Sudan: Five ways MSF brought healthcare back to a war-damaged hospital

Acting fast

When I first arrived at Nyala Teaching Hospital, MSF had only recently started working there. Before the war patients from across the region had travelled to the hospital to receive specialist care. Now the MSF logistics team was working hard just to bring back basic infrastructure like electricity generators, running water and sanitation.

It wasn’t just essential infrastructure that was missing. At the peak of the violence, anyone who could do so had left the city, trying to get their families to safety. Most of the team who remained were junior doctors and nursing staff, trying to keep some services going in the face of incredible challenges. It was my job to support them to provide the most effective care possible in this new context.

Every department in the hospital needed support, but with limited resources available we had to focus on where we had the most potential to save lives: paediatrics, maternity care, and emergency medicine.

Getting supplies across the desert

Many hospitals in Darfur have been looted, and with neither the UN nor the World Health Organization stepping up, it’s almost impossible for them to get new stocks of vital medical supplies.

In Nyala, hospital staff were scouring local pharmacies across the city, searching for anywhere which still had basic items like spinal needles to do emergency C-sections. When they found them, the scarcity meant some items had increased in price by five times what they had cost before the conflict.

There is a long, difficult route through the desert in neighbouring Chad. The road is made up of a sandy track, but our supply team were determined.

Just before I finished my assignment, we got a big order through, and after months of careful rationing trucks full of vital supplies arrived at last.

Keeping oxygen flowing

For many of our sickest patients, one of the most important tools we have is medical oxygen. So on the day that the hospital’s oxygen factory broke down, lives were on the line.

With the mobile phone network down because of the war, there was no way to call for a repair. We ran around the hospital, assessing how many patients were currently on oxygen, whether the flow could safely be reduced for any of them, and calculating how long we had before supplies ran out entirely.

Meanwhile, the logistics team sent people across the city to track down the one engineer who could fix the system. With time running out for our patients, they not only found him, but also sourced a replacement part, ensuring that no critical patient was left without oxygen.

Transforming blood transfusion

Blood transfusion saves lives. In Nyala we relied on the hospital’s blood bank to treat women experiencing post-partum haemorrhage; dangerous levels of anaemia (often a complication of malaria or a lack of nutritious food); and the people who arrived at the emergency room after traumatic injuries.

But there was a problem. To store blood safely, it has to be kept below a certain temperature. The electricity for the hospital in Nyala was provided by generators, but these had been damaged during the conflict: some sprayed with bullets, other missing parts that had been stolen.

The logistics team were able to repair one of the generators, but this wasn’t enough to provide 24 hour power for the whole hospital. This meant the blood fridge couldn’t be run continually, and instead of blood being safe to use for a few weeks, it had a dramatically reduced shelf-life.

Sourcing the two powerful new generators we needed would take time, which many patients don’t have. Luckily MSF teams are used to working in all kinds of environments, and have lots of ideas and tools we can use.

One day, a truck pulled up to the hospital. It didn’t have a new generator, but it had something else: a new fridge. One with so much insulation that it was designed to stay cold for 12 hours without electricity, meaning the blood bank would be safe overnight while the generator was down.

Sourcing vaccinations

Blood isn’t the only thing that needs to be kept cold. When I was there, the conflict meant that no vaccines had arrived in Darfur for over a year. At the hospital, we were starting to see cases of measles, which is highly contagious and dangerous for young children. With so many people living in cramped displaced people’s camps, there was potential for a devastating outbreak.

But vaccines need to be kept at a stable temperature, and this would be many thousands of doses, driven in trucks through the desert heat. There was a lot that could go wrong, but the part we could control from Nyala was where the vaccines would be stored when they arrived.

We only had a day’s advanced warning of when the vaccines would be arriving. A fridge wouldn’t be big enough, we were receiving a huge truck piled high with boxes. Working fast, we found a cold room at a market which had previously been used for vegetables, and the logistics team sourced enough fuel to power the generator 24/7.

When the trucks arrived, they were packed with insulated cool boxes. Each one had a temperature monitoring tag inside. Had they survived the journey? Yes. The vaccines had all been kept cool, and by partnering with the Ministry of Health, together we ensured that within around a week every dose had been used to protect a vulnerable child.