KGH nurses help fight deadly disease among refugees in Bangladesh

Head of nursing for urgent and emergency care David Anderson, advanced clinical practitioner Mandy Blackman, A&E matron Melanie Donelan and staff nurse Pippa Coe have all spent up to three weeks as part of a UK Emergency Medical Team deployed to Cox’s Bazar.

They were part of a 40-strong team of UK doctors, nurses and paramedics who volunteered to take part in international efforts to tackle the outbreak with the support of the Department for International Development – the body which leads the UK government’s work to end extreme poverty.

The UK team has helped to triage and treat some 3,000 of the 655,000 Rohingya Muslim refugees who have fled from the northern Rakhine province of Myanmar (Burma) into Bangladesh because of persecution from the Burmese military regime – which has involved widespread violence and the burning of villages.

They have been involved in treating diphtheria patients with life-saving anti-toxin and patients thought to be developing the disease with antibiotics to halt its progress and prevent further spread of the contagious disease.

Each day the KGH volunteers would be transported to the refugee camps and spend up to 12 hours working in bamboo-built diphtheria stations assessing and treating patients.

Because of the contagious nature of diphtheria they would wear gloves, gowns, masks and facial visors while undertaking the work.

Melanie Donelan, 34, of Corby, is an A&E matron at Kettering General Hospital.

This was her first international aid effort through the charity UK Med.

She spent 21 days in diphtheria treatment centres in three refugee camps, and returned from Bangladesh on January 18.

She said: “Each day we would go to a diphtheria treatment centre and see patients referred to us by local health centres within the camps.

“The Rohingya people were lovely – very, polite and grateful for the support we brought.

“They were a bit timid at first, especially the children, so we used local interpreters and learned a few words of their language to make ourselves understood.

“We would do drawings with the children which helped to create a bond and relaxed them.

“Our main job was to assess patients for diphtheria by taking a history of their symptoms and examining them to detect any lymphadenopathy or pseudomembrane – a white coating on the back of the throat.  

“Those who displayed these symptoms were treated with antibiotics and the anti-toxin which was administered via an intravenous infusion lasting four to eight hours.

“The patients with symptoms but no pseudomembrane were admitted for 48 hours of antibiotics and monitored.  

“If they developed a pseudomembrane or deteriorated we would start the anti-toxin, if not they were discharged to continue antibiotics in the community.

“It’s hard to appreciate the scale of this situation. Hundreds of thousands of Rohingya people in camps near Cox’s Bazar that stretch as far as the eye can see – with busloads of people still arriving.

“We played a small part helping to control the diphtheria outbreak – but we need to keep international attention focussed on these people’s plight.”

David Anderson, 49, of Braunston, Rutland, is head of nursing for urgent and emergency care at Kettering General Hospital and this is his 10th international emergency response.

He flew home from Bangladesh on February 3 after spending 19 days in Cox’s Bazar at camp AA where he was team leader.

He said: “As team leader I helped to co-ordinate staff rotas and supplies to ensure we could respond appropriately to the people who needed our help.

“Many of the refugees were living in quite awful conditions – eight to 12 people to a single bamboo room with a plastic sheet for a roof.

“But the people were amazingly well organised and industrious and had established many shops and stalls and were doing their best to make the place liveable.

“Lots of the refugees had been through a lot.

“I met a lady who was looking after seven children on her own. Her husband had been shot and her uncle had died during the trip to Cox’s Bazar.

“I think the biggest difference we made was in helping the local Bangladesh health staff to develop their triage skills.

“By doing this we helped ensure that the people with diphtheria were treated and protected those with other similar symptoms from being exposed to it.

“I think we need to keep the focus on this situation because these people don’t have any fundamental human rights. We need to continue to recognise their plight.”

Mandy Blackman, 49, of Cotterstock near Oundle, is an advanced clinical practitioner at Kettering General Hospital.

This is her second international emergency response – she worked with the charity UK Med fighting Ebola in Sierra Leone in March and April 2015.

She returned from Bangladesh on Saturday February 3 after spending 19 days in Cox’s Bazar at Kutupalong D4 camp.

She said: “The refugees’ resilience is something to see. I was based opposite a UNICEF primary school and all day long you could hear the chatter of refugee children learning numbers, the alphabet, and singing songs.

“Whatever their problems the refugees just get on with it and work out some kind of solution.

“Many don’t want to go back to Burma because in Bangladesh they are receiving their basic human rights of being safe and having access to some healthcare.

“The Bangladeshi people have been amazing. Very welcoming to the refugees.

“The camps are well organised now but they are vulnerable to the elements – and the monsoon is going to bring problems.

“It’s hard to say whether these camps will become permanent communities – but I know many of the refugees don’t want to go back because of the persecution.”

Pippa Coe, 32, of Broughton, is a staff nurse at Kettering General Hospital.

The trip was her second international aid effort after serving with the organisation Samaritan’s Purse in Dominica in the Caribbean following Hurricane Maria in October 2017.

She returned from Bangladesh on February 3 after spending 21 days in Cox’s Bazar at all three camps.

She said: “At first the refugees were a little reserved and were wondering what these strange people in crazy outfits were doing.

“As time went on though we got more and more children following us and laughing with us and copying everything we said.

“Then we got more and more smiles and recognition from the adult refugees.

“They have done an amazing amount with very little in the camps – with everything from markets to hairdressers to be found.

“We had a really positive relationship with the local health staff and that built up as we worked side by side with them and became friends.

“They were very competent already in many ways but we brought some additional skills that helped to make them even more effective.

“I think being in a place like this makes you realise just how lucky we are to have the NHS in the UK. It’s an amazing privilege and not one we should take for granted.”

The UK initiative has treated more than 500 individuals with diphtheria who might otherwise have died.

They have also contributed to important disease prevention work which has helped get the outbreak under control.

Local Bangladeshi health professionals working for the International Organisation for Migration (IOM) have now taken over the ongoing work following the crisis response.