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Working in the sudan

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Nursing in a war-torn country can offer many personal rewards. Kathy Oxtoby talks to Jo Grimshaw about her work in Darfur

For Paediatric nurse Jo Grimshaw, pictured, ‘there is no sadder sound than a mother crying for her dead baby’. But she was to hear such cries many times in the three months she spent as a nurse volunteer in war-torn Sudan in 2005.

During her time at a camp for internally displaced people in Darfur, Jo witnessed suffering and starvation on a massive scale, treated patients while working in basic conditions and under fierce heat, and on two occasions was forced to leave the site for her own safety.

But despite its many challenges, her volunteer work has, she says, also been ‘hugely satisfying and gratifying’, allowing her to save lives and learn new skills. And the experience, she feels, has changed her ‘immeasurably’.

The chance to do humanitarian work in developing countries had been a long-held dream for Jo. But she put the idea ‘on the backburner’ for 20 years, while her children finished their education and she built a career as a ward sister on a paediatric unit in Guernsey. Eventually she felt she was in a position to give up work and begin a journey that would eventually lead her to Darfur.

To obtain some training before going overseas and to learn more about the type of work she wanted to do, she enrolled at the Liverpool School of Tropical Medicine to study for a certificate in community and tropical medicine and health.

Of the various non-governmental organisations (NGOs) whose representatives gave talks to students on the course, Jo was particularly impressed with the range of activities offered by international medical charity Médecins du Monde. Given her family commitments, she also liked the fact that it would consider sending volunteers on relatively short missions of three to four months.

Having been accepted for a three-month mission, Jo was soon on her way to work as a nurse at a camp for around 150,000 internally displaced people in Kalma in South Darfur. Thousands had fled to the camp since 2003 following the conflict between the Sudanese government and rebels in the western region of Darfur. The ongoing conflict has resulted in untold deaths and casualties, destroyed homes and villages and left survivors seeking refuge in camps like Kalma.

Jo had expected conditions at the camp to be bad but says: ‘The first time I saw it I was appalled at just how bad they were.
‘People were living in dwellings that were about 3m by 3m at most. The dwellings looked like bundles of sticks with bits of tarpaulin over the top. I was appalled.’

On arriving at the camp’s clinic, Jo was immediately faced with the brutal reality of her mission. ‘That morning there had been an attack on three women who had been collecting firewood. One woman was killed and her body was taken to the clinic. So that was the first thing I faced – a dead body.’

Jo worked as part of a 20-strong team, which included the organisations’ midwives, nurses and doctors. As well as nursing she helped to train local people, ‘so that they could carry on the work we were doing’.

The clinic was made up of a seven-bed emergency ward, a 36-bed inpatient department and outpatients. Patients were triaged outside the clinic – sometimes 200 at a time were lined up to be assessed.

‘This triage was one of the most difficult things I’ve ever done,’ says Jo. ‘You’d try to unravel people’s symptoms and make a quick clinical assessment – sometimes there was an interpreter to help you.

‘But many patients didn’t qualify for treatment because their conditions were not severe enough, even though they were desperate for help. It was hard having to make these choices – and yet you had to make them.’

Dehydration, diarrhoea, war wounds and severe respiratory infections were some of the most common conditions in camp.

Malnutrition was also rife, particularly among children.

‘There was one baby who was severely malnourished – but then after his initial treatment he seemed to be making progress,’ Jo recalls.

‘He started to do all the normal things babies do, like looking at his hands. Then, a few hours later, he died. His system was just too weak to recover.’

He was one of many for whom treatment came too late. ‘For ease of management we put all the malnourished children in one tent. There was a 90% death rate in that tent.’

While life in camp could be distressing, as Jo points out: ‘You’re so busy you just have to get on with it. You don’t become hardened but you work out ways to cope with it – it’s all part of the role’.

Not even the sound of gunshots resounding around the camp deterred Jo and her colleagues from their work. The team were evacuated on two occasions from the clinic because violent incidents in the camp looked likely to escalate. The next day it was business as usual.

When her time in Darfur ended, Jo returned to Guernsey and bank work, which gave her the flexibility to take up another mission earlier this year as a medical coordinator in south Sudan.

After 22 years of civil war between south and north Sudan, a peace agreement was brokered in 2005 and south Sudan
now has its own government which is working with NGOs to build, among other things, a healthcare system. Jo’s mission was to work as part of a team assessing community health needs and to give local healthcare staff the skills to look after these communities.

During this time, Jo experienced one of the most satisfying moments of her career. While she and a midwife were delivering an immunisation programme out in the bush they came across a young girl in labour. Jo delivered the baby but the girl was unable to deliver the placenta.

‘She was lying on the floor of a hut in the dark with chickens scratching around. I had to get a line into her to get the oxytocin in. I offered up a prayer and cannulated her.

‘The midwife delivered the placenta and we gave the girl antibiotics. If we hadn’t been nearby she could have died.’

Without her years of nursing experience Jo believes she couldn’t have dealt with the demands of nursing in the Sudan. ‘The management and decision-making skills which start from the moment you qualify stand you in good stead wherever you are in the world,’ she says.

Her experience also helped her to treat patients at the camp. But compared with nursing in a UK hospital, she says the clinic was ‘busier, more immediate and there was more of everything. In England you might see one patient die in a year. In Darfur it could be three in a week’.

Working in the Sudan made her realise the importance of involving families in the patient’s care – an approach that is becoming an increasing part of nursing in the developed world. ‘Involving families is crucial in a setting like Darfur where you rely on them for a lot of the care,’ Jo explains.

The experience has also made her more tolerant of the demands made by patients and their families in the UK.

‘What astounded me about people in Darfur was their ability to accept what life throws at them. Some were almost traumatised. Parents became so isolated within themselves that it was as though they were unable to grasp the enormity of what was happening to their children.

‘So now I find it refreshing when mothers fight for the right services and care for
their children.’

Her time in the Sudan has also affected her personally. ‘I got to know myself and my limits. And I was able to recognise and accept that there were some things I just couldn’t change.’

She advises any nurse considering volunteering for humanitarian work overseas to do some form of background training because preparation is essential.

Nurses should also be prepared for the work to be hard, both physically and emotionally, she adds, but the personal rewards will be great. ‘You are helping people who are immediately grateful, which is immediately gratifying.’

Jo would love to do more missions – she believes her age, experience and the fact she is working towards retirement puts her in an ideal position to do them. And she urges other nurses who are a few years from retiring, to do the same.

‘If every nurse did a mission towards the end of their career, nursing – and the world as a whole – would be the better for it. After all, we are a global community and we should be helping each other.’

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