May 24, 2011


New York City-based nurse, Hannah Megacz

Hannah Megacz, a New York City-based nurse, has worked with MSF in Cameroon, Niger, the Democratic Republic of Congo, and, for much of 2010, in Dadaab, Kenya, in the Dagahaley Refugee Camp, the largest of three refugee camps set up in the 1990s for refugees fleeing war in Somalia. Originally established to accommodate 90,000 individuals, the camps are currently struggling to support 300,000 refugees. More than 100,000 now live in Dagahaley alone, in fact. The needs are significant and the resources far too few, especially as it pertains to food, water, sanitation, and shelter. MSF has spoken out about the need to provide more care for these refugees, something that seems ever more urgent as the numbers look likely to continue increasing.

When I left we were seeing about 6,000 new arrivals each month. The rainy season had begun. Due to the overcrowding, many families still lived on the outskirts of the camp, unprotected. MSF was carrying out rapid medical screenings, referring people in need of care to health facilities, providing shelter materials, and, together with other agencies, ensuring the supply of water.

Despite the difficulties, there are many ways MSF is improving the health situation for the refugees. MSF is in the process of renovating Dagahaley’s hospital and the four health posts in Dagahaley. I was a part the opening of the new maternity ward in the hospital. It had new equipment and enough space for all our patients. The 27 beds can be arranged for prepartum, postpartum, or labor. We can also handle situations where there is labor distress or complications.

To reduce maternal and neonatal death, we have been encouraging women to deliver in the hospital. This is particularly important with complicated births. One example was a woman named Fatouma, who came to the ward in the late stages of labor, pregnant with twins. The maternity staff reacted quickly, and the first baby was delivered pink and crying. But the second child emerged blue. The staff brought the child to the resuscitation table and after rubbing, warming, and a little bit of oxygen, he was pink and crying right along with his sibling.

The renovation also included the construction of an operating theater. This was the first surgical project we opened in the area, and it complemented the maternity ward because it allowed us to perform C-sections if needed.

A woman named Nasro came in with life-threatening eclampsia, which occurs when the mother’s body “rejects” or has an “allergic reaction” to the fetus. It can kill the mother, the child, or both. Even in the most developed medical centers, a C-section often is the only way that both can survive.

Oftentimes, the staff has to explain the necessity of the operation to the mother and family. I was called in to counsel Nasro and her family. They asked questions ranging from “Will she be able to have more children?” to “What happens if the anesthesia doesn’t work?” They gave their consent, but the child was delivered limp. The OR staff carried out resuscitation measures and revived the child. Then Nasro and her son had a full recovery.

We enlisted community health workers and traditional birth attendants to speak throughout the camp. In August, they visited 27,000 families to talk about the importance of giving birth in a maternity hospital, basic hygiene, and the services MSF was offering. Over time, we saw an increase in the number of women delivering in the hospital.

This was one of the first full-service projects that I’d worked in with MSF. In addition to our maternal and surgical ward, we have an adult ward, a pediatric ward, an emergency department, and a therapeutic feeding center to treat malnutrition. We also have an outpatient department that offers HIV and tuberculosis care. Throughout the hospital we admit more than 600 patients each month. We also run the four health centers in Dagahaley, providing vaccinations, antenatal care, and mental healthcare to more than 10,000 patients per month.

There are now generations of Somalis who don’t know life outside of a refugee camp. I often wonder how they will eventually, or ever, be able to settle back into Somalia. This is a chronic conflict with emergency medical implications.

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