Médecins Sans Frontières' volunteers are working in 70 countries around the world to help victims of natural disasters, epidemics, famines and wars.
Ngaire Caruso is a Doctor from Crawley in Western Australia who graduated with a Bachelor of Medicine and Bachelor of Surgery from University of Western Australia in 1997. Currently Dr Caruso is on her third mission with Médecins Sans Frontières (MSF) in Lira, northern Uganda.
Below is Dr Caruso's article to ACLW in which she explains in detail the difficult context of working in a war zone trying to assist displaced civilians and former child soldiers.
Report From the Field by Dr Ngaire Caruso
I am currently working for MSF in Northern Uganda for seven months as the Medical Team Leader. It is a fairly managerial and administrative role, rather than a clinical role. I coordinate our medical activities and liase with other actors (such as the Ministry of Health, ECHO, UNICEF, and other NGOs). Other areas of responsibility include providing medical advice and support to the medical team, epidemiological surveillance, managing the drug orders with the logistician, training of National Staff, following our referral patients and National Staff health.
Since 1986 the Lord's Resistance Army (LRA), led by Joseph Kony, has waged a war in Northern Uganda. The LRA attack Ugandan Government forces and civilians. During the conflict, the LRA have abducted more than 20,000 children, forcing them to be child soldiers and for sexual exploitation. The insecure situation has forced over 1.2 million people to move from their villages into Internally Displaced Persons (IDP) camps.
In northern Lira District, about 200 kilometres north of the capital Kampala, it is estimated that up to 80% of the population is currently displaced and living in IDP camps. Living conditions in these camps are terrible. The tukuls (huts) are packed tightly together. Access to fields for cultivation (and therefore food production) is largely restricted because of the insecurity.
Basic services such as clean water, sanitation and medical services are grossly lacking.
We have a large project here in Lira District and a large team of 13 expatriates (the medical team comprises a team leader (me), three doctors, three nurses, one laboratory technician and one mental health officer. We also have over 400 national staff. We work in seven sites ? six IDP camps and a therapeutic feeding centre here in Lira town. 20,000 to 40,000 people live in each camp, so in total we serve a population of around 170,000 people.
In each of the six camps we have a clinic which provides basic health care, and a water and sanitation program. The camp clinics each see around 600 patients per week. Malaria is overwhelmingly the major cause of morbidity. The other main causes of morbidity include diarrhoea, respiratory tract infections, wounds and skin infections. At the moment we are not testing or treating HIV/AIDS, but clinically suspect the prevalence is quite high. In keeping with the HIV/AIDS prevalence, there is quite a lot of tuberculosis as well.
Its remarkable how many lives can be saved with antimalarial drugs and simple antibiotics ? a far cry from the way we practice medicine back home. On the other hand, it's difficult to cope emotionally with the other 5% or so of patients for whom we can do nothing here, but could easily be helped if we had more resources.
As well as basic medical care in the camps we do antenatal care, have a supplementary feeding program for moderately malnourished children and are starting family planning. We are working in conjunction with the Ministry of Health to provide immunizations.
The therapeutic feeding centre in Lira town provides feeding and treatment for severely malnourished children. Our occupancy varies from around 150 up to 320 patients. We're also treating malnourished children who have tuberculosis, and are planning to expand our tuberculosis program to treating people of all ages in the camps.
Access to clean water is a nightmare for the IDPs ? earlier this year a survey found they have access to 1.7 litres/person/day. The internationally recognized minimum standard is 15-20 litres/person/day. Following our water and sanitation program (drilling bore holes, protecting springs and digging wells), access has increased to 5.6 litres/person/day, but there is obviously still a long way to go.
I really enjoy spending time in the camps, rather than in Lira town. When you consider the conditions under which these people are living, it's amazing that the camps are not an oppressive depressing place. Walking around the camps you see old men sitting around playing cards, young men playing soccer, women preparing food or carrying water or washing their children (as usual it is the women doing the work). We are met with friendly smiles and greetings, and followed by a hoard of barefooted dirty laughing children chanting "munu, munu" (white person). Some small babies just howl with fear when they see these strange white people, much to the amusement of everyone else.
Certain incidents bring you back to the harsh reality of their life. A few examples from my time here: two women presented to our clinic with multiple scalp lacerations. They were part of a group of seven people who had gone to the fields to collect seeds. They were attacked by seven LRA rebels (most of the rebels in their teenage years). The other five people were killed. These two women only survived by pretending to be dead. Another lady we sent down to Kampala for plastic surgery - the LRA had cut off her lips and her ears.
Young boys, aged 11 to 15, have a weekly session with one of our mental health counsellors. These are children who were abducted by the LRA but have now managed to return to their families. Often they have been forced to kill members of their own family, so face huge difficulties when they return to live with their families. They seem to greatly enjoy the chance to draw pictures on books given by our counsellor ? the pictures are full of LRA and UPDF (Ugandan Army) soldiers shooting each other or cutting off limbs. Occasionally there is a soccer player thrown into the mix. They told us of their nightmares, where they find themselves strangling people or cutting off limbs with an axe.
Then there are the people who do not have war injuries but are suffering because of the lack of services here. For example a 14 year old epileptic girl had a seizure whilst cooking and fell head first into the fire. We are now managing her horrific burns in our clinic. On the other hand it's absolutely wonderful to see the kids in the TFC transform from listless skeletons into chubby energetic kids.
My time here has been busy and challenging, filled with many highs and lows. Overall I feel very glad to be part of a project that really is helping a lot of people.
Médecins Sans Frontières Australia; http://www.msf.org.au