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By the banks of the Nile – Omar Salim Akhtar

I first heard about Médecins Sans Frontières (MSF) as a child. I was seven and, at that very moment, impressed by the selflessness of the French doctors risking their lives to save the refugees streaming across the Afghan border into Pakistan, I decided to become a surgeon. As fate would have it, 21 years after the day that I first read about MSF, I walked into their office in Delhi to be interviewed for the post of a surgeon.

A few months later, I underwent the Primary Preparation for Departure (PPD) course in Bonn, Germany, and was told that I was being sent to work as a surgeon in southern Sudan.

I spent a few days in a cool Nairobi, Kenya, on my way to Juba, the capital of southern Sudan, where, when I arrived, it was 52 degrees, with blistering hot winds that blew across my face. I was welcomed by the MSF team at what is one of MSF’s largest missions, with more than 40 international staff and 800 locals covering five centres, and the following day flew to Nasir in a single-propeller plane with the MSF logo on its side. I was told that the plane carries food and medicines as well as staff, so the more staff they have to carry, the fewer supplies the teams receive!

Nasir was once an ancient trading town on the banks of the Adok river, a tributary of the Nile, which straddles the border of southern Sudan and Ethiopia, where people of different ethnicities and speaking many different languages would come to trade in the famed central square – which was basically a very large, dusty field of sand, surrounded by huts built of straw. When I arrived, the river had run almost dry, and the heat of early April had dried most of the banks. In the rainy seasons, the river often bursts its banks and floods the town, but I never saw this spectacle, although I was treated to the sight of one-metre-tall birds, small sparrows, crows, and even bald eagles flying across the horizon during the two weeks that I was there.

I worked with a very experienced German surgeon, operating on cases that included gunshot wounds, caesarean sections and appendectomies, among others. We also had daily outpatient clinics, did our hospital rounds, and treated many minor cases: most often old, neglected foreign bodies, or small abscesses. The MSF hospital is a large one, with a separate surgical ward, a therapeutic feeding centre, a general medical ward, a labour ward, and also a ward reserved for treating patients with kala azar, which is endemic in the population. My stay there coincided with the midwife achieving a record number of deliveries.

MSF-trained clinical officers run the outpatient department on their own, referring any surgical cases to us, and, I must say, they were extremely well-trained. After a short stopover in Loki, in northern Kenya – the home of MSF’s logistical base, where all the food, supplies and medicines for southern Sudan are stored – I was sent to Leer for three months.

This was extremely rewarding, both professionally and personally. Quite unlike the bustling Nasir, Leer is an extraordinary place: a textbook 19th century African village, with mud huts, straw roofs, dirt roads, cattle, barefoot tribal people, and the continuous chirping of birds, insects and other animals always audible nearby. The only two pukka buildings were the Commissioner’s Office, and MSF’s hospital. MSF has a rich history in Leer, having served the local population for more than 20 years.

The hospital is the only one for more than 100 miles in any direction, which meant that, besides dealing with emergencies, we treated several old, neglected cases. Some patients are flown to the hospital, while most simply walk – often for weeks, or even months – to reach s. I found the entire MSF team in Leer to be a model of exceptional dedication, with a perfect blend of experience and youth, while the local population have a great respect for MSF. In fact, the team itself was a wonderful microcosm of the organisation, with every continent represented by one or two staff. The compound where we lived had 12 mud huts (known as tukuls), with only limited power because we used solar panels, which inevitably did not perform well on cloudy days.

I conducted more than 220 procedures, including more than 50 major surgeries. Many of the cases related to trauma, of which the majority were caused by gunshot or spear wounds. I also dealt with common tropical surgical conditions, such as typhoid perforation, or TB, and also neglected ulcers, abscesses and osteomyelitis, among others. On top of that I performed caesarean sections, and assisted the midwife as and when I was needed.

I remember particularly a tough case of an infant with recurrent vomiting after birth, who was operated on later, and found to have malrotation of the gut. It was a very tough surgery, as we had no anaesthetist, and all our procedures are performed under ketamine. The infant survived the surgery, and made a healthy recovery.

I had a fantastic time at Leer and Nasir, and my most rewarding moment came a few days before leaving, when a 10-year-old child, who had been receiving regular dressings for a bone infection on our ward, came up to me and said, ‘God will reward you.’

To be out there in the wilderness and to be tested in an emotional, physical and mental way, and to strive to perform in those conditions, was a wonderful experience. It is said that ‘true happiness comes from the service of others.’ With MSF I found that true happiness. I am delighted to be a part of MSF, both now and in the future.

Omar Akhtar, Surgeon, Mission in South Sudan

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