Sam Templeman is an Australian paediatric nurse. For his fourth assignment with Médecins Sans Frontières he worked in Shamwana, in Katanga province, Democratic Republic of Congo. His mission was to participate to the handover of the hospital to the Congolese Ministry of Health after ten years of Médecins Sans Frontières support.
What were Médecins Sans Frontières’ activities at the Shamwana hospital?
The Médecins Sans Frontières program opened in a health centre in Shamwana in 2006 in response to a large influx of internally displaced people fleeing high levels of violence. The centre became a referral hospital for the area and over the years Médecins Sans Frontières supported the Ministry of Health to transform it into a fully functional facility. The hospital now conducts surgeries including for vesico-vaginal fistula and has a general ward for adults. There are maternity and paediatric wards, a small intensive care unit and a malnutrition ward. It also coordinates HIV/Aids and tuberculosis outreach programs and supports seven health centres, as well as a community malaria program. There are 60-70 beds in the hospital. When I was there we had between 120 to 150 admissions per month, rising higher during the malaria peak.
"As an emergency medical association we need to concentrate on the most severe contexts and needs, and we have to take decisions to handover activities to the authorities whenever the situation justifies it"
What was your role?
I was a nursing activity manager, responsible for nursing care and infection control. I also supervised the pharmacy and data collection on hospital activity. The other international medical staff were a doctor a midwife in the hospital, and a nurse who managed the outreach programs.
Why did Médecins Sans Frontières decide to handover the hospital?
After 10 years of activity, we were observing decreased levels of violence and decreased numbers of patients. As an emergency medical association we need to concentrate on the most severe contexts and needs, and we have to take decisions to handover activities to the authorities whenever the situation justifies it. This was one of those situations; there was no further need to have such a large hospital in a village of that population.
How did Médecins Sans Frontières perform the handover?
We have standard procedures detailed in a handbook, to support the process, and we prepare months in advance with the Ministry of Health. Our first step was to support the staff members from the Ministry – including doctors, nurses, midwives, laboratory technicians and outreach program coordinators – with the comprehensive training needed take full responsibility of the hospital. We identified future supervisors and provided them with specific training, and prepared rosters to ensure medical services were not disrupted by the transition.
We donated three months’ worth of medicines as a first stock for the staff. Patients will have to pay for these, because Médecins Sans Frontières cannot continue to provide, but this creates an income for the hospital to support its running costs. We also left six months’ worth of drugs for tuberculosis patients to finish their treatment, and six months’ worth of drugs for HIV patients to give them time to join another program. As a finishing touch, we installed solar panels to generate vital electricity for the hospital and reduce energy costs.
How did you find the handover experience?
It was certainly challenging to maintain the best levels of organisation and care provision at the same time as preparing to handover the facility. But the tried-and-tested guidelines and the deep, trusting relationship built over the past decade, relations between the Ministry of Health, Congolese staff and Médecins Sans Frontières remained very, very good. For a couple of staff who had been there for several years – or even since the opening – it was very emotional.
Has this assignment affected your return to the medical sector in Australia?
I gained very valuable experience managing staff, coordinating medical supplies and writing operational reports. These are skills I will take on other missions with Médecins Sans Frontières. I have five months before I start a Masters in International Public Health in Sydney, and then I hope to travel to Libya for my next Médecins Sans Frontières assignment.