David McGuinness is an Australian nurse who was working in an MSF-supported hospital in Al-Dhale, Yemen for six months.
Cholera is endemic in Yemen, but a breakdown in the usual support systems and health structures, because of the ongoing conflict, saw this outbreak reach unprecedented proportions. At the four cholera treatment centres we had in Al-Dhale, we saw over 6,000 patients. This was on top of our regular hospital activities and simply keeping up with supplies was a challenge.
"Prevention strategies rely on access to clean or filtered water and ensuring hands and food are cleaned thoroughly"
Prevention strategies rely on access to clean or filtered water and ensuring hands and food are cleaned thoroughly. Treatment for cholera involves rehydration to replace the fluid lost through diarrhoea. Despite this, many people still died from dehydration, unable to reach a centre in time. Some were too old or young to cope with the stress it put on their body, and unfortunately some couldn’t get to the treatment centres because travel was costly and dangerous.
Doing a round of the cholera ward was fairly repetitive. I would review how much fluid had gone out and how much was going in. It was difficult to get patients to drink the oral rehydration salts and some needed constant reminders. The most severely dehydrated got IV fluids until they had stabilised.
While finishing a visit in one of the treatment units one time, I spotted a woman being half dragged, half carried in by her husband. Her eyes were sunken back in their sockets, body limp, she was moaning with belly pain; her lips pale and parched. The team swiftly put in an IV and within 24 hours, she was walking out of the clinic hydrated but visibly exhausted. It is said that untreated cholera can kill within hours. The family had travelled quite far to get her to the treatment centre and thankfully, she made it just in time.
"From another direction, we could hear the crack of gunfire ... the explosion had come from an improvised explosive device about 200 metres away"
“There was a short, sharp and loud bang"
There was a gun shop near the hospital and throughout the day you could hear guns being tested. Combined with the number of fireworks going off, it led me to wonder whether we would know the difference between nearby fighting and regular “test” shots fired.
Late one afternoon, my question was answered. I was in my room, on the second floor and only metres from the hospital when suddenly there was a short, sharp and loud bang. It was followed by a shockwave that I felt through my whole body. I called out to the other staff member who was home and together we moved downstairs to a safer location. From another direction, we could hear the crack of gunfire. After several minutes and some rapidly exchanged messages, we were given the all clear to move. The explosion had come from an improvised explosive device about 200 metres away.
The gunfire continued sporadically and from my window I could hear the rush and commotion in the hospital. People were yelling and some wailing. After several attempts, we contacted my colleagues who were on call in the hospital and they assured us that it was okay to move.
We must have arrived at the hospital about 20 minutes after the blast. There were people everywhere and it was hard to tell the difference between those who were working, the patients and the visitors. The commotion was overwhelming. An eight-year-old girl was already dead and three other children were seriously injured. Four others had come in, suffering from minor injuries.
"The gunfire continued sporadically and from my window I could hear the rush and commotion in the hospital"
After the situation settled, I noticed a child-size body bag lying unceremoniously halfway down the corridor. A distressed man was standing above the body, shouting in deep sorrow at, what I later learned, was the loss of his daughter.
It wasn’t long before everyone was stabilised and staff were able to go back home. The team did a great job without concern for themselves. It was clear they had done this before and will, no doubt, have to do it again as the conflict continues in Yemen.
MSF works in 13 hospitals and health centres in Yemen and provides support to more than 20 hospitals or health centres across 11 Yemeni governorates: Taiz, Aden, Al-Dhale’, Saada, Amran, Hajjah, Ibb, Sana’a, Abyan, Shabwa and Lahj; with almost 2,000 staff, making it among MSF’s largest missions in the world in terms of personnel.