the hospital, which to her mother and other female family members was almost impossible to access. It was the father and the male relatives who took on the role of care takers. The father decided he could not bear to have a child with two amputated legs. Of course, we didn’t want to amputate the other leg but if we didn’t she would die. By this stage, the leg had started to deteriorate and was beginning to become gangrenous; a process that could kill her.
Ultimately, through endless hours of discussions with the father, it became apparent that it was his sense of guilt that was really complicating the issue and stopping him from allowing the operation to go ahead, because the bomb was meant for him. And of course, it was his daughter lying there with one leg, about to lose another. Eventually, we got permission to do the operation, but the process revealed the horrible nature of the fact that her life would be incredibly hard with no legs. She will probably never marry, which means that in his eyes, she will be a burden on the family forever.
In the end, after the operation, the father managed to get into the recovery area and broke down, which was very unusual for a man from his tribe. So he’s crying and she, the little daughter who was only nine or ten, wakes out of anesthesia and starts consoling her father, patting his head telling him it was ok.
That story is across the whole country. I dealt with hundreds of patients but across the country, there are thousands of patients in similar situations.
Malnutrition and refugees in South Sudan
I have just recently returned from South Sudan, where I worked in a refugee camp for a displaced population of about 50,000. The majority of these people had been in the refugee camp for almost a year. It was quite a hopeless situation and the weather conditions were quite extreme. When it rains it floods and then for the rest of the year there is no rain at all and you have 50,000 people in the middle of a countryside that really can’t support many people.
They are completely dependent on food aid and there was no foreseeable resolution to that. There was no real possibility of them become self-sustainable at all. They had some animals but there wasn’t enough. You could barely give them enough water to drink let alone grow vegetables. And there was nowhere else to go; the refugees told us of how planes would fly over their villages every day dropping bombs.
We were providing the main medical care to that population. We had health posts out in the community and I was in charge of the main clinic that took the more dire cases. We had a feeding centre for the malnourished kids, an inpatient department for malnutrition and acute sickness, and an outpatient department which saw between 1200-2000 people a week. Occasionally, we referred surgical cases on to a hospital for the host population. It was astounding that it was enough for 50,000 people. But somehow, it was. We routinely treated all kinds of illnesses, which we really never have to see here in Australia, or certainly don’t kill like they do there. Despite food aid from other actors, there were still cases of malnutrition, as well as malaria and diarrheal diseases killing kids. There was also an outbreak of Hepatitis E.
We’re not thankful for food in Australia, we just expect it. Seeing what the South Sudanese people actually had to live on at some level felt criminal. It was inconceivable how small a quantity of food a family received to supply them for a month. I lost 16 kilograms in three months, even though we had much better food and far greater quantities of it.
There has to be some limit to what we will accept for our fellow human beings. It may not be gold standard medical care for the entire world – maybe that’s not achievable. Maybe we can’t do MRIs on every person that needs it. But we live in a world where people are starving to death. And that is entirely unacceptable.
When you witness situations that threaten entire populations, you know you have to do something about it. Aside from malnutrition, there are so many diseases that are unacceptable today, so many situations that deny people access to basic health care. It’s so easy to treat some of these diseases, to provide basic care and we have all the possibilities in the world to do it.
I see humanity as humanity, not as any type of cultural, racial or economic divide. People are people and they deserve care. And I honestly believe all people deserve the same care no matter where they come from.
To learn more about Médecins Sans Frontières life saving work visit www.msf.org.au