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24 hours in a Bangladeshi field hospital

A Red Cross field hospital in the heart of the world’s biggest series of refugee camps is the only 24-hour emergency facility to service close to a million people.

The morning call to prayer wakes me up at 5.30. I shuffle out of bed and down to the outdoor camp kitchen by the light of my head-torch. Porridge again for breakfast. Coffee will help.

Colleagues finish their breakfast before racing off to their shifts, though first we meet to receive short updates from the surgeon, wards, maternity, outpatient department, head nurse, team leader and security.

I have barely walked into triage at Outpatients when the first ambulance of the day brings in a young woman. She has been involved in a tom-tom vehicle accident. She is extremely distraught and is very worried about her young child who was also in the vehicle. We reassure her the child is okay. She is stabilised and sent to x-ray to check for bone injuries. She has broken both her arms and her leg. Plaster casts are applied and she is admitted to the female ward.

The Outpatients consists of two canvas tented wards and a bamboo structure where people can wait, near the main road that runs through the camps. We see 120–200 patients a day.

Together with a local translator, we assess all the arriving patients and triage them accordingly. The local translators are indispensable and crucial to dispensing quality medical care. They provide a voice for our patients and a means of communication. Yet the job isn’t easy.

Being a type 2 referral hospital, unfortunately we are unable to see all the patients who arrive. There are limited resources to treat chronic cases. Instead, we focus our efforts on treating acute medical and surgical cases, obstetric emergencies, newborn health, along with maternal and child health.

Triage can be one of the hardest places to work. Patients travel long distances to attend the Red Cross field hospital and it’s heartbreaking to turn them away. Yet many times I have no choice.

A young child presents with his mother. He has fallen and hurt his arm. It appears to be a broken humerus, which an x-ray confirms. He is placed in a collar and cuff sling and provided with analgesia for the coming days. He’s young, the fracture is in a good position and it should heal well.

Another young woman presents with a fractured ulna in the forearm. It’s an uncommon injury and suggests domestic violence. We treat her fracture and contact our psychosocial support colleague, who ensures the woman is linked up with the appropriate services.

Minutes later, an eight-year-old girl arrives. Like the first person we saw today, she has also been hit by a tom-tom vehicle. She has an altered conscious state and it’s good that she is rousable. She has a large scalp laceration. It’s deep and we can see bone. She is quickly stabilised and taken to the operation theatre. In theatre the wound is washed out, cleaned and sutured. She’s taken to the Paediatric ward to recover.

Lunch brings a slight reprieve as the OPD is shut down for an hour. Only emergency cases will be seen during this time.

Already we have seen a mix of clinical presentations: measles, diphtheria, asthma, fractures, tuberculosis, pneumonia, ascites, abscesses, diarrhoea and skin disease. Acute cases are reviewed and either admitted or discharged. Some patients are referred to other facilities for ongoing care.

We work alongside local doctors and nurses, helping them improve their assessment skills, treatment decisions and general nursing care. They represent continuity in a context where change is constant. They are young, motivated and invaluable to the successful running of the field hospital.

Across the road the camp sprawls for kilometres. Shelters built from bamboo and tarpaulins litter the hillsides as far as the eye can see. The living conditions are tough. It’s difficult to comprehend how these refugees are surviving with so little.

Each day patients are transported to the hospital, many walk in, some are carried in on makeshift bamboo stretchers, and some arrive in ambulances from other aid agencies.

Shortly after lunch, an older man presents vomiting blood. It’s clear he has a malignancy. Although we are limited in the treatment we can offer him, we admit the man for palliative care. It’s not long before the family decide to take him home.

As evening falls. A young man is carried in from a car accident nearby. He is initially unconscious. He has a head injury and there is blood coming out of one ear. We have no CT scanner or neurosurgeons at our hospital. We are left with only our clinical assessment. It’s dark and too late in the night to transfer him beyond the camp checkpoints. The decision is made to monitor him, and fortunately his condition improves.

Overnight we receive three maternity referrals. All three required C-sections. Two healthy babies and one stillbirth. The sad reality is we’ve had all too many babies die from birth complications here. Many arrive too late.

The mother is saved in this case, but at a cost; she requires a last-minute hysterectomy and several blood transfusions to stabilise her.

Time for bed, the call to prayer is still singing from the hills across the road.

Jean-Philippe Miller is a Red Cross aid worker and an emergency and trauma nurse based at the Alfred Hospital in Melbourne.

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