Australian nurse Toby Gwynne recently returned from his first mission with Médecins Sans Frontières (MSF), working as the Nursing Activity Manager in Kobane/ Ain Al Arab, northern Syria.
When you Google ‘Kobane’, most of the images you find are of the town laid waste from intensive bombing. But the Kobane I saw, three years on from the most intense battles, was completely different.
Kobane lies in an agricultural region surrounded by rolling hills. Towards the end of my seven months there, the area started to get some rain, turning the hills a lovely green. Whenever I left the town on outreach my head was stuck out the window, staring at the evolving landscape.
“To encourage change you need to be present, spending time with the locals who are providing the care”
The MSF project in Kobane is focused on vaccination, outreach, maternal healthcare and mental healthcare. MSF has been working alongside the Kurdish Health Administration since March 2015, but the project has recently expanded, including the addition of an international midwife and gynaecologist to the team at the maternity hospital.
The focus of my time in the Kobane Maternity Hospital was working on the basics: things we take for granted in Australia, like improving handwashing, infection control and systems that promote newborn care and resuscitation management. For instance, it is common in Syria to carry newborns by their feet as a method of stimulating, which can slow babies from taking their first breath. My role as Nursing Activity Manager involved trying to retrain staff and reshape practices like this. To encourage change you need to be present, spending time with the locals who are providing the care.
I also worked on implementing systems to improve triage and nursing care, as well as prescribing practices. There is an over-prescription of antibiotics in Syria, due to an expectation that antibiotics fix everything. It’s a cultural norm, so even if doctors know they shouldn’t prescribe them, patients expect it.
“The Syrian population remains extremely mobile, so vaccinating against the spread of communicable disease is a huge challenge”
The Syrian population remains extremely mobile due to the destruction inflicted by conflict, so vaccinating people against the spread of communicable disease is a huge challenge. Right now, the northeast Syria projects are focusing on improving routine vaccination coverage for under-fives. We were providing hepatitis B and tuberculosis vaccinations for newborns; polio, measles, mumps, rubella and pentavalent vaccines for children under five years old; and tetanus shots for women of reproductive age. By the end of my time in Kobane the hospital was offering newborn vaccinations 24 hours a day, seven days a week, and the nurses were autonomous in giving vaccines, which was great to see.
MSF is well-accepted in Kobane. I played football each week with a mix of local MSF staff and other doctors and locals, with the World Cup qualifier between Australia and Syria a hot topic! Out in the community, people were friendly, wanting to know where you came from and often inviting you in for tea. I arrived in Kobane not knowing how to speak Kurdish or Arabic, so I generally relied on a translator, but I did start to learn the local language. It was a great feeling to be able to have a conversation – often in broken Kurdish-English-Arabic – with my Syrian colleagues.
Moving forward from the devastation of conflict, the community in Kobane has really expanded. There are new shops, new restaurants: people want to move on with their lives and make the best of things.