Embedded For 5 Days And 5 Nights At A Doctors Without Borders (MSF) Hospital In South Sudan : Goats and Soda They're in a crowded refugee camp, running the only hospital in a war-torn corner of South Sudan.

Five Days And Five Nights With Doctors Without Borders

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I'm Kelly McEvers, and this is EMBEDDED, an NPR podcast where we take a story from the news and go deep.


MCEVERS: Navpreet Sahsi is an ER doctor from Toronto. People call him Dr. Nav. A couple years ago, he went on his first mission for Medicins Sans Frontieres - MSF - also known as Doctors Without Borders. These are these incredible people who are, like, the first ones to get there when there's a war, earthquake or outbreak of Ebola or famine. Dr. Nav was posted at a hospital in Yemen, right on the front line of Yemen's civil war. One day, he was working in the emergency room.

NAVPREET SAHSI: I was rounding. I was doing my rounds - daily rounds - in the hospital and seeing patients. And while that was happening, there was sort of heavy fighting going on outside.

MCEVERS: And then this happened.

SAHSI: There was a really loud - really loud sort of boom. And I actually - my - sort of my initial thought was, whoa, something had just kind of hit, like, just outside us. What I didn't realize was that there actually was - all this glass had cracked just in the window that was not too far from me - I mean, 10, 15 feet to my right.

MCEVERS: A mortar had hit the hospital and broke that glass window.

SAHSI: When I looked behind me, there was smoke everywhere. And then, like, in those situations, everything kind of goes really slowly.


MCEVERS: Nav eventually gets himself together, runs to a safe room at the back of the hospital. He says MSF was not the target of this mortar. It was an accident. This is what's been happening to a lot of MSF hospitals, all around the world.


UNIDENTIFIED WOMAN #1: Another Medicins Sans Frontieres hospital has been leveled by airstrikes.

ROBERT SIEGEL, BYLINE: Doctors Without Borders said that their hospital was partially destroyed by barrel bombs.

UNIDENTIFIED WOMAN #2: These deadly attacks appear to have been deliberate.

UNIDENTIFIED WOMAN #3: ...Says 27 people were killed in an airstrike.

UNIDENTIFIED WOMAN #4: That one killed at least 23 people.

MCEVERS: And when these attacks happen, sometimes, of course, the hospital has to close. And then all the people in these places - Afghanistan, Central African Republic, South Sudan, Syria - will now have no access to health care. They basically lose their lifeline. That's what happened at Nav's hospital in Yemen.

SAHSI: We got to a point where we thought that the risks and the benefits were not balancing out anymore, and we were taking too high of a risk.

MCEVERS: So they decided to leave. There were Yemeni doctors who stayed, but now all the people in this part of Yemen have been left without any help from MSF's highly trained international staff. Nav went home for a while, and then he signed up for another mission with MSF in South Sudan.


MCEVERS: What we wanted to do is get inside one of these hospitals and stay a while. We wanted to know what it's like to work there day after day. I mean, working in a hospital's hard enough, let alone in a place where you don't speak the language and a mortar might hit you. Who are these people who get bombed while they're doing their work, but keep coming back?

So we sign up for a week in an MSF hospital in South Sudan. That country's just come out of its own brutal civil war. We spend a lot of time with the people who work there, and we also spend a lot of time with one patient - one tiny, little patient whose case tells us a lot about why these people do the work they do.


MCEVERS: So the idea to do this story came from one of my favorite reporters at NPR, Jason Beaubien. He covers global health, and he is the one who arranged our trip to South Sudan with MSF. Here's Jason.

JASON BEAUBIEN, BYLINE: The place we decide to go is called Bentiu. It's a place that saw a lot of fighting during South Sudan's civil war, and now it has the largest refugee camp in the country. A hundred and twenty thousand people are crammed into this camp. It's basically a small city, and inside that camp is a 170-bed hospital that's basically a bunch of tents.


MCEVERS: So we go straight to the busiest tent in the hospital. It's the ward for malnourished children. There's 20 or so beds. Families are there with their kids. Some of the moms are actually sleeping under the kids' beds. The walls and ceilings are white plastic tarps that let in a lot of light. There are only two doctors in this entire hospital. Dr. Nav, who you heard at the beginning, and Dr. Jiske. Her full name is Jiske Steensma. She's a pediatrician from Holland. She's here on a six-month mission, as they say in MSF.

Hi, there.


MCEVERS: How are you?

STEENSMA: (Unintelligible).

MCEVERS: Good. Do you mind if I stand near you a little bit while you're doing rounds?

STEENSMA: Yeah, sure.


Back at home, Dr. Jiske - that's how they do it at MSF - they use their first names - works at a major research hospital in Amsterdam. When she's done in South Sudan, she's going on a fellowship in Cambridge. She says she's the kind of person who likes extremes. Her idea of a vacation is camping on glaciers.


MCEVERS: She's working in this ward for malnourished kids. She is clearly very good at this.

STEENSMA: She's slowly starting to improve. Yeah, this is really funny. Yeah. (Laughter).


MCEVERS: This is how Jiske communicates with these patients. She doesn't speak the local language, Nuer, but still, she tries to talk to the mothers and the siblings, so the patients will get to know her and maybe trust her.

UNIDENTIFIED WOMAN #5: (Singing in foreign language).

UNIDENTIFIED CHILD: (Laughter). (Foreign language spoken).

BEAUBIEN: Right in the middle of the ward where Dr. Jiske works is this baby. She's in a bed. She's naked except for a necklace of red and white beads, and then she has this feeding tube that's taped to her cheek. The hospital staff keeps wiping her down with wet cotton balls to try to pull down her fever. One of the hospital workers, Michael (ph), says she's unconscious. MSF has asked us for security reasons to only use the first names of their South Sudanese staff.

MICHAEL: This confusion has just happened today.

MCEVERS: Unconsciousness happened today.

BEAUBIEN: The baby's named Ngoni (ph). She's malnourished, and she has malaria and a respiratory problem. She wheezes whenever she breathes. Earlier that morning, there was a moment when she was getting cold and didn't have a clear pulse. They put her on an IV and stabilized her. Now she's not waking up.

MCEVERS: Is this the mother? Is this her mother?

UNIDENTIFIED MAN #1: Yeah, this is the mother.

MCEVERS: Could we talk to her? It's OK?

UNIDENTIFIED MAN #1: OK. Yeah. Yeah, it's OK.



MCEVERS: So when did they come to the - to the camp?

UNIDENTIFIED MAN #1: (Foreign language spoken).

UNIDENTIFIED WOMAN #6: (Foreign language spoken).

UNIDENTIFIED MAN #1: They came May last year. Yeah. May last year - they came.

UNIDENTIFIED WOMAN #6: (Foreign language spoken).

BEAUBIEN: The baby and her mother and the rest of their family ran away from their home when the fighting started. In South Sudan, a lot of houses are made of mud and reed walls, and they have these thatched roofs. And a lot of them got torched in the war. People completely fled their villages. Many women were raped.

Tens of thousands of people were killed. So a lot of people in the refugee camp that surrounds this hospital are too afraid to go back home. This sick baby is the youngest in the family. She's one of three kids. The rest of her family comes and goes to her bedside throughout the day.

MCEVERS: Is this the first time the child has been in the hospital?

UNIDENTIFIED MAN #1: This is the first time the child's been in the hospital.

MCEVERS: What about her other children? Have they ever been sick?

UNIDENTIFIED MAN #1: (Foreign language spoken).

MCEVERS: She doesn't want to talk.

UNIDENTIFIED MAN #1: (Foreign language spoken).

MCEVERS: If she doesn't want to talk, it's OK.

UNIDENTIFIED MAN #1: Oh, no. When the child is severe like that, you know, the mother is purely disinterested so that maybe the child will not be survive whatever. That's why she is not willing to talk.

BEAUBIEN: He's basically saying the baby's mother is too overwhelmed to talk anymore right now, but she stays close to the bed. She's wearing a long, red dress that at one time was probably nice, but now it's been dulled by the dust of the refugee camp.

MCEVERS: Tell her we're sorry. We know it's difficult.

UNIDENTIFIED MAN #1: (Foreign language spoken).

BEAUBIEN: We move away from the mom and the other kids and stand at the foot of the sick child's bed.

MCEVERS: Is the temperature going - changing?

UNIDENTIFIED MAN #2: I keep temperature looking, so I hold up.

MCEVERS: He's taking the temperature now.

UNIDENTIFIED MAN #3: It's going up.

MCEVERS: It went back up. Yeah.

So Dr. Jiske is still doing her rounds in the ward for malnourished kids. Some of these kids are so small, they're getting weighed in what looks like a big plastic salad bowl with a scale attached. Eventually, Jiske comes back to the baby - Ngoni (ph). She was unconscious before, but now we realize she's awake.

We were watching this other patient, and she's awake. And that's great. (Laughter).

Jiske and I go talk to John (ph). He's the South Sudanese nurse who runs the intensive feeding ward for malnourished kids.

That's good. She looks tired, but she's awake, yeah?

JOHN: Yeah.

MCEVERS: That's good, no? Is the fever down?

JOHN: Fever before is down, and now it is up again.

MCEVERS: Again? Down, then up?

JOHN: Down, then up. And we continue to control fever again...


JOHN: ...'Cause our main problem now is fever.

MCEVERS: She's awake - a little bit awake.

It's so clear how you can get really wrapped up into the drama of it really fast. The staff at this hospital has seen so much. They're used to these ups and downs. I am clearly new at this.

It's good. She's awake. Hello, she's awake. Yeah. This is good, right? It's very good. Yeah.

BEAUBIEN: It is kind of amazing, though, I mean, seeing these other kids that are watching. These are family members, and really, quite frankly, it's, you know, a question of whether they're going to have a cousin or a sibling later in life is in the balance right here, right now. You know, it's kind of amazing when you think about it. This kid would not be surviving if this hospital wasn't here right now.

MCEVERS: It's a roller coaster, even for Dr. Jiske. At one point later on, I see her just sit down, looking overwhelmed, and then just walk out of the tent for a minute. She does this sometimes, just takes a break, goes to her tent or goes and talks to one of the other MSF staffers. I mean, these people are doctors and nurses. They're pros, but still, this work has got to get to you. It's already gotten to us.


BEAUBIEN: Even when they're not doing rounds, the doctors here hardly ever stop working. They're on call every other night. They have a walkie-talkie blaring next to their heads, so it's hard to sleep. You may have to get up at any moment and run to the hospital. And it's always hot here - over 110 degrees most days. You're sweating constantly, and it feels impossible to drink enough water.

Also, you're not allowed out. The international staff spend most of their time inside the hospital compound. Remember; the refugee camp that surrounds this hospital - it's like a city. There's petty crime, and MSF doesn't want their people to just go out for a walk. You have to have some reason to go out of the hospital.

Everybody lives in tents, usually with a roommate. They share showers, pit toilets. And then there's the food - endless pots of lentils. One of the Canadians has started putting maple syrup on her lentils and insisting it makes them fabulous. So remember Dr. Nav, the doctor you heard about at the beginning of this story?

SAHSI: How's it going this morning with all that other stuff?

BEAUBIEN: Right now he's on one of the isolation wards at the hospital. Today he's doing the rounds of the adults. He's checking on a woman with this horrific rash that's covering her entire body.

SAHSI: How's the rash (unintelligible)?

UNIDENTIFIED MAN #2: (Foreign language spoken).

UNIDENTIFIED WOMAN #2: (Foreign language spoken).

BEAUBIEN: This woman just got to the refugee camp. Before that, she says, she was hiding out for ten months in a swamp. That's because soldiers came and destroyed her village. She says she would spend the daylight hours in the water with just her head above the surface, like a hippo, to avoid the gunmen who were murdering and attacking people in the surrounding countryside.

At night, she and some of the other women would climb out to dry land to sleep and to try to get something to eat. Now Dr. Nav says he's very worried that her wounds could get infected.

SAHSI: We don't live in a very clean environment. Flies are going in and out of her wounds. We can't really stop that, except for I encourage you to be in a mosquito net most of the time. But her risk of, like, getting a secondary infection is quite high, which is why we just gave her antibiotics.

BEAUBIEN: Antibiotics and a skin cream.

SAHSI: She should put it over any place that's, like, scabbed or painful or open. Just cover, cover, cover, cover. That'll protect it.

BEAUBIEN: Dr. Nav happens to have a lot of this skin cream, but there are shortages of a lot of other supplies. The roads to the hospital are either washed out or unsafe most of the year, so everything - even lab tests - has to get flown in and out by plane.

SAHSI: So, like, yeah - so we don't always have all the medicines that we - that we would like for all of the patients that we see. Although I would say that we have, like, a lot here. I'm very impressed with what we do have, but we never have everything, right? And then investigating-wise, we're limited in what we can investigate for, right? We only have a few lab tests.

BEAUBIEN: Nav is very clinical about all of his cases. A lot of these people have had it way worse than anything he's ever been through, even Yemen. Nav has been here in South Sudan for a while. He's about halfway through his mission. One way he deals with it is to try to laugh - ribbing the Scottish guy about his new haircut, joking about the broken air conditioner - but still, sometimes it's just really tough.

SAHSI: I mean, then there's, like, a cumulative, like, emotional wear, for sure. I mean, we - (unintelligible) - we deal with, I mean, a lot of death - right? - a lot of death - much more than we're used to seeing at home, by far. Here, a child dies almost every - it feels like almost every day. That one individual case might not be - you know, you might be able to deal with it and feel OK with it, but dealing with it every day, the - I mean, the constant drain of that definitely builds up.

MCEVERS: Later, Dr. Nav tells us about that mission in Yemen back in 2014. Turns out, when MSF decided to pull out all its international staff, they needed one person to stay to the end. And Nav volunteered to be that person. We asked him - why?

SAHSI: Personally, I was asking myself that, too. I said, wow, this is pretty - this is a pretty high-risk situation that's escalating. So do I want to leave? Should I leave? Should I go? I mean, I think, yeah, like, why aren't - and I didn't at that point. And I asked, well, why don't I want to go?

I think - like, I think in my own mind maybe I downplayed the risk a little bit, too, and maybe up-played the responsibility aspect of it because I - 'cause I felt like that was important. Like, it's a really hard job, but I think - I know I can do it. And so - and because I know I can do it and because I know the need is there, it's hard not to be involved in something like that when you know what's out there.


BEAUBIEN: So it's pretty clear why Nav wants to do this work. If he wasn't here, more people would die. But how do other people - the other doctors and medical staff - deal with all the misery without losing their minds? That's what we want to ask Jiske. And also, what about that tiny patient, Ngoni - the baby from the first day with malnutrition and malaria and that respiratory disease - the baby who woke up after being unconscious? We want to know what will happen to her.


MCEVERS: So I am back with Dr. Jiske in the ward for malnourished kids. Local staff have just called her to check on the baby, Ngoni. She was awake, but now things are bad again. The breathing's getting slower and slower.

She has a very low blood sugar. Very low - 18 - so her blood sugar's dropped way low. Dr. Jiske said, oh, [expletive]. She's moving fast.

Jiske tells a nurse to hold the baby's leg while she opens a package that contains a really thick needle.

STEENSMA: This goes into the bone.

MCEVERS: She has to push the needle into the baby's bone - it's a bone marrow IV. Because the baby's so limp and dehydrated, they couldn't get a vein in her wrist. They even tried to get one in her head. That's what they have to do with these kids. After this needle goes into the bone, Jiske does not look happy. The baby should have reacted, but she didn't. The baby does start getting the fluid she needs, and her breathing does even out.

So she's breathing, but slowly.

STEENSMA: Yeah, yeah. She's being quiet.

MCEVERS: Yeah. Her eyes open again?



STEENSMA: Not now - blood sugar too low. It's a sign of shock.

MCEVERS: She's a little bit better, but really, she's not. And it all just seems so unfair. This baby didn't do anything in South Sudan's civil war. She was born, and then she didn't get enough to eat, and now this.

It's going to be hard to not sit here all day. This baby was definitely going to die when she was putting in the IV - basically, when she was shoving a needle into this girl's leg bone - and the girl didn't react. I just can't seem to leave.

So I sit there for about a half an hour, and then this happens.


MCEVERS: She's opening her eyes.



The nurse is the baby is awake and asking for water, like, with words.

UNIDENTIFIED WOMAN #3: How old is she?

MCEVERS: Because it turns out she's not a baby.

UNIDENTIFIED WOMAN #4: She's three years.

MCEVERS: She's three years old. She's just so small - she only weighs 15 pounds - that this whole time I and a certified medical professional both thought she was a baby, which means her situation is probably even worse than I thought. But right now, she is drinking water, and she is crying, and that is good.


UNIDENTIFIED WOMAN #5: Look at that.

MCEVERS: All right. Complaining - this is good.

STEENSMA: Jiske's clearly affected by sick patients like this. You can see it in her face, smiling like crazy when things go right, all twisted up and worried when they don't. Jiske tells Kelly it was really hard when she first got to this hospital.

STEENSMA: I think that the beginning was the most intense. The - just getting used to the mortality, to the children dying, to every two or three nights, on call, big hospital - yeah, the whole environment. I remember at first I did have nightmares - the first week - just not really feeling comfortable here. But that lasted, you know, first week, I think. Actually thought last week, I don't want to leave here. I can't imagine going back to Amsterdam and being at work again in, you know, an academic hospital.

MCEVERS: Now you've crossed the line where you can't imagine.

STEENSMA: Yeah. Yeah. I feel happy being here. I mean, it's hard work. You've seen it. And it's really, really frustrating. It has really high highs and deep lows, but especially when the moms are appreciative of it, that's just really, really nice. You see the children - you know, they get their cheeks and smiles back, and their moms are happy. That's just wonderful. And so many of them get really, really better.


STEENSMA: They don't die. Yeah, every other day or maybe every day, somebody does die, but we can - we can save so many. But, yeah, here sometimes you do think, OK, there's just not enough for these children. And sometimes if you die and you write down the cause of death, then sometimes I do think - born in South Sudan. So we're lucky, yeah.

MCEVERS: Is that why you do this work? - I ask. To remind yourself you're lucky?

STEENSMA: Yeah, maybe. Yeah, maybe. I do feel very lucky. Yeah.

MCEVERS: The next day is a Sunday. Jiske hasn't had a day off in a long time. She goes for a run, goes to the back of the compound and sings. She's in an a capella group back home. She Skypes with her friends. Her being off means Dr. Nav is the one who's on duty. I meet up with him in the intensive feeding ward, and he's asking the staff about Nenyoni (ph).

SAHSI: So what happened last night? Do you know?

UNIDENTIFIED MAN #4: Last night?

SAHSI: Yeah, with her. Any problems or anything you know about? Do we hand over?

UNIDENTIFIED MAN #4: Yeah (foreign language spoken).

SAHSI: If you feel her feet, they're, like, ice cold. Again, she's just, like, really shut down peripherally.

MCEVERS: Nav says it is not looking good.

SAHSI: She's still - I mean, the one good thing she's got some strength in her. She'll still kind of respond a little bit if you - you know, she'll kind of look at you if you kind of get her attention. Earlier, she was sitting up a little bit with mom but still very, very drowsy, you know.

MCEVERS: Yeah, she looks worse.

SAHSI: Yeah, she - even throughout the day she's gotten a little worse than she was this morning, so it's...


SAHSI: Yeah, so it's unfortunate, yeah. But we still - you know, I never - we don't give up hope until...


SAHSI: ...There's no hope left.


SAHSI: Yeah, so that's her.


SAHSI: She's the sickest person in the ward - probably in the hospital right now. And let's just look at her medicines here 'cause we finished erythromycin clogs (ph). She finished her malaria medicines today. I'm going to give her some fluids more today. Can we do another ReSoMal today, another one?

MCEVERS: While all this is happening, Nenyoni's mother is sitting on the bed next to her. She's not talking to anyone. Her face is angry then blank then just really sad. The doctors say when a child starts to deteriorate in the hospital, the parents can't help but blame it on the hospital. Nav tells the staff to keep a close eye on the girl, and then he has to go deal with all the other patients in the hospital. He's the only doctor on duty.

A few hours later, someone comes to tell me an emergency has been called in the girls ward.

Dr. Nav got called to resuscitate the girl. And now I'm standing at the hospital door.

Nav walks by and just nods his head.

She died. She died.


MCEVERS: So I'm standing here at the entrance to the hospital because we don't want to, you know, bum-rush them during this moment. But it happened. She died. It's Sunday afternoon. I mean, it's not been looking good for a couple days, right, but it finally happened.

A little bit later, I talk to Dr. Nav. He says the girl died of severe malnutrition and severe malaria. When Dr. Jiske finds out the girl died, at first she's upset. She doesn't say it on tape, but she wants to know if there's anything else they could've done. Then later she tells me she's accepted it. She has to believe they did what they could. By the time I go back into the ward, there's another patient in Nenyoni's bed.


MCEVERS: I keep thinking about another thing Jiske told me - that the highs here are so high and the lows are so low, like, the smallest thing can be amazing after the worst thing happens. Life doesn't feel that way in Amsterdam. Every week, there's this thing the staff does for the kids at the hospital.

FRANK: (Singing) Clap your hands.

MCEVERS: A Dutch guy named Frank plays his guitar.

FRANK: (Singing) Clap your hands. If you're happy and you know it, then your face will surely show it. If you're happy and you know it clap your hands.

MCEVERS: But pretty soon, the women and the kids hijack Frank's sing-along and start singing South Sudanese songs. More people crowd around.

UNIDENTIFIED CROWD: (Singing in foreign language).

MCEVERS: And in that moment, it is so good. All the moms are into it. I'm laughing like an idiot the whole time.

And another one.

All the international staff is there. Nav's blowing up balloons. Everyone's dancing. There are a lot of people in this hospital who are still alive.

UNIDENTIFIED CROWD: (Singing in foreign language).

BEAUBIEN: A few months after we reported this story, soldiers approached the camp that surrounds this hospital. They lobbed a rocket-propelled grenade into the compound, fired a few shots. South Sudan's Civil War is at a lull, but attacks like this still sometimes happen. The MSF staff had to hide in a bunker for 15 minutes or so, and then they finally got the all clear. During that incident, a stray bullet hit a child inside the camp, and that child was treated at the MSF hospital.

UNIDENTIFIED CROWD: (Singing in foreign language).


MCEVERS: This story was reported by me, Kelly McEvers, Jason Beaubien and David Gilkey. You didn't hear David because he was too busy taking stunning photographs of the hospital and all the people we met there. You can see them at npr.org/southsudan. Do it. The story was produced by Rebecca Hersher and Chris Benderev and edited by Vikki Valentine and Sean Cole with help from Megan Cain (ph), Abby Wendle (ph) and Brent Bachman (ph). Digital production is by Alexander McCall, research help from Will Chase, production help from Ricky Nevetski (ph), Jess Chung (ph), Saxon Baird (ph) and Jacob Cruz (ph). Operations help from Angie Hamilton-Low (ph) and special thanks to Scott Carrier (ph). Original music in this podcast is by Colin Wambsgans. The show is executive produced by me, Chris Turpin and Anya Grundmann. Our project manager is Kasia Podbielski.

You can hear more NPR on your local public radio station on another show I host called All Things Considered. And here's some good news - there's a new season of Invisibilia coming soon. Listen to a preview at npr.org/podcasts. EMBEDDED will be back next week, where we will hear from a reporter who spent three months in the Arctic. Here she is looking for someone who went missing in the middle of a suicide crisis.




UNIDENTIFIED WOMAN #6: Nothing from Julius (ph)?


UNIDENTIFIED WOMAN #6: No. I think I'm going to walk up to his house.

UNIDENTIFIED MAN #5: Yeah, try that.

UNIDENTIFIED WOMAN #6: I'm actually quite worried. Do you know where Julius Nielsen lives? Which house? No?


UNIDENTIFIED WOMAN #6: So where is he?


MCEVERS: And, hey, I want to thank every person who has left a review of EMBEDDED in iTunes. It really does matter. Now we want more. Whether you like us or not, we want more reviews, and please, tell your friends about EMBEDDED on social media, on the front lawn, wherever. I'm Kelly McEvers. Thanks.

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