Dr John Kiogora is a GP and head of the childrens’ stabilisation unit at the IRC’s Hagadera hospital in Dadaab, Kenya. Dadaab is the largest refugee camp in the world, sheltering some 500,000 refugees. The stabilisation unit of Hagadera hospital is where treatment is provided to children under the age of five, many of whom suffer from severe acute malnutrition with medical complications. During the East Africa famine in 2011, which was officially declared exactly one year ago today on July 20th, Dr John and his team were on the frontline of the humanitarian emergency. They treated thousands of children who fled the drought and famine in Somalia with their families and arrived in Dadaab with nothing but the clothes on their backs, having walked for days without food or water. Of the 1,472 children admitted to the stabilisation unit during the famine, 65% were suffering from severe acute malnutrition. Whilst it was an extremely challenging time for the IRC’s team in Hagadera, thanks to their tireless efforts, and to the support of all our donors, 96.6% of those children survived. Dr John recently visited IRC-UK’s headquarters in London and we asked him about his work, the experience of responding to the humanitarian crisis, and the situation in Dadaab one year on.
You were on the frontline last year during the famine crisis in Dadaab, can you tell us about that time?
During the crisis 1500 refugees were arriving in Dadaab each day. At the stabilisation unit where I was in charge we had 1472 children admitted with severe acute malnutrition and associated medical complications. The crisis was a very challenging and difficult time for me personally as a doctor, and also for my team at the hospital. Out of the 1472 children, 96.6% survived, thanks to the donor support that we had, which enabled us to procure more medicines, improve our infrastructure and employ more staff so that we could respond to the crisis and save many children.
You have talked about what a challenging time the crisis was. What kept you going, inspired you to continue your lifesaving work during that time?
Together with my team, I was able to get inspiration from the children who were doing well, and recovering, and going home. As a doctor and team leader during the crisis it was challenging. You are in charge, you determine so many things. First, the quality of care given to the children, their survival rates. That’s the ultimate goal. You want to save as many children as you can. You want to save all of them. So you have to put all your energy and time into the ward. And of course work together with your team, because you can’t work alone, you need support staff. You also need the support of the caretakers themselves, the mothers, fathers, and relatives of the children who are in the ward, so that during the feeding hours the children will get fed. Also, if there is any problem with a child, the mother will be the one to tell you. You see, those are the people who matter to me. At any moment even before you rest they may call you, they may tell you there is a patient here that needs your attention and of course you come, running fast to make sure you can save the life.
You treated many children during that time, is there any one story that has stayed in your mind that you would like to share with us?
Baby Minaj is a baby boy who was brought to the stabilisation unit in Hagadera by his mother at lunchtime one day. He was 7 months old at the time. Upon examination it was clear that the child was extremely malnourished and on the verge of death. If the mother had not come then, he would not have survived. Minaj weighed only 3.1kg, was extremely dehydrated and had very low blood sugar. A child of seven months should be at least 8 kg or above. It’s at these times that you know as a doctor that you and your team have to be fast, respond to the child’s needs immediately, otherwise they can even die in your arms. We had to do immediate resuscitation without taking a history; you can’t take the history of a child who is actually dying, you have to be aggressive in the response. So we fixed and IV line and gave him 10% dextrose. This was to ensure he was able to get some glucose which would ensure his survival. If a child has very low blood sugar then the brain cells can die. Remember, fixing a line for a child like Minaj can be very difficult. With Minaj his skin was very redundant, he looked like an old man, he had an old man’s face. So it was difficult to get a line, but I managed it, fast. When we ran the dextrose through the syringe into the line, the syringe actually looked bigger than the arm of the child. We treated and stabilised the child and I am happy to say that he started doing well and even the next day started to cry. Soon his face went from the face of a old man to a new face. After a few weeks of treatment he started gaining body mass, his weight was increasing and he was smiling. For me I was really so happy that the child was alive and was smiling. I got a lot of joy from seeing that baby live. It is good always to see a child smiling at you after that child recovers. You see a child that is so severely sick they cannot even cry and then some days later they smile at you and maybe even cry. The mother is also happy. It gives you inspiration and energy to continue serving the people who need you.
How do you deal with losing patients when that does happen?
For me as a clinician the objective is to save as many lives as possible. That’s why I chose medicine. That’s why I am a doctor. But of course, nature has to take its course sometimes. You do your best to save every child, every patient for that matter, and of course some recover and you feel good, but some of course might die. But if they die and you did your best you may not feel guilt. But if someone dies and you know you could have dome something, intervened, maybe even saved the life, of course you may feel guilt. Things that happened during the 2011 crisis, children were brought to us too late and we weren’t able to save them, or they died on the way to the camp. Many of them died of very treatable problems, and for me this was very frustrating. So you see these are the things that can make you feel bad, because if you could have treated the child earlier, you could maybe have saved their life. But when we lose patients we do audits, so we can learn and improve our treatment and processes. That is how we learn.
One year on, what is the current situation in Dadaab & Hagadera. What challenges are you facing at the moment?
Dadaab is the largest refugee camp in the world with a population of 500,000 refugees. Hagadera is one of the 5 camps in the Dadaab complex, with the largest population of 140,000 people. As a result of this the camp is congested. With overcrowding, people are even living on the outskirts of the camp where the water and sanitation facilities are not as good, and also they are living in makeshift structures. Currently the humanitarian crisis of last year has stabilised and we are seeing fewer arrivals of refugees to the camp as opposed to last year. Still, we need to be on high alert, what led to the drought and famine last year may happen again if there is insufficient rain in Somalia. Of course, we need to support these people, we want to take early measures to prevent an emergency crisis by being on high alert for disease outbreak and assessing levels of malnutrition in the camp.
The other major challenge in Dadaab at the moment is of course the security situation. Currently there are a lot of security issues and so there is restricted movement for humanitarian workers.
Did you always want to be a doctor?
I didn’t know I would become a doctor. In high school I remember when I went to the registration, on the first day in form one, I had to fill in one of those forms where you say what you want to be. And I chose that I wanted to be a doctor, but it never occurred to me that I would be one. I was just filling out the form for formality purposes. But as time went on I realised my dream and I did very well in my exams and I decided to study medicine at university. When I was a child I was afraid of getting injections and I remember there was a time when my mother took me to a hospital and the nurse was trying to give me an injection and I ran away. At the time I wondered, why does this nurse not give tablets instead of giving me injections? But at the time it never clicked with me that one day I might be giving people injections. One day I might be a doctor. If I can, I prefer to give tablets than injections, I don’t like the patients to feel pain.