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.