Jessica Comi is an operating theatre nurse who has worked with MSF in various contexts. Recently, she spent two months as part of an MSF’s surgery project in Khartoum, Sudan, where MSF is working in several major hospitals. She describes what she saw and how she felt working in this challenging context.
Let’s make it work
I was excited because I knew it was, in that moment, the right place to be. I knew, professionally, that I could be useful. But there was also fear about what we were hearing about the situation. We had two days on the road to get to know each other as a team before we arrived at the Bashair Teaching Hospital in Khartoum.
When the conflict started a lot of hospital staff left, so volunteers stepped in to restart activities. There were also challenges with supplies. Plus, we were in the middle of a conflict. We received a beautiful welcome because everybody was super happy to have us there but it would not be easy. There were a lot of different feelings.
At the same time, we knew the needs. It’s as if something clicks in your head and you say to yourself, “Okay, we have water. Sometimes we will have electricity. So, let’s make it work.”
We arrived in Khartoum on 8 May 2023 and started operating at noon the following day. The first week was incredibly challenging.
There were no more than ten patients being cared for in the hospital before we arrived. By the end of June, we had over 58 patients admitted on some days. This seemed like an impossible place to work and, working together with the volunteers, we made it possible. That is an amazing feeling.
Local volunteers
There was a volunteer who helped as a translator in the operating theatre. She was an English translator. She saw that we needed people so she just came to us and asked to join us. She didn’t have any background working in an operating theatre but she is just a great person. So many people were coming and saying, “I don’t need money, I just want to be working alongside MSF for now because I know it’s needed for my community.” It was incredible.
After a while, the volunteers really started to trust us and see how we grew together. They started to help us to manage logistics for example. We had somebody that was always responsible for the oxygen. They were the ones that were actually managing and helping us to get connections within the community.
War surgery
There can be a lot of challenges in working with wounded patients. It's really difficult when you aren’t used to doing war surgery. When you are used to it, you know the potential risk for a patient if they are not treated immediately. Risks like infections or losing a limb or haemorrhage. You need to act quite quickly and it is complex. Experience and expertise make a big difference.
As the conflict continued and more people heard that this hospital was open and were able to reach us, we started to see more children and women.
We tried never to close the door to any emergency. But we had limitations. And every patient we operated on meant we needed capacity to provide post-surgery care. We extended the intensive care unit but it was challenging to find enough staff to run it properly.
Mass casualty incidents
Every time we heard explosions, we got ready for a mass casualty incident – a situation where many patients arrive at the same time. You never know if it will be 20 or 40 or 100 patients. The pressure got worse as some of the other hospitals in the city began to close.
One day, 127 patients arrived in a short time after a series of explosions. The volunteers sent messages to their networks saying that the Bashair Hospital needed people to help and people immediately started arriving to assist.
We were running two operating theatres, trying to manage the most complex cases in one and the ones that were a bit less complicated in the second theatre. That day, we ran the operating theatre until four or five in the morning.
In a case like this, all scheduled operations for the day have to be postponed. That has a domino effect. It can be a week before you can get back to your normal activity.
Helping people to recover
Depending on the kind of wound, some patients also need multiple surgeries and many days to recover. Some may need longer treatment – weeks or sometimes months. Sometimes we managed to provide them with crutches or ambulatory walking aids for patients. We tried to teach them how to walk with the crutches, so that they could go home and come back for treatments.
Surgery can change people’s lives. Amputation is one of the common surgeries we did. Patients might come in with a right leg and come back after surgery without the right leg.
In an ideal world, we would be able to link patients with mental health support, physiotherapy and other resources to support their rehabilitation. While I was in Khartoum, it was not yet possible. This is what I wish most for this project.
Working in Sudan has been uniquely challenging
I have worked a lot in war zones. My assignment in Sudan has been unique, even compared to working in Iraq, in Mosul in 2017. The contexts were similar but in Iraq we didn’t face the same challenges and there were a lot more staff.
This has probably been my most challenging assignment. But it was also special how the team worked through all the challenges together. You could feel that we were all working for one reason and that was to save lives. That we’ve done all of that together, for me, was absolutely fantastic.