What it’s like to be an emergency response nurse
By Clare O’Neill, Emergency Health Unit Nurse
I recently arrived in Juba, the capital of South Sudan. I’m on my first deployment with Save the Children’s Emergency Health Unit – a new approach that means we can send a team of healthcare workers to emergencies within 24 hours of them happening.
We’re here because the South Sudanese Ministry of Health have asked us to respond to a fuel-tanker truck explosion. It killed an estimated 300 people and hospitalised a further 200. I’m working as a nurse in Juba Teaching Hospital, where we are treating people both on the ward and in the operating theatre.
Before I left London to come to Juba I spoke to a nurse who’d also been deployed with Save the Children. She told me to try to avoid thinking: “If only this patient was in the UK, we could do so much more.” She told me it’s fruitless. I’m trying to think like that, but it’s hard not to consider the stark comparisons.
I’ve been so impressed by the nursing staff on the ward. They’ve been here since the patients first arrived and they constantly battle tricky conditions to keep nursing standards as high as possible. When I first arrived I was amazed that there were no obvious signs of wound infection – patients were healing despite the open environment, the heat, and the flies. The nurses had done an excellent job but they couldn’t continue that momentum for long.
The simple things can be the hardest
I’ve quickly learned that the biggest challenges of looking after patients in this environment hardly ever stem from the initial problem – in this case their burns.
Those burns are initially shocking, and of course distressing and painful for the patients, but it’s the other factors that make patient care more difficult. Without basic supplies, more complex problems arise, and patients suffer for no reason. It’s often the simple things. Such as water – patients who have lost the top layer of their skin need to be washed with warm water, because cleaning with cold water is torturous, despite the baking heat outside. But sporadic power failures sometimes mean that we don’t have access to warm water.
Poor nutrition and damage to tissues also means that many of our patients have developed contracture of their joints, which makes them stiff and in pain. It also limits their movement, which is vital to encourage important blood flow. Some of them also develop pressure sores, another thing that complicates recovery.
Many of our patients have lost loved ones, and while they’re in hospital here in Juba they may be losing their livelihoods. The children are also missing their education. Even if we can treat their burns, the challenge of rebuilding their lives will continue.
One of our patients, Victoria*, is a child with severe burns on her legs. The explosion has left her emotionally distressed. She’s in pain and can’t walk. She also has malaria. The nurses encourage her to eat, but the malaria means that she has no appetite and regularly throws up.
The bravery of patients
I am learning through patients like Victoria that in South Sudan, it’s not always as easy as getting patients into theatre and treating them with skin grafts. Victoria’s condition is vulnerable – if she becomes more malnourished her health could decline fast and she could die. Luckily, through our Emergency Health Unit, Victoria is receiving expert medical care and access to treatment that she wouldn’t otherwise have had.
We’re doing whatever we can to help. We’re providing vital food supplements and medicines for the patients, and are teaching and supporting the nurses here. We’re working with Handicap International to provide physiotherapy and psychosocial therapy. We’re distributing supplies, such as air mattresses, to patients with pressure sores and are providing clean water reserves for the wards. We’re also supporting our patients on discharge to help them with income generation and education so that they can adjust when they return home. We’re working with the hospital and our skilled plastic surgeon is operating every day.
Our patients are incredibly brave, as are their family-members, caregivers and nurses. Through Save the Children’s Emergency Health Unit, we hope to give these courageous people a better chance of recovery.
*Name changed to protect identity.