In 2012 and 2013, Lilly Schott, a Martha’s Vineyard Hospital maternity nurse, traveled to Africa to lend her skills and services on an emergency mission with Doctors Without Borders, or Médecins Sans Frontières (MSF), as most of the world calls the organization. She remains on the active list, ready to lend a hand if needed.
On her first trip in October 2012, Lilly traveled aboard three planes and a United Nations helicopter before she arrived at her final destination, a refugee camp in South Sudan. For the next two months she slept in tents and worked 12-hour days.
“It was malaria season, it was rainy season, it was everything,” she recounted in an interview about her experiences. “They were fighting every tropical disease.”
Her introduction to Africa and nursing came during her junior year of college. A French literature major at the University of Virginia, Lilly studied abroad in Mali, where her classes were entirely in French.
“I wanted to get credits for my major, and I wanted to go somewhere different,” Lilly said.
While in Mali, she lived in the capital. But as part of the program, students spent time in what Lilly called “the village.” There, she stayed with the community midwife.
“She was a character,” Lilly said. “She let us come to work with her.” In the thick of things, Lilly was enamored with the midwife’s work, and decided then that she wanted to be a nurse.
After she returned to the United States she switched gears. She went to Johns Hopkins and received a master’s degree in an accelerated one-year nursing program. She spent the next few years working in maternity wings around the country.
“I had always thought, based on my time in Mali, that [MSF] was something that I wanted to do,” she said. She applied the moment she had the two-year work requirement for the program, but heard nothing. “I didn’t even get called in for an interview,” she said with a laugh. She did not give up.
Following a volunteer stint in Ecuador, she moved to New York City and again applied to MSF. This time, she was accepted to the program.
This was in early September 2012. MSF told her to expect a four- to six-month wait before she’d be offered a nine- to 12-month mission. But, a refugee crisis in South Sudan created a need for immediate assistance. When she was offered an emergency mission for October, Lilly bid a temporary and sudden goodbye to her family, boyfriend, and job as a maternity nurse in order to assist with the influx of Sudanese refugees.
At the time, Sudan and South Sudan were fighting over disputed oil-rich regions, displacing thousands of people. Lilly estimated that the number of people where she was stationed in Yida, a refugee camp which was originally a cow-herding village, expanded from 4,000 to 40,000 before her arrival. In Yida, most of the refugees were people from the Nuba Mountains, fleeing Sudanese government attacks.
The Nuba people walked for days, Lilly said, to cross the border and seek safety. Yida was an unsanctioned refugee camp, meaning that though the U.N. might provide some food goods, it was not involved in the camp’s organization.
“No one was running it,” Lilly said.
MSF volunteers slept in separate quarters, in a compound away from the refugees. Guards watched over the area, and if she left the compound, she had to take a radio with her for safety.
When Lilly arrived, the immediate staffing crisis had subsided. She felt out of place.
“The group that had been there had really bonded,” she said. “So it was hard to sort of join that team … It was tough at first.”
She ate a lot of rice and pasta, and was introduced to hummus out of a can, and pickled eggplant, which she didn’t expect to like.
“We were afraid to open it, but this girl from Nebraska opened it one night, and it was delicious,” she said.
Across the world, Lilly said, she was totally overwhelmed and desperate for a friend. She found one in an Australian nurse named Robyn.
“She was immediately like, ‘Honey, let me help you,’” Lilly said.
The assignment also tested the limits of her relationship with her boyfriend Rob, an architect from Ireland. They had been together for nine months when she was sent on the emergency mission. The Internet kept them in communication.
“We were able to talk almost every day,” Lilly said. “He’s a brave soul for being like ‘Yes, do this, you’ve always wanted to do this.’”
Though she was out of her element and homesick, especially for Rob, Lilly found the work rewarding.
“We were just so needed,” she said. “Because of their history, South Sudan has a shortage of any kind of medical personnel. So you’re training … Everyone wants to learn something. Everyone wants to learn to speak English.”
Medical personnel in Yida out of necessity had to think on their feet. The nurses and medical staff worked without a lot of the lab equipment readily available at most hospitals in the United States.
With such limitations, Lilly said, the volunteers’ medical opinions held a lot of weight.
“Because there’s maybe one doctor in the camp, they really rely on you; rely on your assessments, your opinions,” Lilly said. “Your opinions are really respected.”
A short return home
Lilly ended her mission in Yida around Christmastime. She was excited to return home. But, after a short time, she was requested for a second emergency mission. There was a hepatitis E outbreak in a different refugee camp, and South Sudan needed her again.
“When they offered me the mission and told me where it was, I cried,” she said. “I didn’t want to go back.”
Rob asked her, “Is it really about where you go? Is that what this job was about?”
Lilly responded, “No.” She packed her bags.
She returned to South Sudan in March, to a camp called Jamam, and helped manage the general inpatient department, as well as the inpatient feeding center, which was “booming.”
This mission was run by the MSF headquarters in Amsterdam (there are five headquarters around the world), and the culture of this camp was very different from Yida, she said. For one, everybody spoke English. “It was so welcoming. Everyone was so friendly.”
Though most of the illnesses were the same as in Yida, the refugees were different. “In some ways you felt like they had suffered more,” Lilly said. “They had been refugees longer. Some of them had been displaced multiple times during the war.”
Jamam was a U.N.-sanctioned camp. Refugees were living in U.N.-provided tents, and there were water points throughout the grounds.
“There’s a lot more stuff, a lot more bureaucracy,” Lilly said.
There was also a maternity ward. Lilly was able to assist midwives in Jamam. “They did most of it, but I was able to help out,” she said. In Jamam, as everywhere else, women were having children, and kept the maternity ward busy.
“A busy month would have been 30 babies,” Lilly said.
Pregnant woman in Jamam at the time had an extra risk: the hepatitis E outbreak. The disease has an exceptionally adverse effect on pregnant women.
The disease is transferred fecal-orally. In a refugee camp where sanitation is a daily challenge, people become more susceptible to contraction. “We had several mothers die, and it becomes a whole community problem. Sometimes the baby survived, and what do you do with this orphan?” Lilly said that because families had been broken up, there wasn’t always an immediate relative to take on a new baby, let alone someone to breastfeed one.
“We never had a baby that was abandoned, but we really had to work with these families to get nutrition for the babies,” Lilly said.
MSF works in refugee camps specifically to treat conditions like malnourishment, but it can be a challenge to figure out why the condition persists.There are food rations and treatment facilities specifically for malnourishment, but sometimes food seems to disappear, or simply not be enough.
“You just wouldn’t believe, with all of the resources that are in the camp, that children can still be malnourished,” Lilly said.
Part of the issue is bureaucratic: “Some [people] are new arrivals, so they are not a part of the system yet,” Lilly said.
Malnourishment was an immediate concern for the children 5 and under, because once a child becomes malnourished, he or she becomes susceptible to a range of illnesses.
Children may not understand that they are malnourished, she said, but they know they’re hungry. However, once the condition goes on for a long time, children can lose their will to eat. Mothers often sat with malnourished children and willed them to eat.
“Their mothers sit with them literally all day, saying ‘Eat.’”
It was not always easy to initially predict who would recuperate. At one point, Lilly said, she was helping to treat two malnourished toddlers. One got better, she said, but one did not, and eventually died.
“You’re just doing your best,” Lilly said. “We had a lot of really, really sick, malnourished babies.”
Lilly remains on the list of active volunteers. She is in contact with the organization, but is realistic about the difficulties of taking personal-professional time to travel abroad with MSF.
“You don’t go home at the end of the day. If I could do that job and teleport back to my house at seven, I’d do it forever,” she said.
But because MSF pushes education on its missions, Lilly knows that the work she did likely had a lasting impact.
“Teaching is a huge part of what everyone does all the time. Every basic nursing skill — taking blood pressure, taking a temperature,” she said. “The idea is that we’re emergency medical [personnel]; we’re not going to be there forever.”
Teaching could be challenging. She laughed as she recounted two nurses she was training at once, named Bang and Boom.
“Bang was the sweetest man you’d ever met, [but] getting him to remember things was a challenge. But he would show up at work every day 15 minutes early. Boom was a younger guy and learned so fast. They were opposites.”
Lilly is still with Rob, and continues to work in the maternity ward at the Martha’s Vineyard Hospital, but her experience in South Sudan was eye-opening.
“I think the most amazing thing to me is that you’re working with refugees,” she said. “You listen to their stories and your heart is broken, but they get up in the morning, they laugh with each other, their kids do silly things.”