December 21, 2016

After working with Doctors Without Borders/Médecins Sans Frontières (MSF) in Liberia at the tail end of the Ebola epidemic, Australian nurse Emma Parker spent almost six months at Al-Salam Hospital in Khamir, Yemen. Here she describes her experience working as head nurse. 

I had worked as a nurse in Melbourne, and also in Indigenous communities in Australia’s Northern Territory. Working in these remote districts was good preparation for going into the field with MSF — there are similarities in that people wait until they’re really sick before they come to the hospital. I was glad to have had that experience.

Many people don’t know it, but the humanitarian crisis in Yemen is the worst in the region. It is now estimated that 80 percent of the population — around 22 million people—require some form of assistance. Coming from Australia, with our population of 24 million, the scale of the emergency is almost impossible to comprehend. 

At Al-Salam Hospital in Khamir, MSF is involved in the emergency, surgery, maternity, pediatric, inpatient and intensive care departments, and collaborates closely with the Ministry of Health to improve medical services. We also support the blood bank and laboratory.

During my time there as Head Nurse, we treated many children for malnutrition and severe diarrhea, as well as respiratory infections and malaria. For women, we managed a lot of very complicated obstetric cases. For men, it was trauma: mostly gunshot wounds and road traffic accidents.

The war has intensified in Yemen. It has restricted access to medical facilities (or destroyed them completely). Injuries from airstrikes didn’t discriminate by age or gender. We were seeing more and more people who had traveled from far away; I heard of people walking seven hours to come to the hospital. By the time they reached us, they were often in bad shape. 

A Balancing Act 

My official duties were to supervise and support nurses, organize rosters and assist with the running of the pharmacy. In reality, I got involved in a bit of everything. People liked to show me the leaking roof!

Your drive as a nurse is to be with patients, so it was sometimes frustrating to be drawn away to deal with administration. It was always a bit of a balancing act. Of course if there was a large influx of patients or another emergency I stepped in to provide direct care, but otherwise it was about the other value I could add, and the legacy I would leave.

An example is training. The Yemeni nurses are educated; you’re not teaching them how to take a temperature. I focused more on advanced care — treating malnourished children, resuscitation — things like that.

As a nurse in Australia you do a lot without the doctor. I’m not talking about administering medications, more so thinking ahead and being prepared. In Yemen, nurses don’t do these things unless directly instructed. So I also tried to guide them in that respect. Getting the nurses to think, “Ok, the patient has these symptoms. What do I need to get ready?”

The people were the absolute highlight of my time in Yemen. When you read about the country you get a sense that people are ‘closed’; the women are covered and it appears to be a serious and conservative society. In many ways that wasn’t my experience.

Yes, there is a divide between men and women, and things that are simple in Australia are not simple there because of that. But they are very friendly people.

The women are very affectionate, they give a lot. And I found the men to be quite open to me. I was head nurse but I’m still a young female. People might not think they’d be respectful of that, but they were. 

Unexpected Experiences 

I was there during Ramadan and, along with some of the other international staff, I decided to take part. It didn’t seem right to eat in front of people who were fasting. Our Yemeni colleagues appreciated our participation, and many of them invited us to break fasts with their families. We experienced a real closeness.

Once, we were at the nearby internally displaced persons (IDP) camp and two families who were living in one tent insisted that we share their scant food and water. We tried to politely decline, but they wouldn’t take no for an answer. It makes you think, how many people in that situation would behave that way?

The role of head nurse is a bit of a balancing act between medical and administrative tasks, but I made an effort to always be in touch with patients. Many of them stick in my mind, of course.

We had a lady in her late 60s who was at the hospital for two months after being badly burnt on her face and hands by an explosion. Even in the most modern hospitals it would be difficult to survive those injuries at that age.

She had to endure regular, painful dressing changes but remained an upbeat woman. She would come to find me every day if I hadn’t said hello. She was making good progress but I’m sorry to say, she succumbed to a chest infection and passed away. It was terribly sad.

Fortunately, I can also share stories with happier endings. Another patient I think of is an 11-year-old girl who suffered a rare complication, a fistula, from a surgery. An opening had been created to her bowel and she ended up having four or five surgeries. She was so spirited though. She spoke like an adult. She’d lecture the doctors every time they came in about what she needed and what she’d been eating, she was so funny. Before her last surgery she even told them she wanted a local anesthetic instead of a general!

She was in the hospital for a long time, about six weeks, before the fistula was repaired. All the nurses were in tears when she was discharged. Her family was from the outskirts of the city and they were very poor.

We treated a lot of patients from outside Khamir, including many from the IDP camp. A lot of people are without work and are surviving day-by-day. I spoke to a father about why his young daughter was very obviously malnourished. He told me that his wife had died and he hadn’t been able to bring her to the hospital because there was no one to care for his other five children.

Every patient at the hospital requires a female caretaker but a male signature for consent and discharge. It can make things difficult but that’s the way it is.

No Jobs, No Hospitals: A Forgotten War 

Sometimes we had to refer patients to Yemen’s largest city, Sana’a, for further treatment ,  but because of the worsening conflict there are basically no working hospitals there, only private facilities. People would say to me, “I can barely feed myself, let alone pay one million rial [about US$4,000] to go to the hospital.”

There used to be many public hospitals in the city. But with no electricity, no fuel for generators, no equipment, no drugs, no staff, it becomes impossible.

There are no commercial flights in or out of Sana’a anymore; just humanitarian ones. You look around at the airport and everything has been bombed…the planes, the buildings.

You feel like there’s not much you can do and you worry, because you know the fighting is getting closer and closer to Sana’a.

Yemenis are known to be incredibly resilient. But as the war drags on, you can see the effects. Very few people are working and there are chronic shortages of food, water, energy. People are struggling.

Our national staff in Khamir are among the “lucky ones.” MSF employs more than two hundred at the hospital (as well as ten international staff). Some of the staff were from a nearby IDP camp. That was positive because if someone is employed, it doesn’t just help their family, but others too.

In the town, unless you work for MSF, in a shop, or selling street wares, there’s not really much else. Even the MoH can’t really afford to pay salaries. The Yemeni bank doesn’t have the money to pay. The country has almost ceased to function. One of my Yemeni colleagues said, “No one governs this place.”

Despite all this, the minute you leave the country, you really want to go back. It’s hard to describe…there’s something special about it. All the other field workers I have spoken to have said the same thing.

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