Humanitarian Aid Worker

Living the Dream - A Day in the Life (1) – Happy Birthday

Living the Dream
Once upon a time, being a medical humanitarian aid worker was just a distant dream of mine. As a medical student I would read books about doctors who had dedicated their lives to improving health in communities as far-flung as Ethiopia, Uganda, Burma and Haiti (e.g. Catherine Hamlin, Albert Schweitwer, Fred Hollows, Paul Farmer). I would imagine myself one day living a similar life - walking in the African sun, squatting by malnourished kids, treating tropical diseases like malaria, and saving lives with basic health treatment and education.

Yesterday, as I ambled down the dusty road to the hospital yesterday morning I noticed the hot African sun on my head and realised how disturbingly similar my life here in Darfur is to my student fantasies. It was a surreal realisation that this exciting fantasy was now the routine of my every day. Of course, for every similarity between my life here and my student fantasy there are a million things I could never have imagined. So today I thought I would try and give you a nuts-and-bolts picture of my life as a humanitarian aid worker. Enjoy!

A Day in the Life (Part I)
At 6am I wake to hear the call to prayer echoing from one of the mosques scattered around town – “Allahu Akbar, Allahu Akbar…ashadu Allah illaha ilallah…heya ila salat…heya ila falah (God is Greater, God is Greater…there is no God but God…come to prayer…come to worship…)…”. After hearing this daily benediction called in the deep, rich tone of the African voice, blessedly welcoming the dawn (just as it has been done for centuries), my day becomes more mundane - squat over the long-drop toilet, cold shower, breakfast of bread and fruit. Then, decked out in my MSF shirt I am ready to start the day.

First stop is to check the vaccine fridges, ensuring the mandatory cold-chain is maintained (3-8 degrees Celsius). Tick the boxes, and hope there are no generator troubles that will cut power and threaten our store.

A short walk down a dirt road leads me to the ‘hospital’ where I get a handover from the doctor who has been on overnight. A couple of admissions, the death of a lady with liver failure, a soldier with a minor gun-shot injury (and another who was taken away dead), a malnourished child with malaria looking better overnight, one woman in labour… – and yes he had managed a few hours of sleep.

During the day there are usually two doctors on duty and we start the ward round together in the ‘ICU’ (not really an intensive care unit – but it at least has one oxygen concentrator, a 1:8 nurse:patient ratio, and the resuscitation gear). Today there are a couple malnourished kids from the TFC (therapeutic feeding program) who are sick with malaria and pneumonia, a premature baby with hypothermia, a low birth weight neonate with poor feeding, a couple of babies with severe Pneumonia, a child with diarrhoea and dehydration, a pregnant lady with hypocalcaemic cramping, and a lady with probable complicated Typhoid fever. We move from patient to patient, my translator by my side (translating between English, Arabic and the local Fur dialect), questioning, examining, explaining and adjusting their treatment.

For many patients this is their first experience of allopathic medicine, and it still carries a strong aura of ‘magic’ to it – reminding me that we really do take things like antibiotics, rehydration salts, vaccination and other basic medications for granted in Australia. This means that patients are always impressed and grateful for the results and will do anything the doctor asks. But it also leads to expectations that there is a medicine that will fix every complaint, and difficulty understanding that sometimes it doesn’t work that way (either because they don’t need medication, we don’t have the medication indicated, or because there is simply no cure).

After ICU I move on to the Paediatric/Women’s ward while the other doctor sees the Male ward and Isolation (where we treat patients with dysentery, tuberculosis, hepatitis etc.). Today I find the ward looking quite orderly with about 20 patients – frequently the beds are packed in like sardines with up to twice that number. I greet the nurse and nursing assistant and we get started. In addition to the many cases of childhood pneumonia, diarrhoeal cases, today I see children with malaria, glomerulonephritis, facial trauma after a donkey bite, severe scabies, complicated urinary infections, burns, rheumatic heart disease, sickle cell crisis, and possible lymphoma. I see women with kidney infections, typhoid fever, pancreatitis, breast abscesses, deep foot infections, severe post-natal depression, and bleeding peptic ulcers. I work my way around the ward slowly, noting down cases to discuss with the other doctors.

The next ward is the TFC (therapeutic feeding centre), which is the inpatient nutrition program for severely malnourished children. These are the kids with marasmus and kwashiakor that you will remember from television coverage of famines across Africa – skeletal frames, sunken eyes and often with oedematous swelling of their feet, face and bellies. In the TFC these children receive intensive feeding until the oedema resolves, they are putting on weight and are able to eat the oral nutrition biscuits. This usually takes a few weeks, after which they are followed up once a week as outpatients. The transformations are pretty remarkable! The TFC is run by a nutrition team and I generally just see the complicated cases or those that are not responding to treatment. Today there is another malaria case, and a child with persisting watery diarrhoea who is looking dehydrated again.

By the time the ward round is finished it is early afternoon – and since this letter is getting rather long I will leave the rest of this story until next time…

Happy Birthday

Thanks to everyone who has sent birthday greetings. The staff here found out after a call on the satellite from my parents, and threw a little party for me in the evening. No balloons or party hats, but plenty of food, drink, cake and music. The best part was being sung happy birthday not only in English, but also French, Spanish, Arabic, and a couple of local African dialects. Very memorable indeed! I was also given a full traditional Sudanese dress, complete with handmade shoes and a funky cap. They will make their debut for the Eid celebrations at the end of Ramadan next week.

Villages Burning

Beauty – Among the Rebels – Burnt out Villages – Hope

Seeing the Beauty
It is a beautiful sunny Friday in Niertiti, my one free day for the week, and I have just returned from a stroll along the river. In the midst of the Darfur chaos, it is so essential to take time out and observe the peace and beauty that surrounds me. It is a particularly impressive time of the year now, with regular rain keeping the rivers and waterfalls flowing and the hills covered in green vegetation. As I meandered along the river dozens of men, women and children were bathing and washing clothes, the rocks covered with bright dresses, shawls and shirts drying in the sun. Smaller children splashed and jumped around in the pools, and made a particular effort to show off when they saw a khawadji (foreigner) walking past. Their smiles and laughter never fail to amuse me, and I had had more than a passing thought to throw of my shirt and join them under the waterfall today!

Among the Rebels
Earlier this week I headed out into the Jebel Marra mountains to visit two of the remote clinics that MSF is supporting. It was a great opportunity to see the area, as well as to better understand the complex social and political situation that exists and what it means for civilians from day to day.

The Jebel Marra region is home to the Sudan Liberation Army (SLA), the Darfur resistance movement, and almost all the towns in this area are under their control. So as we bumped along the dirt track towards the mountains the Government of Sudan (GoS) checkpoints were soon replaced by SLA checkpoints, all manned by guys toting big guns and big smiles as they waved us on through. To this point I have been very impressed with the cooperation from both sides for our work here, and the SLA are well aware that without international humanitarian aid their people would have no health care at all.

It was market day in Kulin, one of the many small villages we passed through, and hundreds of people had loaded their donkeys and trekked to Kulin to trade and catch up. It was great for us, not only because I could procure some spices for cooking, but also because it meant we could sit down with the SLA administrators and community Sheiks (leaders/elders) to touch base and ensure their support. As we discussed our activities, the current security situation and various mundane issues of logistics and transport, I looked around and realised how surreal the whole situation was.

To my left was the SLA humanitarian affairs coordinator, a young local guy who could speak passably in Fur, Arabic and English and was constantly on the phone to representatives from various NGOs and UN groups. Beside him was an old Sheik, decked out in the traditional Sudanese white robes, a turban atop his head and an aura of respect surrounding him. A respect that had no doubt been earned in the toughest of situations – a regional resistance against far superior national government forces. Alongside him were a couple of younger guys, and a sheik from another village. My interpreter and Field coordinator completed the circle. But perhaps most surreal was looking over my shoulder to see who was providing the security. Two boys in SLA camouflage gear were perched on rocks and cradled guns that were almost as big as they were. Child soldiers! I noted how shiny the hair was, falling in plaits down the sides of their faces, and wondered what it would be like for kids like these growing up and only knowing war. War, bloody war!

Burnt out Villages
One of the enduring images of my trip into the Jebel is seeing the remains of burnt out Fur villages. Mud brick walls of houses still stand, without roofs and charred black from fire. They tell a dreadful story and my mind filled with images of raiders sweeping through on horseback, villagers fleeing, women raped, blood sprayed, bodies falling and the whole place going up in flames. The villages are now mostly overgrown with weeds, and rumours of Janjaweed ensure the villagers don’t return.

As we drove through these ghost villages my driver pointed out houses where various local MSF staff members and their families used to live. “That is Ibrahim’s uncle’s house”, he said, pointing to some domestic remains. Ibrahim told me later of his family’s flight from the Janjaweed in 2003, and how he ended up getting work with MSF to help other IDPs like his family. It is a familiar story, with most of the local MSF staff coming from the IDP communities themselves, having fled similar incursions on villages all over Darfur.

Here in Niertiti there are around 24,000 IDPs (a relatively small camp), and most IDPs arrived here in 2004 after the first big wave of violence. However, attacks have continued all over Darfur, and the last big influx to Niertiti was as recently as December 2007. In the whole of Darfur, over 2.2 million people have been displaced – accounting for more than one quarter of the world’s refugees and displaced persons! These numbers are way too big for me to comprehend. But seeing the numbers translate into real people, that is something even more mind-blowing!

In Hope
Equally incomprehensible is how people here manage to do so well! After all that they have been through and the daily struggle of survival, the astonishing thing is that people don’t just give up. Maybe it is an innate survival instinct, maybe it is the hope that things will improve, or maybe it is just the fact that they all have children/parents/friends who continue to give life meaning and purpose. I don’t know, but for this hope I am extremely grateful and very humbled.

I realise that this letter I have completed neglected the medical side of what I do here. Most of my time is spent consulting with patients, supporting the medical assistants and keeping the medical side of things running smoothly. In the past 3 weeks I have seen things ranging from the bizarre to the tragic, from donkey attacks to kids dying from renal failure, from obscure tropical diseases to the pussiest abscesses imaginable. But more on that next time…

Thank you to all of you who have written, and I am sorry I cannot give you the replies you deserve. But I do love hearing from you, so please don’t think your letters have been ignored!

p.s. You may have heard reports last week of clashes between the SLA and GoS soldiers in northern and eastern Darfur. We had varying reports of tens to hundreds of SLA, GoS soldiers, and civilians killed and many more injured. That was all on the other side of the Jebel Marra mountain range, so we have not been affected and do not have any more information than would be available to you.