“It is my belief that every doctor should at some point give back to people and society,” says Dr.Lt. Col. P. Nandakumar, as he talks about his recent trip to South Sudan as part of Médecins Sans Frontiéres (MSF), more popularly known as ‘Doctors Without Borders’. Nandakumar, who is an anaesthetist, served in the Indian Army, before retiring as Lieutenant Colonel in 1985.
However, it was in April this year, after having worked five years each in Saudi Arabia and Grenada, and another 15 in the United States that he went on his first field mission with MSF, to a town called Aweil in South Sudan with a population of around 15,000. “I decided to move to California from Maryland after 2012. As I had to get licensed again in California, I used the time while I went through the process to apply for the MSF programme. Following a rigorous selection process, I was kept on reserve for a year, my first assignment involved helping with maternity and paediatric care at Aweil, for which I accompanied a gynaecologist and a paediatrician,” says the soft-spoken 73-year-old.
In a new country born of much political strife, Nandakumar says the major problems are lack of infrastructure and education. “South Sudan does not have a national airline, so we took a World Food Programme (WFP) plane to Aweil from the capital city Juba.
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“Life there is quite different, as there are almost no surfaced roads and only one small government hospital. People make a living by farming or raising livestock, with the exception of some traders from Uganda who have set up shop in the region,” he says, adding that the lack of education has led people to place emphasis on faith healing and witchcraft, complicating matters for medical teams such as his.
“Our primary mission was to provide maternity and child support, and there was scarcely a day when I wasn’t called at night for some emergency. Multiple pregnancies and absence of proper antenatal care lead to lots of complications. That, and certain beliefs like not bathing newborn children for three months, leading to skin infections, kept us busy during our stay,” he says, elaborating that maternity-focussed teams do six-week missions due to their stressful work.
And what about personal challenges? “Sanitation and potable drinking water were the main issues, and despite our briefings and precautionary inoculations I did fall sick. We were also told to be wary of kidnappings, and though security was provided, MSF does not endorse gun use so the guards are usually unarmed. It was quite surreal as all our valuables were taken away upon arrival and some money was given to each of us, to offer as ransom in case we were kidnapped,” he says with a wry smile.
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He explains that the professional working environment, with limited resources, can take a toll as well. “There were many cases where there was not much we could do for the patient, and our own specialisations would suggest different courses of action. If we lose a patient in the operation room, there is a chance we will be blamed for the death and that could lead to complications with locals. But thankfully MSF has a good system in place where we can discuss and settle things,” he says, though he admits that he also made good friends through the programme, apart from learning to administer anaesthesia under stressful circumstances.
Despite the problems, Nandakumar says that the people trained to interact with the MSF team are friendly, and talks at length about their culture. “When a man gets married, he usually receives around 25 cows from the father of the bride, which made me curious how anyone could possibly manage to get their daughters married. But then it was explained to me that since usually each family has many sons and daughters, the balance is made up when the sons get married.”
In the midst of all this, Nandakumar says that the MSF doctors would take to playing volleyball in the evenings, and sometimes go out for a meal. And once at a restaurant he discovered that the popular saying that enterprising Indians can be found all over the globe did hold water. “There was an entire Malayali family there, small children and all, and they came up, introduced themselves and started a conversation. It was a relief to talk to someone from home in a foreign land,” says Nandakumar, adding that South Sudan and its people hold great potential, thanks to the fertile land and resources available.
“All they need is a stable government, basic infrastructure and education.”
Did he ever fear for himself? “I think my army background helped with that. At the age of 24, I was on the frontlines of the 1965 Indo-Pakistan war, and the day we crossed the border there were many casualties and grievous injuries where there was not much we could do. Having experienced all that, I was able to face this assignment without much trouble. However, I have requested not to be sent on more missions this year, and opted out of more field missions. Now I would prefer to be sent to hospitals with enough equipment to work with,” he says, signing off.