Rugby six nations and a log burner, just another Saturday in February?

I had just arrived back in the UK to a cold and icy Scotland, kit bag to empty and memories to unpack.

It’s a year since I came back from a 6-week deployment to Cox’s Bazar, Bangladesh, where I have been working with UK-Med as part of the UK-Emergency Medical Team response to a diphtheria outbreak among the Rohingya refugees. UK-Med is a core partner in the delivery of the UK Emergency Medical Team (UKEMT) programme funded by the Department for International Development (DFID).

Their escape from Myanmar had started in large numbers the previous August when tens of thousands of desperate people ran for their lives from brutal treatment across the narrow water way in Rakhine State, north west Myanmar, to the relative safety on the Cox’s Bazar peninsular in southern Bangladesh.  An estimated 700,000 Rohingya people are now living there in poverty.

The fleeing population had of course lost any access to medical care including a robust vaccination programme.  Consequently, it became apparent during late November 2017 that cases of, rarely seen, diphtheria were being diagnosed among the refugee population in Cox’s Bazar

The close proximity of make-shift housing, poor sanitation and lack of an effective vaccination programme lead to rapid spread of diphtheria indiscriminately among the population.

Diphtheria is a bacterial disease caused by Corynebacterium Diphtheria which, if untreated, can cause life-threatening sequalae including heart failure, breathing difficulties, neurological disorders and death.

UK-EMT responded to a request from WHO and subsequently DFID to go to Bangladesh to treat people presenting with signs and symptoms of diphtheria.   If recognised early, diphtheria may be treated with common antibiotics however, later presentation with an already established pseudomembrane over the back of the throat required treatment with an anti-toxin. This came with inherent risks of severe allergy so much of our work was around monitoring, recognition and treatment of such reactions.

Few of our team had treated diphtheria before, thankfully due to a successful and comprehensive vaccine programme in the UK.  Nevertheless, we soon established three treatment centres, working with colleagues from International Organization for Migration, working 24 hrs a day to diagnose and treat our patients.

Across the three centres we saw over 5000 patients and treated about 10% of them with diphtheria anti-toxin, undoubtedly our joint efforts saved lives.

Leaving a project to return to a comfortable, secure life in the UK is never easy.  I’ve done it before: it can be very difficult and unsettling for a time afterwards.  it almost engenders feelings of bereavement; loss, guilt, sadness, anger, helplessness.  There was time for quiet reflection on the aircraft home.

And a year on?  It’s the Six-Nations Rugby again, the log fire is lit and I remember the people from Myanmar, still experiencing daily crises of poverty, malnutrition, lack of opportunity for education and the threat of trafficking and abuse.

Dr Freda Newlands

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