An interview with Dr Bhavna Chawla, a surgeon at MSF India
Bhavna Chawla is an Indian surgeon with Médecins Sans Frontières (MSF). Previously a general surgeon in the Indian Armed Forces, she joined MSF in 2015. Since joining, she has carried out seven assignments: three in South Sudan, two in Yemen and one each in Papua New Guinea and Jordan.
In South Sudan, the world’s newest country that was formed after gaining independence from Sudan in 2011, there has been a civil war since 2013, a result of conflict between the government and opposition forces. MSF has been working in the region for more than 30 years to provide emergency and other healthcare services. Dr Chawla's first MSF assignment was in Lankien, South Sudan, where an MSF hospital has been in operation for 23 years. Her next two assignments were in a hospital in the Bentiu Protection of Civilians camp (PoC), where MSF provides paediatric, maternity and emergency surgical services.
Dr Chawla’s first assignment in Yemen was in Khamer, north of the capital city Sana’a, where MSF manages the surgical facility and provides support to other medical departments in a local hospital. Since 2015, fighting between a Saudi Arabian-led coalition and Houthi rebels led to a widespread humanitarian crisis in the country. Dr Chawla then worked in K-hospital in Ibb in southwest Yemen.
According to a report by MSF in 2016, Papua New Guinea has some of the highest rates of sexual and gender-based violence in the world outside a conflict zone. Dr Chawla was part of the Tari project for which MSF managed a surgery department and ran a mental health service for survivors of sexual and domestic violence.
In Jordan, there are over half a million registered Syrian refugees. More than 80 per cent are urban refugees while the remaining live in camps, such as Zaatari refugee camp. Dr Chawla was at Ar Ramtha hospital, located near the Jordan-Syrian border, where MSF provides healthcare support to Syrian refugees.
As part of our initiative at IWI/The Lead to highlight the work carried out by women who make a difference, we spoke to Dr Chawla about her experiences in the field.
Talk about your time in South Sudan. What were the greatest challenges you faced while working with limited resources in remote areas of the country?
During my time in Lankien, the hospital received hundreds of patients who had been injured because of violence. We had limited resources because there are no roads that lead to Lankien. Bentiu camp is a unique project in MSF as we are a part of the humanitarian hub adjacent to the UN. It is under the legal protection of the UN and has a population of about 120,000 refugees. MSF employs people from the refugee camp as national staff and daily workers.
Since resources are scarce, you have to tap into your own resourcefulness to find alternatives. I have had to operate in inflatable tents and envelope operating rooms. Most of our wards were in tents and tended to get slushy and flooded when it rained. The patients tended to be extremely malnourished or may have reached after several days of travel through the bush. These variables, if not taken into consideration, could contribute to high morbidity. It is challenging to keep up with polytrauma or chronic illness in the absence of investigations, but the clinical thrill that comes with patients getting better and getting discharged is unparalleled. The one constant that makes a difference is my colleagues, whose zeal, enthusiasm and ability to multitask help deliver quality healthcare to people. The camaraderie of the team when handling a crisis, such as a mass casualty, is extremely gratifying.
Have you faced any specific issues in your work because of your gender?
Surprisingly, not so much. MSF staff – both national and international – are always very open to working with people from all backgrounds and cultures. There is often a look of surprise when people find out I am a surgeon, but that is about it. I remember one time, near the end of an assignment, I was giving preoperative instructions to the doctor when he looked questioningly at me and asked if I had called the surgeon. When I told him I was the surgeon, he replied: ‘Ah, we thought you were the expat midwife. We have not had any female surgeon here so far.’
Sometimes I find that I need to be more assertive at the beginning of an assignment, especially when I am in the Middle East. I like the look of wonder that comes along with ‘Ah, Jarraha!’ (‘female surgeon’ in Arabic). I was once told that a male patient felt uncomfortable because I laid my hand on his shoulder. His religious beliefs required him to shower before his prayers every time I touched him. I can understand that because a male surgeon may face similar issues with a female patient. The bottom line is: I see myself as a surgeon and not a female surgeon.
What initiatives has MSF taken to address the high prevalence rates of violence in Papua New Guinea?
MSF has had extensive outreach programmes in the Highlands region to reach out to people and encourage them to seek intervention and increase awareness about sexual and gender-based violence (SGBV). In 2008, MSF took over the surgical department at Tari hospital, followed by the addition of mental health officers to provide psychosocial support to survivors of sexual and domestic violence. MSF has also trained national staff as counsellors as they have better engagement with the local community. Our main tools in such a context are silent advocacy and outreach to generate awareness. I noticed that people, who were starting to realise the severity of the situation, had become proactive and empowered to speak up against violence and help others seek medical and psychological assistance.
How different was it to work at the hospital in Ibb, close to Taiz, which is one of the major frontlines of the conflict?
At the K-hospital in Ibb, most of our patients were referred to us from Taiz and had conflict-related injuries. I found this assignment to be relatively more strenuous because we were under complete curfew and I treated a lot of children injured by gunfire and air strikes.
What was your experience of working in a refugee camp in Yemen?
As a surgeon, the operating room/ICU and wards are my domain. During one of my assignments, however, I had the opportunity to visit a refugee camp in the northwest region of the country where MSF conducted an anti-scabies campaign to tackle a scabies outbreak. I saw large families consisting of nine to ten members cramped in small tents with very basic to no amenities, struggling for food. There are a lot of health issues in refugee camps as a result of malnutrition and the spread of infectious diseases. At the moment, it seems like the entire country has become one giant refugee camp, more so a prison with very little movement allowed in and out of the country and declining living conditions.
Could you share some highlights from your most recent assignment in Jordan? How does MSF support Syrian refugees?
This was my first tenure as a surgical focal point where I had a managerial role as well. This involved liaising with various other humanitarian actors for referrals and discharges, besides supervising the department of surgery. The project I was a part of ran for four years and closed in January 2018. From late 2013 to 2016, the project saw an influx of war-wounded patients from across southern Syria. MSF provides surgical care and mental health and physical rehabilitation services to refugees. In 2016, there was an attack near the border, which made crossing the border difficult for Syrian patients, but MSF proactively began advocacy for the wounded to reach Ar Ramtha.
Finally, do you have any rewarding experiences you would like to share?
Given the politico-cultural contexts of these projects, the resilience of people and the smiles of patients in these areas, despite everything they face, are very inspirational. Each assignment gives me the opportunity to witness human nature at its best and, sometimes, at its worst. My favourite memory remains that of Hape, a 20-year-old man from Tari, Papua New Guinea. As a result of a stray bullet from a celebratory gunfire, he suffered an open brain injury. There was no CT scanner or ventilator available, and given his unstable condition, I had to perform the primary surgery in the emergency room. Three days later, he opened his eyes and asked for what we thought was food and water. He could not find words for what he wanted, but could point out things to his cousin and our nursing staff. Soon after, he was able to eat and drink without a feeding tube.
We continued conservative care and his health began to improve slowly. One day, he greeted us with a big smile and a loud ‘Agarepagi’ (good morning in Pidgin). We carried out cranioplasty to cover his open brain. The delicate nature of the procedure and carrying it out in a resource-limited environment was an exceptional challenge – my first of its kind. I have no words to describe how I felt when he surprised me a month later by getting out of his wheelchair and walking towards me. I will always treasure the gifts I received from him: a small jute bilum bag woven by his mother and a letter of thanks in broken but understandable English.