My name is Jenny Caddick. I’m a doctor, from Bristol originally but trained in Newcastle. I’m now living in Sheffield and I’ve been working for Médecins Sans Frontières in Congo Brazzaville for the last five months. I didn’t know much about the country before I left – MSF gave me some information of course, but it’s a country that’s been ignored by the media and there’s not much written about it.

When I first got there I was surprised by how beautiful it was. I had expected a bombed out war zone. Although the area I worked in had been very affected by the war, because it’s so lush and verdant and breathtakingly beautiful, it conceals a lot of what has gone on there.

But the people have had a very bad time. Although it took a while to get over my communication problems – people in Congo Brazzaville speak French and mine is not very good – I soon got an idea of what people had been through in the last few years. Congo Brazzaville had previously had quite reasonable health and education systems, so people are not ignorant about what is on offer. And yet because of the war they’ve been reduced to the lowest level of existence; driven out of their homes, having to hide out in the forest with their children and their grandparents, really very frail people living on nothing. And they are surprisingly willing to talk about it. Everyone that you speak to has lost someone because of the war - children, their elderly parents and lots of people have stories of sisters or cousins being raped. Some people are quite matter of fact about it.

My job was to get the hospital back up and running again. It had once been quite a good hospital, a nice open plan building, with X Ray and a pharmacy - that people had to pay for but it worked- and a good maternity service. Previously there had been four doctors there, but during the most recent conflict most of the hospital staff fled to Brazzaville. Those few who remained, to look after the few patients who’d stayed in town and not gone into hiding, were mostly untrained. When I went there, some of the people who had been displaced were gradually starting to return to Kinkala, either from the capital or from camps. Some of the hospital staff also returned but most did not.

People were still frightened, although in the five months that I was there, the town did really change. In the early days, all the houses on the main street, which we walked up to get to the hospital, were just shells. But by the time I left people had put their roofs back on and planted trees in their gardens and were starting to live again. So there were signs of increasing confidence. But there were still a lot of people in the camps for internally displaced in Brazzaville who said they were too frightened to go home. A lot also said they had nothing to go back to – either their homes had been destroyed or they had been taken over by soldiers, but a lot were just too scared to go back. With the hospital staff this was a big issue. The ones who were there said that the others didn’t want to bring their families back in case they just had to flee again.

Our job was to get the hospital up and running again, both physically in terms of buildings, beds, mattresses, mosquito nets, electricity and water etc, none of which was there, but also to set up the pharmacy and actually provide medical care. We were not only teaching the staff who were there how to do things, but also medically treating patients ourselves. There was one other medical expatriate, a nurse, and myself. We also had a team of national staff who were mainly handling the nutritional centre that we set up for malnourished patients.

I spent my mornings doing ward rounds and the rest of the day I would be doing outpatient consultations or I would be operating if there was surgery to do. Most of the surgery was Obstetric, Caesarian sections, ectopic pregnancies and then there was some general surgery, for bowel obstructions, trauma, broken legs, machete wounds, car accidents and the suchlike.

There wasn’t masses of trauma cases - I was expecting more. I only had a couple of gunshots the whole time I was there. It was more treating people in the aftermath of war. People hadn’t had any medical care at all for a long time so a lot of the problems we saw were more neglect-related, things like malnutrition, and tuberculosis (TB). Conditions that are exacerbated by the very poor conditions people had been living in for such a long time.

The hardest thing is that there is a limit to what you can do and there are some things that you can do nothing for, for example, people who have very advanced tumours. And that’s very hard, it’s hard to see things that are treatable back home but there’s nothing you can do for them here. But there are also a lot of things you can do. It makes you wonder what people did when there was not medical care at all. I’m not sure if anyone has done any studies on how many people just died in the forest, but if we look just at obstetrics for example, it must have been a lot. I mean, all the Caesarian sections I did were on women who would absolutely not have been able to deliver normally – we certainly didn’t do any elective Caesarians – and you think what would happen to these women if there was no doctor there? There must have been many women in this situation in the past. The consequences would have been death, probably of both the mother and the child.

Being a doctor in Congo was much more ‘in your face’ medicine. There are two sides to this – sometimes people come with horrendous problems and it’s too late and there’s nothing you can do and that’s tough.

But the flip side of that is that there are patients who have quite simple problems but they would die without treatment and because you can provide that simple treatment you can save their life. And that’s what’s nice about surgery, you’re doing something physical, so you see that, like doing Caesarian-sections. We had one patient who had been up in another hospital with a bowel obstruction and had been slow to present. He was a young man, which is not typical, and had gone home and then come back to hospital very sick, in a terrible state. He was up in this other hospital, very isolated in the middle of nowhere, and there was no surgeon there. There was a little MSF hospital up there and we had transport so we brought him down to me and I operated on him, because I could. It was a dangerous operation – we had no safe anaesthetic, no oxygen, no suction, no blood transfusion, so any surgery was a bold undertaking and I was reluctant to do anything that didn’t need to be done. He arrived in a very poor state but I was able to do something, it wasn’t hugely difficult, but if I hadn’t done it he would have died. This man actually worked for MSF as national staff and at the same time that I was operating on him, his wife was at one of our other hospitals delivering a baby. It’s wonderful to do something like that, to see him get better, to go back to work, his wife’s just had a child, that family is not being left without a husband and father. Things like that make up for the frustrations and the things that you can’t do.

There were frustrations of course: not having the right equipment or drugs; not being able to refer patients with cancers that need radiotherapy or chemotherapy; watching patients with TB not receiving proper treatment. I guess the most frustrating thing for me was malaria, which mostly affected children. Malaria affects everyone but severe malaria mostly affected the children. Seeing these children come in very ill and you treat them, they go home, but next month they’re back with malaria again, and again the month after that. And although you tell the parents to put them to sleep under mosquito nets and try to protect them it’s clearly not happening, people just don’t have the resources to do that. And every time the child comes in they’re weaker and weaker and more and more anaemic and that’s very hard. We did manage to do some blood transfusions and when that works it’s great but there are so many that just turn up way too late for that. The parents keep them at home hoping they’ll get better and by the time they bring them in to the hospital there’s nothing we can do for them. And that’s very hard.

People do know about the importance of sleeping under a mosquito net – they would tell me that the child does, but will admit to the nurses later that they don’t because they can’t afford one. Often patients lie to the doctor, rather they tell you what they think you want to hear, perhaps because they’re scared of doctors.

I didn’t really find that the local people were as reliant on traditional medicine in Congo-Brazzaville as in other African countries where I’ve worked. I did have some problems, particularly with burns patients who had some funny treatments, crushed up snail shells or chicken feathers. I had a little baby with burns who had been completely poisoned by the crushed up bark of some tree, some traditional medicine or other, I don’t know what it was. I did see it, but there wasn’t that much of it. The nurses said patients would deny it even if you asked them directly.

But I got so much out of it. I made some great friends, both with the people I work with and the people in the village. I learnt a lot, about myself, about other people from other countries and about running that kind of hospital in a difficult and stressful environment. Things were difficult because we didn’t have everything we needed, the staffing levels were very low and I had to conduct everything in French, which I am not very good at, because I was doing operations and managing illness I’d never dealt with before. I learned a lot of things clinically but that’s only a small part of it. I learned about dealing with people, about managing people and managing relationships. And most of all I learned about how people can survive. These people have got on with their lives despite what they’ve been through and that’s a real inspiration. You take that home and don’t forget it in a hurry.

For more details about MSF’s programmes in Congo-Brazzaville, click here.