A Doctor in a Peacekeeping Mission

In a very short notice to be prepared, we left home for the residential pre-deployment training on January, 2018. In the freezing cold of the winter, we started our day in the early morning with P.T (Physical Training). We attendend various sessions, which made us familiar on topics of Core Pre-deployment Training Materials (CPTM) including language classes and firearm training. CPTM represent the essential knowledge required by all peacekeeping personnel to function effectively in a UN peacekeeping operation. As a medical officer and medical personnel, we also conducted clinical examination and ran some lab test and X-rays as specified by United Nations (UN) to rule out any disqualifying conditions and prepare the MS-2 (entry medical examination) forms for all the trainees. All of them were immunized with vaccines as per the guidelines.

The road uphill seemed impossible every other morning until ascended.

The uncertainty that the peacekeeping missions bear hit us in the predeployment phase. Who wants a prolongation of a bootcamp like training? When we were all prepared to end the training, we had to spent one month or more in the training center. Finally in March, we passed the FPAT examination which included CLA (Combined Language Assessment), firing assessment (as a command staff, I had to disassemble and assemble the pistol within 5 minutes, and shoot 5 rounds each at the 45cm X 45 cm target from 5 and 7m, with atleast 9 out of 10 hitting the target) and participated in some demos.

We boarded on the Chartered flight on the night in the 2nd of April, and reached the mission area the night on the next day. It was a time for the troops rotation. We stayed in the TRANSIT camp with the previous contingent members whom we were replacing. They had many experiences, stories, advices and warnings to share. While they looked happy to return home after more than a year, many of us were doubtful if we could make adjustment in this new environment easily. The next day, we received our ID cards, bid farewell to our friends returning home and some of us stayed for the induction training for a few more days before reaching our duty station in Cap-haitien.

Chartered plane of UN at TIA. It was raining cats and dogs.

There was a well set-up level 1 hospital in the camp which was intended only to provide immediate life-saving and resuscitation capabilities along with routine clinical care. It was not meant to run even basic lab tests and X-rays. Having had worked only in the tertiary level hospitals and under the guidance of specialized seniors in the past, I knew from the very beginning that this was going to be a different experience for me. It was difficult to rely solely on the clinical judgements and making decisions. I found myself frequenly by presentation of the patients, and I was often reading a lot about them to rule out possible differentials and come to a final diagnosis. There were no well-equiped hospitals nearby, the UN clinic and other level 2 hospitals were atleast 6-8 hours away by road and 1 hour by helicopter. Level 3 hospital facilities were available only in the neighboring countries. This situation was pretty much like working in a very rural setup. Another contrasting experience was the medico-administrative duties that I had to carry as a medical officer in the Level-1 hospital besides daily clinical duties. Assigning duties to the other medical staffs, signing on the official documents, writing e-mails regarding the patients – these all were a new experience.

level 1 hospital
Displaying medical equipments for quarterly COE/ORI inspection in Level 1 Hospital

Fortunately, we managed to complete our mission, without any casualties and/or medical repatriation. There were few situations which required special attention. There were cases of surgical abdomen, one with the acute appendicitis and two with the acute cholecystitis which required MEDEVAC (medical evacuation) to level II or level III hospital. In such cases, a MEDEVAC request form must be prepared urgently and sent to the UN clinic while a NOTICAs (a system of notifying serious illness and casualties upto the UN headquarters) to the police co-ordination office. While accompanying these patients, I got an opportunity to observe the level-2 medical facilities in the mission area which were good enough but had a common problem. Emergency room was almost always overly-crowded with patients (mostly road traffic accidents, I guess), many patients were seen receiving treatment in the chairs and sometimes, it was really hard to find a bed for the patient. I also remember a case of prolonged fever, headache and diarrhea with ongoing treatment who required some changes in antibiotics and finally responded well when treated in the line of enteric fever. The staffs in the UN clinic including CMO and nurses were very supportive and easy to communicate with which eased our job during the difficult times. And not to forget, few friends in Hopital convention baptiste d’haiti (HCBH) who were available for us anytime in our need.

In MEDEVAC flight, accompanying the patient.

Besides, in the other day to day hospital hours, entities we commonly encountered and managed were the cases of upper respiratory tract infection, acute gastroenteritis, sports injuries, work-related injuries, acid-peptic disease, dermatophytosis, eczema, tension-headache, back-pain, cervicitis, urinary tract infections, etc. and few of scabies, pericoronitis, hypertension and diabetes. We also treated IPOs (Individual Police Officers) whenever they came with the problems. The tetanus immunization carried during pre-deployment phase comes real handy during management of the wounds. When I look back, I think many of their problems might be due to their previous history which they hid during the predeployment medical examination and cumulative stress resulting from monotonous environment far from their home. Living and working for a year in a closed camp with the same faces is no less than a BIG BROTHER or BIG BOSS situation. You can expect many ups and downs in your personal life during this period.

National medical commander demonstrating life-saving skills to the soldiers.

Some activities were carried out weekly like blood pressure and weight measurement, distribution of malaria pophylaxis tablets, and spraying of anti-malarial insecticides around the fence. We distributed chloroquine tablets as the prophylaxis for malaria, but in the beginning the compliance with many was doubtful and the reason was a common misbelief they had that the chloroquine caused erectile dysfunction. With repeated briefings and explanations, this improved to some extent. During the mission period, we also conducted few sessions for medical staffs and whole contingent members as well.

Once, a violent protest struck injuring several protesters as well as the local police. There was no concept of Police Hospital there and this created a problem as the injured protester and cops had to go to the same hospital available. That didn’t seem feasible for that day, so we provided the injured police with basic first aid treatment.

Notably, we assessed the pretest knowledge of the soldiers on basic first aid and provided them with necessary first aid knowledge to these first responders. Later, we also conducted a Basic life Support (BLS) session to them by burrowing manikins from the UN clinic.

The magnificient Citadelle in Cap-haitien (A UNESCO heritage)

We received our UN medals on 14th March in the medal parade cermony. Our end of mission was on the 4th of April, 2019 but the climate of uncertainty was there as always. By March, I was already counting the days to return home. Many people were happy with rumors of their mission extending for 6 more months and the same rumor made some of us anxious, as we wished to return home on time. We couldn’t return on our End Of Mission (EOM) date but fortunately, our return dates arrived for the 1st of May, of which I was skeptical about until the last 3 or 4 days. And most fortunate was to not get stuck in the rear party which I never wished for. Near the time to return, you may as well feel a bit down-hearted to be departed from friends who have become more like a family.

Playing indoor games like ludo and cards, doing sports like football and table tennis, watching movies and listening songs, participating in social gatherings, going for short vacations, etc. were our stress busters. The place that we were located at had some amazing places to roam and spend vacation – forts, sea and beaches. Beaches are an excellent place to relax.

I had designed an infographic as an assessment for the online course – United Nations and Social Media. It was about mental health issues in peacekeeping mission. I had also written a poem highlighting the contribution of female nurses in peacekeeping mission for the compeition organized by MINUJUSTH Women’s network on the occassion of International Women’s Day.

I also learned some basic french online through the UN Inspira (Online learning platform) where instructor frequently assessed our writing and speaking skills.

Je m’appelle Sulabh Shrestha. Je suis vingt-sept ans. Je viens de Kathmandu. Je suis médecin.

Trying to boast some francais :D. But the sessions were really helpful.

There was a song some of us looped during the final days – “Coming Home” by Skylar Grey. This song will definitely resonate with many peacekeepers waiting to return their home.

And this time, it was not just the end of mission for us but also the repatriation of the contingent as well. The month of April was very much bustling with ceremonies and ongoing repatriation process. In the process, non-operational equipments were seprated to be disposed, some medicines were donated to the other FPU and others were packed to be shipped back to the country.

UN chartered plane in Toussaint Louverture Airport and after a while in the skies – au revoir Haiti.

Finally, we boarded a chartered flight on the first of May to return home.

Leave a Reply

Your email address will not be published. Required fields are marked *