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When the smallest difference counts

Many nurses will at times feel like they work in a war zone, but for Sydney nurse Julie Gawthorne it wasn’t just a feeling, but a reality. Annie May reports.

Children dying from diseases easily treated with modern medicine, incredible poverty, suffering and starvation on a massive scale and heavily armed soldiers.

This was what Julie Gawthorne faced on a daily basis in the six months she spent as a volunteer nurse in war-torn Sudan. It was one of the toughest experiences of her life – and she will treasure it always.

Drawn to nursing because of her desire to help others, Gawthorne always knew she would take do some sort of humanitarian work. It was just a matter of deciding what and where.

A nurse of 14 years, she had already travelled and spent time in developing countries and knew her skills would be of value to the struggling communities.

Her research into non government organisations led her to Médecins Sans Frontières (MSF) and eventually to her first mission in Zalingei, West Darfur.

Zalingei has a population of about 30,000 people, and another 103,000 internally displaced people live in the four camps surrounding the town.

MSF runs two outpatient nutrition programs and a child and women’s health program in these camps. Volunteers also work in the paediatric medical ward and therapeutic feeding centre in Zalingei district hospital, and this is where Gawthorne worked.

The level of poverty and disease she witnessed would shock anyone.

“I was quite realistic about the level of health and living conditions, but once you are actually there and a part of it, it can be overwhelming,” Gawthorne says.

The paediatric and therapeutic feeding centre ward has 60 beds and admits children from newborns to 15 years of age. The majority of children are under five years, and the most common reason for admission is respiratory infections, malaria, gastroenteritis, heart failure, anaemia and tetanus.

As Gawthornes mission came to end, so did the malaria season.

“During September and October we saw a huge rise in the number of children admitted to the ward. A majority of the children had very high fevers with associated vomiting and diarrhoea,” she says.

“Those with the most severe form, cerebral malaria, were often unconscious and having seizures.”

Thankfully the majority of children responded well when treated with anti-malaria drugs and made a full recovery.

During her time in Sudan, Gawthorne lived two extremes – the worst and the best aspects of life.

To see a child recover and go home was one of the best. The worst was when they didn’t.

“Babies die very frequently in Africa. There are days – and weeks – on end when children will die from preventable disease. They wouldn’t have died in Australia.

“I saw many during my time in Zalingei that did not survive. This was one of the hardest things to deal with during my mission.”

In her role as a nurse, she also worked in the therapeutic feeding centre where severely malnourished children were treated. The children often had associated illnesses such as vomiting and diarrhoea and were extremely sick when they arrived.

Working in the centre was what helped Gawthorne keep going when faced with enormous tragedy.

“It was wonderful to see children who had arrived critically ill and malnourished gain weight, regain their personalities and return home to their families.

“In my last weeks there I became really close to three boys who had been at the feeding centre for three or four weeks. When they arrived they were very sick and were flat – not interested in anything. To see their personalities come to life as they put on weight was fantastic.”

Memories of those boys and the many other families she treated will always be accompanied by a smile, but Gawthorne warns nurses who are considering volunteering in a developing country need to be prepared, and realistic.

“It’s a completely different world and you are pushed to the limit every day,” she says.

“We worked six days a week and incredibly long hours. There isn’t the access to medication and resources we have in Australia and you have to be a jack of all trades.

“My role was very varied and included anything from teaching mothers to breastfeed, to training and educating the nursing staff.”

It was also very important to be aware not just of the work involved, but the living conditions, which Gawthorne describes in one word: basic.

There are also the soldiers to get used to.

“Seeing heavily armed soldiers was a daily occurance so it just becomes part of your life.”

“Darfur is a very uncertain place, but I never worried about my safety and knew MSF had evacuation plans in place if needed.”

And you can’t afford to be too idealistic.

“You can’t save all the children in Darfur. If you go in thinking that way it will be very traumatic,” she says.

“The way I looked at it was that me as an individual, the difference I’m going to make is very minute. But MSF makes a large one and that’s how I contribute.”

She also recommends prior exposure to other countries and cultures, particularly developing countries, before joining a mission, and the more nursing experience you have, the better.

“Every day brought a new set of challenges and learning opportunities, and things that I had only ever read about in textbooks were now part of my everyday practice.”

“I worked with some great people and am still amazed and humbled by the generosity of the local people. Despite the difficulties they face they are always smiling. I was lucky enough to be invited to people’s homes to share a meal with them, visit homes in the camps, and experience many local cultures and traditions.

“These are the memories that will remain with me forever.”

Caught in crises: what’s needed to be an MSF nurse

Essential criteria

• Commitment to the aims and values of Médecins Sans Frontières
• Current and valid registration
• Minimum of two years’ experience post-qualification
• Course in tropical nursing or relevant work experience in developing countries and/or indigenous communities
• Experience in supervising, training and managing others
• Ability to cope with stress
• Ability to work well as a part of a multi-cultural and multi-disciplinary team
• Ability to organise and prioritise workload and use initiative
• Willingness to work in unstable environments
• Good command of English
• Available to work for a minimum of 9 months

Also desirable

One-two years’ post-graduate experience in one or more of the following:
• Public health, nutrition, infectious diseases, paediatrics, obstetrics, A and E, operating theatres, and HIV/AIDS
• Fluency in one or more of the following languages: French, Spanish, Portuguese, Arabic or Russian
• Interest and/or experience in international humanitarian rights issues, international relations, anthropology
• Previous field experience in a similar role with a non-government organisation.
For details on how to apply go to www.msf.org.au or phone 1 1300 136 061

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