Responding to South Sudan Refugee Crisis, Emergency Physician Learns to Embrace the Unexpected
By Sonia Lowman, Communications Officer
May 8, 2013— Walgak, South Sudan (Akobo County West) is one of the most remote places on earth—surrounded by swamps and virtually inaccessible eight months out of the year due to rain. The region is largely dependent on rations from the World Food Program and life expectancy there is just 42 years; the nearest secondary school is a 3-day walk; and a woman is more likely to die in childbirth than to learn how to read. Most of the people who were educated before the war (1983-2005) have since died, while many of those remaining spent their early years fleeing violence.
Violent cattle raids are frequent among the mostly pastoralist inhabitants of Akobo, during which animal caretakers—often young children—can be injured or killed. To address mass casualties resulting from ethnic violence in Akobo, International Medical Corps designed a program focused on trauma training. But as Dr. Melissa Clark, an International Medical Corps Emergency and Disaster Care Fellow, recently learned, humanitarian relief often looks very different in the field than on paper. Melissa spent two months in Walgak with the goal of providing trauma training—but her time there ended up being much more than that.
In Walgak, Melissa encountered extremely low health literacy, as South Sudan faces a severe shortage of health facilities and health care workers—with only about 120 medical doctors and 100 registered nurses for a population of nearly nine million people (International Committee of the Red Cross). The Walgak Primary Health Care Center, which receives hundreds of patients every week, has no South Sudanese doctors, and the closest hospital is a four-day walk. Those who function as doctors are actually Community Health Workers (CHWs) who receive nine months of training after high school and have “very variable levels of practice.” South Sudanese nursing assistants only receive on-the-job training and, as Melissa discovered, frequently do not know how to do things that we expect nurses in the U.S. to do —like take vital signs or administer proper medicine dosages.
Thus identifying multiple issues in patient care, Melissa had to branch out from trauma training and try to upgrade from there. Melissa trained “everybody she possibly could”—on everything from latrine use, to treating life-threatening infections, the importance of prenatal care and much more. She also trained village health committees on how to get the word out about health services and overcome community resistance to accessing them. Says Melissa, “A lot of it is having them come up with what will work for their communities—asking them what will work for them and what won’t—and then brainstorming together.” Melissa trained about 35 health staff and 100 community members in Walgak.
Originally from Marin County in northern California, Melissa went to UCLA as an undergraduate and then onto medical school at Georgetown. Her dad and grandpa were doctors, so she pictured doing something different—but eventually settled on medicine because it combined her love of science and helping others. It was while completing her residency at Highland Hospital in northern California that Melissa learned about International Medical Corps, with which she volunteered in Haiti in 2011. Melissa loves International Medical Corps’ mission of training because “it really creates a longer-lasting impact.”
Despite no running water, eating virtually the same thing every day, contracting malaria and living in a mud hut, Melissa loved her time in Walgak. She felt embraced by the community and says that people there remain optimistic even in the face of so much death. She recalls the 14-year-old boy she stabilized after he and his family were shot in a cattle raid. International Medical Corps got the boy evacuated by helicopter for a blood transfusion and seven hours of surgery, without which “he absolutely would have died.” Melissa got to see him fully recover and play soccer again. She also got to see the community really bind together when, after the shooting, “all of these people came out of the woodwork” and stayed all through the night helping.
When she works abroad, Melissa relies more heavily on her clinical skills, which she says makes her a better doctor overall. As an emergency physician, Melissa is “used to seeing awful things”—but in the developing world, working with so little, it is “that much more amazing when people recover.” She feels that working with International Medical Corps has broadened her experience and made her more compassionate and conscientious of the resources that she uses. Melissa currently divides her time between Harbor UCLA Medical Center in southern California teaching residents and researching global health issues for International Medical Corps. She’s looking forward to her next assignment in the field, where she’ll no doubt make a tangible impact by embracing the unexpected challenges—and rewarding experiences—that arise.