GROWING up in South Africa and witnessing inequitable access to healthcare was one of the drivers that led Dr Catharina Grobler to pursue a career in medicine. Having completed her undergraduate medical degree in Bloemfontein, she moved to Brisbane and trained as an emergency physician for five years through the Australasian College of Emergency Medicine.
Driven further by the imbalance between the level of healthcare in low-income and wealthy countries, Dr Grobler signed up to work with Médecins Sans Frontières/Doctors Without Borders (MSF). The international medical humanitarian organisation offered her a chance to make a meaningful difference on an individual level, providing free healthcare to those who otherwise might be unable to access it.
In January 2020, and Dr Grobler found herself working with MSF in Mosul. An ancient city in northern Iraq, Mosul is still reeling from the aftermath of conflict and the battle to recapture it from Islamic State control. While some infrastructure has been repaired, many buildings remain severely damaged and uninhabitable.
Health facilities were also destroyed, leaving locals with a fragile health system that is still struggling to meet the increasing needs. In Nablus hospital in west Mosul, MSF runs a comprehensive maternity unit with surgical capacity, emergency obstetric and neonatal care, inpatient paediatric services, and emergency treatment and stabilisation of patients before referral to other hospitals.
Dr Grobler’s role in the emergency department of Nablus hospital over four months included a mix of clinical and supervisory work, with a focus on quality assurance. One of the stark differences between her role in Iraq and Australia was the patient load. “In Mosul, up to four doctors would be seeing between 100 and 150 patients per shift and patients wouldn’t expect to be in the emergency department for longer than an hour. Whereas in Brisbane, a team of 12 to 15 doctors would see 170 patients a day!”
By February 2020, the COVID-19 pandemic had made its way to the Middle East, pushing the team to prepare a rapid response plan. The community health area of the hospital was transformed into a respiratory area, and equipment and drugs were stocked in preparation. “I spent a lot of time trying to help develop a COVID-19 plan for the hospital to make it safe for the staff and the patients.”
Dr Grobler admits the onset of a global pandemic was the biggest challenge she faced while on assignment.
“Suddenly the whole world was facing the threat of COVID-19. Everything was insecure and I was far from my family who were experiencing the same thing and equally concerned about the escalating situation in Iraq.”
Add to that the obvious difference in infrastructure and resources available to provide healthcare in Mosul.
“In Australia, a large percentage of people coming into emergency departments can receive CT scans, specialised x-rays, and ultrasounds. There is a series of blood tests available, and patients could receive results within 90 minutes. In fact, in Australia there is the expectation that you will be completely diagnosed, treated, and either admitted or sent home,” adds Grobler.
“In Mosul, the patient expects to go to hospital and be patched up but not completely fixed – all within an hour. There was little access to blood tests and other diagnostic tools.”
While some people might think wound care would make up the bulk of the work in the ED in Mosul, the reality was different, says Dr Grobler.
“Interestingly many patients presented with kidney stones – we saw about ten cases per day – largely related to the drinking water which had a high mineral content. There were many patients with smoking-related diseases such as chest infections, heart attacks and strokes; children with respiratory illnesses like asthma; and a great need for mental health services.”
One patient that Dr Grobler still thinks about is a young girl who was also the daughter of one of the paediatric nurses.
“She had rheumatoid arthritis, which was compounded by other health issues. Her presentation became worse over time and despite organising scans, blood tests and providing the best care we could, she deteriorated quickly.
“There just weren’t enough resources to support someone with such complicated health issues in Iraq. We had a discussion with her father regarding the limits of treatment which was very emotional for everyone involved. Sadly, she passed away just after I left.”
Despite the challenging work environment Dr Grobler reflects on how encouraging it is working with a passionate team who has a strong desire to make a difference: “They were very dedicated; they cared a lot about their community. The staff worked really hard and were incredibly compassionate in such difficult circumstances. This is one of the reasons why I would choose to go on another assignment with MSF.”
Asked whether other emergency doctors should sign up to work with MSF, Dr Grobler says: “Absolutely, it’s exactly what we’ve been trained to do! It fulfils the dream that emergency doctors have – to challenge themselves, to see interesting things and help people, and that’s essentially what working with MSF is.”
Médecins Sans Frontières/Doctors Without Borders is urgently recruiting emergency doctors available to work in the field for six weeks to four months.
For more information, register to attend our special Webinar for Emergency Doctors on 22nd April here: https://msf.org.au/event/emergency-doctor-webinar or contact email@example.com.