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AYITI – My first mission as an MSF Doctor – Kalyansundari Gomathinayagam, M.D.

A lot of expectations and excitement, starting right from the Preparation for Primary Departure (or PPD) training course: who is going where, through chitchats and Facebook; anticipating that next it will be my turn; being proposed for the Central African Republic (my French is not up to the mark!), Papua New Guinea and finally landing up in Haiti for a six month emergency mission (still not sure about my French!). So my first MSF volunteer assignment kicked off with much enthusiasm.

Landing in the Dominican Republic – a country which is green and lovely – and then next day landing in Haiti, where destruction greets the eyes, starting right outside the airport and continuing to my final destination in Carrefour, at the Papwest project (short for Port-au-Prince west). This was the first shock I received.

I was to be the medical doctor for two outpatient clinics, working alongside Haitian doctors and medical staff and an international nurse colleague. At first, my role and the exact nature of my duties seemed to be quite ambiguous. With a rushed handover with the outgoing doctor, and with struggling to communicate with the Haitian staff in my broken French, my challenge for the next six months started.

My routine duties included supervising the quality of care we were offering, according to MSF standards; doing training with the national medical director regarding MSF protocols; liaising with the referral setups for patient transfer; and, last but not least, handling sexual and gender-based violence cases and reporting. When I started work at the clinics, we were doing primary healthcare and seeing 150 to 300 patients per week. When I left Haiti, we were no longer a primary healthcare unit, but had evolved into a community health centre, seeing 1,200 to 1,500 patients per week.

The zeal of the Haitian doctors and medical staff always kept me spellbound and humble; they would attend patients from eight in the morning to five in the afternoon, with no more than a half-hour break in between, in the small tents which were divided up into cubicles and extremely hot. They did an excellent job, with such devotion, which often made me realise how I needed to strive hard myself to keep abreast of their knowledge so as to be their supervisor!

As with any job, nothing is ever perfect. Slowly, as normal life returned to Haiti, my clinics were flooded with patients seeking treatment for chronic health conditions like hypertension, diabetes and asthma. Unfortunately we didn’t have much to offer such patients, being restricted to primary health care. We would still have patients under observation at 4.30 in the afternoon for whom there were no hospitals for admission, as every non-governmental organisation (NGO) with inpatient facilities was still in emergency mode and would only accept life-threatening emergencies. The Haiti General Hospital was the very last choice, as it was overcrowded, partially collapsed and most of the time did not have any beds!

Five pm was critical, as we had to move due to security regulations, and my frustration level would rise higher and higher, in rocket proportions! At times like these, I really struggled with the fact that we could not do more for our patients. As we were only set up to provide outpatient care, I would beg and wheedle, and do whatever I could to get my patients admitted to a hospital, at least for the night.

The most memorable period of my mission was the two weeks that I spent doing mobile clinics. This time was action-packed, work-intensive and very satisfying. It was a very different experience from working in the outpatient clinics, where I was far less involved with patient care. All the members of the team would kickstart the mobile clinic into action, irrespective of their job, and make themselves useful so as to treat as many patients as we possibly could, since we had a time-limit in which to finish the camp, pack up and go! Back home we would immediately start planning and preparing for the next day, and then off we would go again!

The mobile clinic was basically a bus modified into a clinic, with three consulting rooms; everybody else was out in makeshift tents. Outside the perimeter tape of the mobile clinic were the tents where people were living. It was almost unbearably hot, but if one thought the sun was merciless, then in the afternoons, when the torrential rains started, it really did seem as if the weather was making merry of our plight!

Rain or shine, the spirit of the people of the country was commendable, and their faith in their God unshakeable. Sunday would see them all going to church in their best outfits, salvaged after the earthquake, while their hymns and prayers would reach out to the sky seeking… I often wondered seeking what?

Of course there are difficult moments as a first missioner, when one longs to leave everything and come back to India, but it would have been a tough choice to leave halfway through the mission when there were so many things still to be done and never enough time to do them! So I stuck it out through the difficult moments and stayed until the very last day, and would like to believe that I did contribute a very small bit to the great humanitarian action that is going on in Haiti.
Au revoir, Ayiti cherie!

– Kalyansundari Gomathinayagam, M.D.

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