Darfur - Tragedy and Hope

Crimes Against Humanity – Humanitarian Rights – What to Do?

It is now 2 months since I returned from working as a Medical Doctor for Medecins Sans Frontieres in Darfur, Sudan. Since I left things have gotten a lot worse with the expulsion of aid organisations (including MSF) leaving the people of Darfur without even basic health services. Some of it has made the news, but not enough. So I want to give you an update, and use the words of those still there to describe it to you.

Crimes Against Humanity
On 3 March, 2009, the International Criminal Court (ICC) issued an arrest warrant for the President of Sudan, Omar Hassan Ahmad Al Bashir on charges of war crimes and crimes against humanity. In the words of the ICC:

“He is suspected of being criminally responsible, as an indirect (co-)perpetrator, for intentionally directing attacks against an important part of the civilian population of Darfur, Sudan, murdering, exterminating, raping, torturing and forcibly transferring large numbers of civilians, and pillaging their property.”

This is the first time an arrest warrant has been issued by the ICC for a sitting Head of State and the decision has been applauded by human rights groups (despite little expectation that he will actually be brought to justice any time soon). However, for humanitarian workers and for the Darfur people they serve, the fall-out has been catastrophic. MSF has been one of many aid organisations forcibly expelled from the country by the Sudanese Government who accuse them as acting as “spies” for governments with a “neo-colonial agenda”. This is farcical, especially for MSF, who are so careful to maintain independence from political forces and neutrality in their operations.

The result is that the majority of the 2,700,000 displaced Darfuri men, women and children have lost access to basic humanitarian assistance – including health services, water and sanitation, and livelihood recovery. Letters I have received from Sudanese doctors with whom I worked in Darfur paint a bleak picture.

“The situation is gloomy, we are all in a daze, the patients in Niertiti will not have that simple health service.”

“They took everything, everything in any place where MSF had office or cars, even the computers and personal things in the compound.”

Since MSF was expelled, the field activity in Niertiti has ground to nothing. Reports from the few remaining medical assistants in Niertiti are tragic.

“Its very sad, with no doctors now in Niertiti. We had an outbreak of meningitis [which started at the time we left] and now there are more and more deaths reported in Thur and the Jebel Marra mountains. It is painful to hear that.”

“There is no one to take care for the people… all the activity to Zero.”

In spite of these setbacks, the strong spirit of the Darfuri and Sudanese people is evident. Some of the doctors with whom I worked and who were evacuated out of Darfur with the rest of the team have found ways to go back and continue work with other agencies like the United Nations. But for people in places like Niertiti, this will be no consolation.

The Right to Humanitarian Assistance
MSF, like other humanitarian organisations, operates on the basis that every community in distress has the right to humanitarian assistance. This should not be dependent on political, economic, ethnic or other factors – it is a basic human right. Yet in Darfur, one of the most troubled areas of the world, millions of men, women and children are being denied even the most basic humanitarian assistance.

Political action on an international and national level have once again had their most devastating effects on the little people – the communities scattered in camps and villages throughout Darfur. It was the big people’s political and military game that put them in the situation in 2003-04, through rampages through village after village. In 2009, once again, the people of Darfur find themselves pawns in a political and military game that is totally out of reach. This time as a consequence of conflict between the Sudanese Government and the International legal bodies.

Can We Do Anything?
It is easy to feel helpless given the dire situation. And nobody could be feeling more helpless than the ordinary people of Darfur. Yet, if they can keep going, keep doing whatever little thing they can to survive, keep hoping for peace - then perhaps the least we can do is to try and stand in solidarity and do the same.

So… if you can pray, then say a prayer. If you can read, then look up more information and share it with your friends and colleagues. If you can write, then write to the newspaper, or your local MP, or the Australian Government, or maybe even the Sudanese Government and United Nations (hell, why not!). If you can write music, compose a song and play it til your fingers bleed. If you can paint, splash out a banner and hang it off a bridge. If you have money, invest in a humanitarian charity. If you have friends, get them together and invite a speaker to show pictures and tell stories. If you have a computer go to www.savedarfur.org or www.darfuraustralia.org, and get Active.

Peace

Leaving Darfur

Farewells – Profiling ‘Mahmoud’ – Homecoming – More Info

My time in Darfur has come to an end. As I return to Australia I want to say a huge thank you to all of you who have vicariously accompanied me on this extraordinary adventure. It has been a great encouragement knowing there are so many people interested in Darfur and the work I have been involved in. Already my humble letters home have found their way into hundreds of hands all over the globe. And very soon they will all be publicly posted as a blog on the MSF Australia website along with lots of photos (www.msf.org.au). So please invite all your relatives and friends to check them out and also read the letters and blogs of other MSF volunteers from all over the world.

Farewells
My last few weeks were spent tying up loose ends, completing some pet projects and saying lots of goodbyes. The end of my mission has come so quickly, but as I reflect on everything that I have seen and done I find it difficult to believe it is has been only 6 months. A list of highlights is impossible, but here are a few memories from my last week.
· Visiting friends in the IDP camps and feeling so humbled by their love and generosity (it still leaves me speechless and moist-eyed - and an upset tummy).
· Being stopped a dozen times while walking down the street by men who heard the mosque health talks to have tea and chat more about sex infections (and starting to see condoms come into vogue).
· Giving the medical assistants a quiz which they took very seriously (and gratefully seeing results that justified the many hours of teaching).
· Playing with kids in the hospital and seeing their fantastic reactions to my little koalas (with one mother wondering if I would like to take her son back to Oz).
· Receiving a huge tub of wild honey from the staff in Thur (and seeing their motivation and hard work reap results in the improved malnutrition program).
· Enjoying my farewell party complete with live music and a swarm of cute kids who came to join the fun and dance (and could they dance!).
· Being given a traditional knife and decorate leather pouch by our beautiful cook Fatma (then miraculously getting it through customs despite it being a ‘dagger’).
· Being loaded up with jalabiyas, shawls, writing boards, tagia, and local craftwork that I will treasure as a reminder of my amazing friends in Darfur.
· My tough translator (and best Darfur friend) hiding his tears as we talked of when we would meet again (and him reminding me that the traditional marriage rules for his daughter could be modified for a certain khawadji doctor…uh oh).

Profiling 'Mahmoud'
Mahmoud Abdujamal Issa, 69 year old man from Nieriti who I see regularly for diabetes and heart failure.

Mahmoud has been sitting in the queue outside my consultation room since the morning along with dozens of other patients attending the Monday chronic disease clinic. I am hot and sweating as I usher him in and try not to rush as I apologise for the long wait. He looks me in the eye, smiles beautifully and tells me how grateful he is for our work no matter how long the wait is. I thank him, and as I look back into his one eye I think with amazement of all the things he has witnessed in his life.

Mahmoud was 18 years old when Sudan became independent from British-Egyptian rule. He was in Darfur at the time and cannot remember many details about the event. But he remembers well the overthrow of the civilian government two years later while he was living and working in Sudan’s capital, Khartoum. Another couple of years and the Communists were in power, only to be overthrown by another military junta (who executed a few of his communist-leaning friends). By this time Mahmoud was 32 years old and decided it was time to return to Darfur to get married and start a family.

At the age of 42 years Mahmoud decided to head south to the newly opening oilfields in the hope of improving the situation for his family (now grown to wife and three children). Mahmoud soon found a job and had his first experience working with the culturally very different south Sudanese. Unfortunately this was soon disturbed by a fresh outbreak of war in the south so Mahmoud returned to Darfur determined to stay out of the political conflicts. This turned out to be a good choice as southern Sudan was locked in a brutal civil war and another two military coups took place in Khartoum (finally depositing the current President Omar Al-Bashir into power in 1989).

Mahmoud’s homecoming was mixed with joy and sadness. His children were all growing up quickly. But his wife had been very unwell and died a few months after he got home. Mahmoud took this very hard and initially resisted encouragement to marry again. But in the end he realised he needed a wife to look after his children and married his younger cousin Hawa. Life settled into a pattern for Mahmoud who had reopened his trading business, headed a growing family, and played his role as an elder in the local community. It would be these strong social connections that continued to give Mahmoud hope and meaning in the next difficult years.

Mahmoud does not like to dwell on his suffering and loss, preferring to praise God for what he still has. But I do know that he has lost sons and daughters in the fighting and suffered great personal loss at the hands of the various armed factions. Mahmoud’s concern is for the children who have never known the peaceful coexistence with neighbours that he remembers from his own childhood. He tells me that it is for them he tries to tell his story “so that they know that peace is possible”. I ask him if he really believes that peace is possible and he reminds me of the peace agreement that ended over 40 years of war between north and south Sudan – “the same can happen for Darfur…it must happen”.

On his last visit to see me Mahmoud took my hand and asked if I would come back to Darfur. I said that I would certainly like to, inshallah. Mahmoud concluded by telling me that the world needed more people who could see beyond the colour of skin or the identity of race and tribe. I cannot remember his exact words but the touch of his hand and the intense sincerity of his gaze will always stay with me as a profound challenge. A challenge to always confront my own prejudices and assumptions and actively seek to identify with the marginalised. A challenge to free myself from the tribal thinking that defines my relationship with others in terms of race or ethnicity or gender or language or religion…

Homecoming Challenges
Since leaving Darfur I passed through Paris, Sydney and Melbourne before heading to Tasmania to spend some quality time with my family. I am still reaching for the mosquito net when I wake up, but the novelty of hot water has faded and I actually wonder if squat toilets are not anatomically better for bowel functioning. I know culture shock is invariably worse on return home and I am sure it will be a while before things get back to ‘normal’. I just hope I can find enough friends who I can continue to share my experience with – there is nothing worse than finding those closest are apathetic about something I am so passionate about. So I will ask you (as I ask myself) what now? Will this adventure just be filed in the ‘interesting story’ box or is there something more that we can do?

Personally, I don’t want my involvement with Darfur to end here. And I would love your help in trying to make a continuing contribution to Darfur and the world. Here are a few ideas I have been pondering. If you are interested or have other ideas please drop me an email and let’s make something happen.

1. Discussion forums and presentations. Lots of you have expressed interest in seeing my photos and hearing more of Darfur, humanitarian aid work and the work of MSF. I am very keen to share my experience and would be very happy to speak to any group of co-workers, friends or family that you could get together. Perhaps you are also involved in a community group or religious community that could organise something like a Darfur dinner or discussion group…

2. Polly push. Before leaving to Darfur I sent letters around a few Federal MPs. When I arrived home I found a pile of really quality replies from Jenny Macklin, Kevin Rudd’s African advisor, Bob McMullan, and Brendan Nelson. I wonder how we can do more to encourage our government to contribute more strongly and effectively to areas of the world experiencing humanitarian crises. Perhaps I can send around some of my letters that you can use to write to your own MP. And if they are interested, we can pay them a visit and push global health and international affairs onto their agenda even more strongly…

3. Write to the newspapers. Writing a letter to the editor of your local newspaper is pretty simple but can attract a great deal of attention to an issue. Perhaps you also know of other magazines or newspapers who would be interested in publishing a feature article on Darfur. Maybe we could even get together for a writing workshop…

4. Money. There are many aid organisations like MSF doing really amazing work in some of the most challenging places on earth. Of course they all need finances to keep things working and provide their much needed services. Unfortunately the current global financial crisis has slashed donations and program spending is being tightened across the board. Perhaps we could all sign up as regular donors to an aid organisation we respect and trust, and encourage family and friends to do the same. And maybe we could organise a fundraising evening to both raise awareness and raise money...

5. Thoughts and prayers. It is sometimes easy for important issues to fade from our consciousnesses as they disappear from the media. It is also easy to get overwhelmed but the suffering that saturates the media anew every day. But maybe there are some things we can do to keep our hearts caring and minds sensitive. We are all part of a family and friendship group, and perhaps also involved in discussion groups or spiritual communities. Perhaps these all offer us great opportunities to share our concern for justice and humanity with others and keep ourselves passionate…

More Info
When I left for Darfur 6 months ago I sent around a list of books, films and websites for you to check out. I hope you have found them useful. Here are some more resources you may be interested in.

Books – personal stories
‘The Translator’, by Daud Hari a Zaghawa tribesman from north Darfur who risked his life translating for journalists and genocide investigators after his own village was destroyed and community destroyed.
‘Heart of Darfur’, by Lisa French Blaker about her experiences as an MSF nurse in Darfur during 2005-2006.
‘Darfur Diaries: Stories of Survival’, by Jen Barlowe (and others) who collected testimonies from many survivors of the Darfur genocide.
‘What is the What’, by Dave Eggers following the story of one of the ‘lost boy’ refugees from Sudan through refugee camps and finally to the USA.

Books – exploring the issues
‘Not on Our Watch: The Mission to End Genocide in Darfur and Beyond’, by Don Cheadle (actor in Hotel Rwanda) and John Prendergast.
‘Darfur: A New History of a Long War (African Arguments)’ and ‘War in Darfur and the Search for Peace’, edited by Julie Flint and presenting essays from African activist and thinkers.
‘Darfur’s Sorrow: A History of Destruction and Genocide’, by MW Daly.
‘Darfur: A 21st Century Genocide’, by Gerad Prurier.

Films
‘The Devil Came on Horseback’
‘Darfur Diaries: Message from Home’

Websites
www.msf.org.au
www.savedarfur.org
www.darfurolympics.org
www.reliefweb.int
www.alertnet.org

Mosque Sex Education

Mosque Sex Ed – Profiling ‘Abdullah’ – Christmas –New Year

Christmas greetings from Darfur! Here is another update from Darfur for you to read while you nibble on the leftovers from your Christmas feast.

Sex Education in the Mosque
A couple of months ago I got an unusual request from some community elders. I was invited to visit the local mosques during Friday prayers to talk to the men about sexual health!

How did this come about? Well, as part of my regular teaching sessions with the medical assistants we had been talking about sexually transmitted infections (STIs) and the alarmingly high rates we have detected in the local area. This is particularly concerning because of the damage one particular STI (HIV/AIDS) has done in other parts of Africa. HIV/AIDS is not widespread here currently, but the social stigma regarding condoms and ignorance of sexual health combined with the population displacement and conflict make Darfur a perfect place for a catastrophe. This got one of our older medical assistants thinking, and after talking to some local imams and sheiks he came to me with the idea of having sex education in the mosques!

We brainstormed some ideas together and came up with a 20-minute presentation about nutrition, hygiene and sexual health. Unsurprisingly there are some things I cannot say. For example, I cannot say ‘condoms’ - so instead I say that there are ‘ways of preventing sex infections are available at the hospital’. There are other things I can only say in a particular way. For example, I cannot talk about ‘birth control’ or ‘preventing pregnancy’ - but I can talk about ‘family planning to space children’. The final draft seemed rather simple and quaint to me, but the old medical assistant assured me that it would be great.

Our first talk was three weeks ago, and proved an interesting test case. I dressed up in my best jaalabia (robe), tagia (cap) and markoub (leather shoes) and headed for the Friday prayer gathering at the nearest mosque. After prayers finished the imam announced a special talk by the khawadji doctor from Australia. I took my place at the front with my translator and surveyed the crowd with some trepidation. Two hundred faces looked at me with serious curiosity. I raised both my arms with a hearty Asalaamu alaykum and, having received an encouraging reply, launched into my talk.

All was going unremarkably until I got to the bit about sex, at which stage a murmur ran through the crowd. Then one of the old men sitting closest interrupted my translator to make some comments of his own. Uh oh, did I say something wrong? The attention level was certainly increased. I started talking again and got through the talk without major incident. But as I said thank you and went to sit down a crowd of smiling men crowded around me. They were all holding out their hands to shake, saying thankyou and wishing peace and blessings upon me. I realised with some relief that the talk had been very well received and the interruptions were just to clarify some important points. [The audience particularly liked the Quranic references I slipped in and my (very bad) attempts at speaking Arabic]

Since then I have visited two other mosques with the same message and the effect is filtering all around town. Men chat about it over tea and at work, women talk about it as they collect water and look after their kids. This has all been a very pleasant surprise and it seems my old medical assistant was exactly right about what sort of message to deliver (and how to approach the socially sensitive bits). Next week is my grand finale at the big mosque in the northern IDP camp. It holds a couple of thousand people for Friday prayers so will be quite an experience!

Profiling ‘Abdullah’
Abdullah Mohamed Abdukareem, 4-year-old boy, who has lived his entire life in one of Niertiti’s IDP camps.

Abdullah’s family left their village in 2004 and came with hundreds of others to Niertiti to find safety. His parents only planned to stay until the attacks against villages stopped and it was safe to go home. They had no idea that four years later ‘home’ would still be in the cramped confines of an IDP camp.

Abdullah was born in the shadowy confines of his family’s camp hut. His grandmother (an experienced birth attendant) guided his mother through labour, tied and cut the cord, then cleaned them up and wrapped them in a blanket. It was the rainy season and Abdullah’s mother remembers lying on the bed with her newborn baby watching water leak under the UNICEF tarpaulin and run down the wall. A pot of water boiled on the wood fire in one corner. Their entire possessions were bundled against the opposite wall. At that time their one-room mud hut was home for Abdullah’s three siblings, mother and grandmother (his father was seeking work in a nearby town). I am sure Abdullah’s mother wondered what sort of world she was bringing her newborn son into.

Abdullah spent much of his first year slung on his mother’s back as she went about her daily work. Every day she would trek down to the river to collect water, and then carry it back up. Later on water pumps would be installed which meant she only had to walk a few hundred metres. Once a week Abdullah’s mother would go to the forest to collect wood with the other women and return with it bundled high on their heads. They also wove grass baskets and table mats which they could sell at the market. Once a month they would cue up and collect food rations from the World Food Program (WFP). Every household was issued with ration cards which they would show when they came to receive their portion of grain, oil and beans. Ration cards were valuable and Abdullah’s mother had heard that some people had got more than one while some others had missed out. But everyone she knew had a ration card and they guarded them closely.

By the time Abdullah turned two, life in the camp had improved. His father had found some business trading items at the market. He had also added another room to the hut and fixed up the leaky roof. Abdullah’s mother was kept busy looking after her 4 children. Water pumps had been drilled, pit toilets were dug and areas had been built for washing clothes. There was a new hospital. And the camp population had grown to over 8,000 people.

When Abdullah was four he was brought to the hospital for the first time. He had a high fever and cough and had been complaining of pains in his head and neck. His father had just brought him home after a two-week trading trip out of town. At first his mother thought he had picked up another minor infection. But when she saw him getting sicker in the evening she decided to take him to a doctor. He was looking very sick when he arrived at the hospital and examination showed signs of meningitis. A sample of CSF was taken and the quick-test confirmed meningitis. Antibiotic treatment was started immediately and he made a full recovery over the next 5 days. Fortunately this turned out to be a sporadic case, but after a meningitis outbreak last year (which claimed many young lives) we were all on alert for another epidemic.

Abdullah is now back to playing marbles in the dirt, wrestling with his playmates, chasing chickens and throwing rocks at the donkeys. In the next year or two he will start school. But beyond this his future is uncertain. There is still no possibility of his family returning to their village – a village he only knows through stories. For Abdullah, the IDP camp is his home and will remain so indefinitely. But he has lots of friends living nearby, plenty to explore, a secret hiding place (perfect when he gets in trouble), and a khawadji doctor who might have some dried dates for him today.

Christmas in Darfur
I didn’t really expect much from Christmas this year. Darfur is a long way from family and friends and the people here are mostly Muslim. But while there were no gaudy decorations in the streets, no carols playing in the shops and no extra wads of junk mail in the letterbox, Christmas did not pass unnoticed. In fact, this Christmas has been the most multicultural and multifaith Christmases I have ever celebrated.

The MSF team here is mostly made up of local Darfuris. However, many of the doctors, medical assistants and nurses are from other parts of Sudan, as well as France, Japan, USA and Ethiopia. As we are all living and working together away from our wives, husbands and children we become something of a surrogate family to each other. This was particularly noticeable on Christmas Day. As the sun rose over the Jebel Marra mountains Christians and non-Christians alike rose early to pass around Christmas greetings. Many of the Christians dressed up in their best (and loudest) African dress and headed off to church. A visiting preacher put on a great service, with singing and dancing from many different tribes. Then a feast was prepared and we all shared Christmas in our home away from home.

As we ate we talked about our families back home. Sara, a nurse from south Sudan, told of her own 4 children and the 3 orphaned nieces and nephews she had also taken in. Her eyes welled with tears as she described the joy and pride she felt when she last saw them. They were healthy and going well at school – thanks to the money Alice earns and sends back to them regularly. Andrew, an 80-year-old medical assistant from south Sudan, told me of his life as a guerrilla fighter during the southern resistance movement (including training in Israel!). His children are all grown and scattered around Sudan – and even one in Sydney! Simon, a medical assistant from south Sudan, told me of his wife and 3 children. He gave an aching-heart sigh as he told me of speaking to them on the phone today. It will be another 2 months before he sees them again. Dr Abdulatif is recently married and gave cute love-struck smile when I asked about his habibi.

As I sat among this beautiful bunch of people I thought of the diverse and amazing lives they have all led and the unlikely circumstances that have brought us to Darfur. Here we are working in imperfect harmony to provide health services to people in need. And while we are all driven by different motivations, I was reminded of the simple dreams that we all share. Dreams of peace, health and happiness for our families, friends and communities. It was then I recognised the Christmas spirit was as strong as ever. Here was a spirit of gratitude for the lives we have had, the love we have shared and the relationships that give it all meaning. Here was a spirit of hope for a better future, where everyone can enjoy peace regardless of race, religion or any other artificial segregation.

Happy New Year!
I hope 2008 has taught you plenty and left you with many beautiful memories. It has been a phenomenally memorable year for me! May 2009 see you rise to new challenges, grow closer to friends and family and play a part in making the world a more just and friendly place.

Oranges, Camels, Satellite TV

Vaccinations – Profiling ‘Halima’ – Oranges, Camels, Sat TV

I have spent the last week back up in the Jebel Marra mountains. The purpose of my visit was both to assist with our vaccination campaign and also train the local health workers. It is a beautiful place to visit and I probably won’t get another chance to stay there so I have come away with loads of memories. So join me now visiting some villages, meeting the locals and seeing some funny sights.

Vaccination Campaign
The vaccination team was up at dawn and ready to hit the road with Landcruisers piled high with all the equipment needed to vaccinate a small town. Today the destination was Buldong – a 45 minute drive from our Kutrum base along a series of dusty, rocky tracks in some of the most beautiful country on earth. Along the way our ‘town-crier’ hung out the window bellowing into a loudspeaker reminders that today is vaccination day. The community had already been saturated with news of this with local sheiks, imams, teachers and other leaders spreading the message for weeks prior. Indeed, half the people we passed were heading to Buldong especially for the vaccines – children on donkeys, babies strapped to young girls’ backs, family groups walking briskly in a cloud of dust.

On arrival we met the rest of the team who had made their own way from their respective villages. Already a couple of hundred brightly clad women were sitting in the morning sun with their children awaiting our arrival. Today we would vaccinate around 1000 women and children – a big organisational task. But it was the third and final week of the vaccination campaign so the team was well-oiled and leapt quickly into their respective roles – registration clerks, nutrition screening attendants, crowd controllers, vaccinators, cooks, drivers (whose first job of the day was to slaughter the goat that had been brought for lunch).

Before starting the vaccinations I joined the campaign supervisor, Mama Joanna, in telling everyone about vaccinations and thanking them for coming. I then took the opportunity to spread some health messages about nutrition and hygiene, which were listened to particularly attentively (though I am sure the oddness of who was delivering the message will be remembered much longer than the message itself). Then the women and children all filed through – polio drops, Vitamin A capsules, iodine, measles and pentavalent injections. It took us until late afternoon to finish up and by the time we returned back to Kutrum the sun was sinking below the dusty horizon. It was a good day. After a cold shower I sat down to eat and play cards before retiring early for another early start tomorrow.

The vaccination week finished up successfully and will be followed up in January with a final round to complete the campaign. Vaccine preventable diseases (e.g. measles) are among the biggest killers among displaced and war-affected persons, and in the past couple of years a number of epidemics have swept through Darfur. Since the Jebel Marra villages are all under rebel control there are no government health services – including no immunisations. So the MSF vaccination campaign this year has been a valuable addition to our regular clinic services.

Profiling ‘Halima’
Halima Isak Esau, 23 year old woman from a remote village in the Jebel Marra.

Halima has known war for as long as she can remember, but it was in her teens that she noticed things really changing. Her family is from a village just west of the Jebel Marra and they lived a relatively luxurious life as farmers and traders. Halima remembers market days with pleasure, when visitors would come from all over the region to trade. She particularly loved seeing the Arab nomads who would ride in on camels wearing such exotic clothes and jewellery.

Halima’s father was good friends with one of the old Arab men called Sheik Ahmed. Each week she would see Sheik Ahmed come and join her father to drink fresh milk, eat stewed meat, share stories and laugh loudly a boisterously. One day Sheik Ahmed gave her a purse made from goatskin. She was so delighted that she decided that next time the Sheik visited she would give him some beads that she was putting on a string. But that was the last time she saw Sheik Ahmed. When she asked her father why, her father explained that some bad things had been happening and it was not safe for Sheik Ahmed to visit anymore.

Those bad things would soon come to Halima’s town and send them running for safety. Unlike most of the displaced villagers, who sought sanctuary in the larger towns, Halima’s family fled deeper into the Jebel Marra. This was much less safe – indeed it was the frontline of the war – but Halima’s father believed that they would be better off staying in the mountains. These mountains have now become the heart of a rebel movement that would quickly grow stronger and more organised. Indeed, all of Halima’s brother would end up joining the rebels, growing their hair long with dreadlocks (like their hero Bob Marley), toting old Kalashnikovs, and wearing the SLA badge proudly (which is simply Sudan’s flag upside down).

I met Halima while doing some village visits spreading news about the vaccination campaign. Her family heard brought me to see her after she had been in bed for 2 weeks with fevers and skin sores. After ducking into her hut it took a minute for my eyes to adjust and what I saw was quite shocking. Halima lay in bed with her whole body swollen and seeping with pustules. She was boiling up with fevers and must have been in dreadful pain. After chatting and deciding that she could return with us to the clinic we helped her into the Landcruiser and slowly bumped back along the road.

Three days later she is much improved. The fevers have gone, her skin is healing, her face is showing human features again and she can give me a smile as I say salaam. If Penicillin had a face I would kiss it, such are the miracles the simple antibiotic can produce. She is much better, but still needs follow-up, not least because she was diagnosed with leprosy in the past and it seems she may not have completed all her treatment.

By chance I met one of Halima’s brothers later in the week. He came to the clinic with a group of SLA members to seek treatment for one of their wives. It was after nightfall so they joined us to eat some bread and honey. As we chatted Halima’s brother introduced one of the other guys as a ‘Janjaweed’ and laughed. It turns out that this guy is one of the Arabs who have switched sides to join the SLA against the government. I wondered if he could be related to the Sheik that Halima remembered from her childhood. It is indeed a peculiar world!

Oranges, Camels and Satellite TV
It was Eid holidays this week, and since I was in Kutrum I trotted around doing the obligatory house calls after work each evening. I met lots of beautiful people but a few scenarios stand out.

One evening we walked through the lush orange orchard that is owned by one of our watchmen. It is ironic that his son was treated for malnutrition when their farm is so productive – perhaps a result both of market forces (the best produce is sold) and simple lack of understanding about nutrition. The Jebel Marra is probably the most fertile ground in Sudan and its oranges are particularly famous. I am told that oranges from the Jebel Marra even adorn the tables of the President.

After returning from the orchard we called in to see our triage attendant. As I entered I noticed a huge homemade satellite dish propped against the wall and thought it kinda odd since there was not even electricity here. But after handing around dates and juice our host treated us to a full display of his satellite television setup. For electricity there were two solar panels lying on the grass roof of his hut, alongside a tray of dried tomatoes – both now soaking up the moonlight. He brought the TV outside and propped up against the fence, then proceeded to unroll the electricity and satellite cords over the gravel. After playing around with the set-top box the TV flickers to life and Al-Jazeera news channel shines with crystalline clarity. I am suitably impressed. The entertainment soon draws some neighbouring children, while a curious camel pokes its head over the fence to catch the sports headlines.

I have been continuously impressed with how well informed the people here are about what is happening in the world. Politics is a topic of hot discussion and I am sure that some of the villagers here could outgun our supposed expert foreign correspondents in their commentary on African affairs. They have certainly taught me plenty!

Violence Against Women

What’s New? – Profiling ‘Aziza’ – IBM Language – Garbage City

I have just returned to Darfur after enjoying a week of rest and rejuvenation in Cairo, Egypt. My ‘holiday’ was nice – I visited the pyramids, camped in the desert, made new friends and avoided becoming a road trauma statistic - but I am very pleased to be back to work in Niertiti.

What’s New?
Returning to the field after my break I was surprised how much news there was to catch up on – good, bad, quirky and frustrating. Construction of a new sheltered area in the hospital courtyard is complete. Built from tree branches and grass it now gives a cool shaded area for patients and their families – and room to triage patients when there are influxes of trauma patients (e.g. war casualities). A new doctor and medical assistant had arrived, as well as the new expat midwife and remote clinic doctor – finally giving us an almost full medical team. Unfortunately the remote clinic doctor will be kicked out of the country next week after only 2 weeks in the field due to a bureaucratic paper issue. It is eternally frustrating for humanitarian aid workers to be delayed and rejected by unwelcoming official procedures when the local population is so wanting for services. But in places like Sudan it is the sad reality.

Security around Darfur has deteriorated for aid organisations, with car-jackings occurring every couple of days and bandits becoming disturbingly disinhibited in their operations. Our vehicles are locked up in the compound and we resort to donkey cart for all internal movements. Our mobile clinic has been closed for one month and remains so indefinitely. The remote clinic is functioning but all travel is done with caution (especially since a nearby MSF team was evacuated after their Landcruiser was ‘borrowed’ to chase and shoot some rebels in the mountains). No personnel have been at risk, but the last thing we want is for our humanitarian resources to end up being directly involved in perpetuating the conflict!

Thankfully there have not been any big shooting incidents since I left. But there are still sporadic assaults and deaths due to local social and political disputes (including the death of a local MSF staff member who was confused with someone else by the gun-toting guys who came to his home!?!). Despite all this I am amazed at the motivation and hope people have after half a decade of insecurity and conflict. In the midst of all this they go about daily activities consistently and regularly talk of their plans for themselves and their families “when there is peace”. When there is peace!

Profiling ‘Aziza’
Aziza Abakar Musa, 16 year old girl from Niertiti who comes to the Women’s Health Centre.

Aziza was 12 years old when she fled her village with her family and came to live in a camp here in Niertiti. She remembers the farm and what village life was like, but for her younger sister life in the camp is all she really knows. Her father disappeared in the raid, and her only other brother recently left to join the rebel fighters in the mountains. So now it is just Aziza, her mother, her sister and her aunt’s family living together in a huddle of mud-brick huts.

Every day Aziza helps her mother with the household chores. She collects water in buckets from the bore-well and brings it home for drinking, cooking and washing. She takes bundles of clothes to the river to wash them and dry them on the rocks. Aziza doesn’t go to school often as there is so much to do at home, but she does have a pencil case and notebook, which she treasures dearly. She accompanies her mother once a month to pick up food rations – grain, pulses, oil and salt. Sometimes she can trade some of these in the market for vegetables, fruit, or even milk. Aziza likes these jobs, they keep her occupied, and give her plenty of time to chat with other local women.

Aziza’s least favourite job is collecting firewood from the forest. It might sound like a simple job, but for young women and girls like Aziza it is a huge risk. And last month, Aziza met with this risk in a very ugly way. As usual she went with three friends to collect wood one afternoon, making sure they had plenty of time before it got dark. On their way back home they suddenly heard the beat of horses and were surrounded in a cloud of dust. Looking up they saw two men on horses with guns hanging from their shoulders yelling at them to stop and lie down. But Aziza and her friend fled, all running in different directions to get away.

It did not take long before one of the men caught up with Aziza. He threw her to the ground and assaulted her, brutally and intimately. Then his companion arrived and he took a turn as well. They dragged her back to their camp, finally releasing her in the early hours of the morning to walk through the desert back home.

I met Aziza the next day when she arrived with her uncle at the Women’s Health Centre. They were both distraught. I sat with her and the female medical assistant and we did our routine medical and psychological assessment and treatment. For Aziza this assault was not only a personal abuse but will haunt her socially for the rest of her life, making things like marriage especially difficult. Unfortunately, her experience is all too common for women in Darfur, who are particularly vulnerable in the context of dislocation and conflict. Rape is a weapon of war, and here in Darfur it is terrifyingly effective. In my desk at work I have hundreds of medical reports for girls like Aziza – and these are just the ones who seek medical attention. Most hide away out of shame and fear.

Two weeks later I saw Aziza for review. She gave me some surprising news. Although initially reluctant to report the assault to the police after a few days she decided that is what she wanted to do. This must have taken extreme courage, knowing that the authorities here have a record of bias towards the perpetrators. Then she told me something even more surprising. The men had been caught, thanks to the efforts of the sheik of their tribal group who heard about the assault and personally tracked them down. They are now locked up behind bars. Realistically, no one expects them to come to trial – but just the fact that they were apprehended is a first for us here!

I check Aziza over and find her bruises and cuts are healing. Her eyes look a little brighter and she gives me a shy smile as we talk about her family. For sure, her life will never be the same again, but she is strong and maintains hope that there is a better future ahead. I hope with all my heart that this is true!

IBM Language
There are three words in Arabic that visitors to Sudan cannot avoid – insha’allah, bukra, malesh. Sometimes it seems that entire conversations can be based around this IBM vocabulary. I was at the airport the other day and arrived at check-in to find my flight cancelled. “Malesh” the attendant sympathised (or gloated!?!). When will the next flight be? “Bukra - insha’allah”, and off I went to return the next day. So for anyone planning a trip to the Arabic speaking world, learn these.
· Insha’allah means ‘God willing’ and is a disclaimer for any future plans.
· Bukra means ‘tomorrow’, which is when most things will happen (insha’allah).
· Malesh means ‘sorry’ or ‘too bad’ (or ‘shit happens’) and is usually said with a big grin when something has just gone wrong.

In Darfur this language carries a deeper meaning and conveys a fascinating mixture of hope and fate. People here are faced with huge challenges, frequent disappointments and never know what tomorrow might bring. A mother sitting beside her dying son looks up at me when I explain we are doing all we can and says insha’allah, reminding me that despite our best efforts ultimately he is in the ‘hands of God’. Our car slides down a muddy bank into a river and the driver smiles malesh, then we all pile out to drag the car back onto the road. My assistant tells me of the raid on his village and how difficult life is as a displaced person, then startles me with his dream of resuming his study bukra, when there is peace. In this case bukra still seems a long way off.

Garbage City
I will finish this letter with a brief tale from Garbage City, an amazing part of Egypt’s capital, Cairo. Cairo has a population of over 33 million and there is no official waste collection for the tons of waste produced by residents and visitors every day. But 85% of waste is recycled – all thanks to the residents of Garbage City. I met one of these residents, Hanna, when I visited a school for working children run by a local NGO (non-government organisation). Hanna took me back home to meet his family and see Garbage City first hand. Like half its residents Hanna’s family is Coptic Orthodox, and as garbage collectors occupy one of the lowest rungs on Cairo’s social ladder. And seeing a glimpse of his life left me absolutely intrigued.

The first thing that hits me as I reach the outskirts of Garbage City is the smell – a potent mix of burning plastic, rotting paper and animals. The alleys are crowded with enormous bags of plastic, paper and metal. The tiles underfoot are buried in the same and I notice a big rat lying stiffly on its back. Despite the dirt and rubbish everything is impressively ordered. I meet Hanna’s sister squatting in a pile of plastic sorting it into piles. After being sorted, cleaned and bundled they will be sold to neighbours who turn it into plastic coat-hangers, cutlery, cups, bowls and plates.

Inside Hanna’s house it is clean, nicely furnished and bright – a stark contrast to the world outside. He takes me up to the roof of his apartment building to show me a solar hot water system made completely from recycled material. For the past year he has been building these with the assistance of a Canadian engineer and donor funding. A few dozen units have been built and distributed to local schools and families. As I watch the sunset over the top of grey buildings, plastic bags blowing around, dust saturating the air and the persisting smell tickling my nose I know I will never look at rubbish quite the same. And I will certainly take more notice of those nondescript people bundling rubbish on the city streets.

Village Clinic

Mobile Clinic – Profiling ‘Aladeen’ – Parties

I am half way through my mission here in Darfur. I have learnt so much about Darfur, the world and about myself. I have had the opportunity to work with amazing people who, in the face of gross injustice and abuse, refuse to be passive victims and instead find the strength to work for a better future. Today I would like to take to on a journey to our mobile clinic and introduce you to a few more Darfur locals.

Thur Clinic
It is 8:30am and the morning sun has risen from behind the Jebbel Marra mountains to cast an orange glow across the country. Today is my weekly visit to Thur, about 30 minutes drive to the southeast, where MSF runs a clinic three times a week. As I walk into the office to pick up the money and travel documents my driver calls out a cheery ‘salaam’ while polishing the windows of our Landcruiser. Joined by my translator and a medical assistant we load the car with boxes of Plumpy Nut (a peanut-based nutrition supplement), a cold-box full of vaccines, sterile equipment for the dressing room and various other medical bits and pieces. In Thur we will meet the local team who do the actual day to day running of the clinic and are already very well set up.

As we leave Niertiti we check in with the local police and wait while our travel documents are scrutinised (even short day trips like this requires authorisation in advance). I look around to see lots of bored young men in khakis lounging around with rifles slung over their shoulders. We get waved through and start bumping along the road to Thur. In the midst of such tight security I love the drive to Thur as it is the only regular chance I get to leave Niertiti and see some of the beautiful Darfur countryside. Today we pass a herd of camels which cross the road in a cloud of dust. A young nomad boy is perched high on one of the camels and he turns to give us a wave before cracking his whip and moving on.

We slow down every kilometre at the unofficial checkpoints. They are manned by Arab militia (many barely in their teens) who make their living holding up the passing trucks. These are the guys known as ‘Janjaweed’ (devils on horseback) by the other Darfur tribes, including those who have lost family and homes from their raids. It always seems strange to stop and chat, swapping cigarettes and jokes, with guys who may well be responsible for the violence and abuse happening in Darfur every day. But it is also a reminder that we are all humans with the potential for ‘radical evil’ as well as ‘radical good’ (to use Emmanuel Kant’s phrase). And if it had been a different group given the arms, money, power and permission the balance of power could be reversed.

Arriving in Thur we weave through the market day masses to our clinic. As we unload and set up there are already dozens of people waiting and our 15 local staff are busy doing registration, taking vital sign, weighing children, doing dressings, pregnancy check-ups and nutrition reviews. Today I begin by seeing the guys doing nutrition screening and the nutrition assistant who manages the outpatient malnutrition program. We are currently seeing a very high rate of malnutrition from this area and the nutrition program has blown out to over 100 children. This is bigger than any of our other nutrition programs and is ringing alarm bells for me so I need to make sure all the screening and treatment is being done correctly. I find that the screening is accurate with particularly high rates of malnutrition in an area a few kilometres south (which has been particularly affected by bad harvests). With the nutrition assistant I work out some areas the treatment can be improved, then leave him to see the kids and give out lots of Plumpy Nut.

The rest of my day is spent doing consultations – malaria, typhoid, scabies, diarrhoea, coughs and colds, pneumonia, complicated malnutrition, pregnancy complaints, urinary tract infections, STIs… At 4:00 we rush around making sure the sickest patients have been seen then have to turn the others away so we can make it back by curfew (any later and we risk being victim of car-jacking by the militia). We pile back into the car, taking with us a few women and children needing admission to hospital – two infants with diarrhoea and dehydration and a girl with severe malaria.

The return journey is without incident and as we arrive back in Niertiti I join my colleagues is breathing ‘Alhamdulillah’ (thanks/praise God) for a safe and productive day.

Profiling ‘Aladeen’
Aladeen Abakar Suliman, 18 month old boy who attends our Thur Nutrition program.

Aladeen lives with his family in Kass, a village about 15 kms southeast of Niertiti. They have been in the area for generations and are among the lucky ones who have not been displaced by the current conflict. But this does not mean they are unaffected. Like most families in the area they rely on agriculture for a living. Good agricultural land has always been scarce and the land has become increasingly degraded since an earthquake 10 years ago the main river flowing from the Jebel Marra mountains. Recent conflict has not only limited the areas they can farm (due to security) but also seen hundreds of additional families relocated into the area. While most of these families stay with relatives who are already in the area it means the already scarce resources need to be stretched even further. And it because of this background of food insecurity that I meet Aladeen and his family.

Aladeen first came to the MSF mobile clinic one month ago. His limbs and face were wasted, his legs swollen, his skin peeling and he stared listlessly at me as I examined him. These are the classic signs of severe malnutrition – signs I had never seen outside of textbooks before coming to Africa but which now confront me every week. We brought him back to the hospital and he was admitted to the TFC (therapeutic feeding centre) for intensive nutritional care. In addition to high-energy, high-protein food, children are also given vitamin supplements, measles immunisation, de-worming treatment, tested for malaria and treated for any other medical conditions. Within two weeks of intensive nutritional care he was looking like a new child – inquisitive eyes, grabbing hands, and glowing new skin.

On my last visit to Thur, Aladeen was ready to be discharged from the program. He should now have the strength to make it through the rest of the childhood risk period and grow up healthy and strong. Of course, the underlying causes of his malnutrition remain (conflict, environmental destruction, poverty…), and until these issues are addressed we will continue to see more children like him come to our clinics.

Parties
It is not all work and no play here in Darfur, and the last couple of weeks I have been invited to a couple of parties. It was a goodbye party for a local UNICEF worker who was leaving to get married and it seemed like everybody came by to wish him well. There were plenty of sweets, loud music and typically restrained Sudanese dancing (except for one young boy who really ripped up the dance floor!). Everyone was decked out in their finest clothes, with the men competing against each other for the biggest turban and flashiest walking cane. I had my hand painted with henna – and the orange stain is still giving the locals a laugh as they ask me who my new bride is.

Too Many Guns

Unpredictability – Profiling ‘Aisha’ – Numbers – Kids

These past two weeks have been full of action, and as share some this with you now I should apologise in advance for the bits of blood and gore. You can avoid this by jumping down to my profile of Aisha, a delightful mother of one of my favourite little patients, or to my inspired ponderings on being a child. Enjoy!

Unpredictability
Hours after I emailed off my last letter home things got pretty hot here. The sporadic shooting accelerated and spread throughout town. A government spokesman later explained to the press that their soldiers had entered one of the IDP (internally displaced persons) camps to retrieve weapons after an alleged assault on one of their officers. I would say much more, except I can’t – but here are a few of my scattered pictures of what I saw.

- Our logistics coordinator presenting up to work to tell in shock of having two dozen bullets become lodged in his mud-brick home. Dozens of other staff from that IDP camp with similar stories and shock and fear.
- Hundreds of defiant IDPs marching through the streets holding banners and sticks aloft shouting out chants of protest. Eventually going home after told in no uncertain terms what would happen if they did not.
- Jeep-loads of reinforcements roaring into town loaded with boys, bullets and big mounted machine guns. Seeing them haunt the town for the next week ‘maintaining order’.
- Bullets in chests, and abdomens, and necks, and legs… Fortunately only two patients that made it to the hospital died. One miracle man had a bullet course right through his neck without destroying any vital structures!
- Feeling the whiz of bullets fly over the hospital and sharing looks of fear, resignation and disbelief with the other patients and staff. Then feeling really uncomfortable realising that if things got worse I would be on a UN helicopter getting out of here – they would not!

Then stranger still, everything just returned to normal. Market day came and went, the roads re-opened, kids rode to school, and we resumed all of our activities (we had closed everything but the hospital). In the days following I would walk to work and look around wondering if I had just dreamed it all. But I slowly realised that everyone here has seen this before. Not always this violent and bloody, but the same forces at work, the same powers and threats and insecurity. And before I knew it things felt like normal again for me too.

As if that was not enough drama for the fortnight, this week finished with a bloody crash too. I was just about to leave the hospital yesterday when the army jeeps started rolling up. Half a dozen jeeps, 13 bloodied bodies. Not war injuries this time, just a damn big motor vehicle accident!

Profiling ‘Aisha’
Aisha Abdallah Adam, 26 year old new mother of baby Heemdan (who is in hospital with pneumonia).

Aisha is a nomadic woman who lives far from Niertiti with her husband and their extended family. She has the striking beauty, shiny dreadlocks, and strong eyes that typify the nomadic women of Darfur, and her lighter coloured skin reveals the ancestry influence of Arabs from the north. Her family depend on their herd of cattle for their livelihood, and their nomadic lifestyle is dictated by finding pasture and water – an increasingly scarce commodity in these parts. This competition for resources underlies the conflict that has existed for decades between rival nomadic clans and between these clans and the settled agriculture based Fur villages.

Every week Aisha travels in to Niertiti for market day. Market day is a big affair in Niertiti, with people coming from miles away to sell their produce in exchange for other necessities. On this day the town becomes its most multicultural, with Arab nomads, Fur villagers, town residents and traders from the larger cities all coming together to exchange goods. Aisha sits with other brightly dressed nomadic women selling the milk and meat from her family’s herd. They are highly valued commodities and Aisha knows that so long as they have healthy cattle her family will survive.

Market day is also the day when Aisha can go to the MSF women’s health centre for her antenatal checkups – a service that has been very readily embraced by her and many other women. However, like many women who live far from Niertiti, her actual delivery was completed at home with the assistance of a traditional birth attendant and a birthing kit from MSF (with soap, a cloth, sterile razor blade and string for cutting and tying the umbilical cord). The availability of pregnancy care and birthing kits have made a big difference to women and their babies here, but we still regularly see the complications from prolonged labour and neonatal conditions like tetanus from the use of dirty knives in cutting the cord.

The reason Aisha sits in hospital now is because her 30 day old baby has pneumonia, which sits alongside diarrhoeal disease as the biggest cause for hospital admission (and death). But today he looks great, and I tickle his tummy while I tell Aisha that he just needs a final dose of antibiotics before she takes him home. Five days in hospital is a big deal for Aisha, as it means five days away from her work and livelihood. So Aisha smiles happily when I give her the news, and her husband and mother beside her share the relief that he is well and they can now go home. Her mother (an older image of Aisha) who jokes that it looks like I want to keep him for myself. I am tempted (-:

Numbers
1 hospital, 60 inpatients, 120 admissions/discharges per week
1 expat doctor (me), 4 Sudanese doctors
1 expat nurse (currently vacant), 14 nurses/nurse assistants
14 births per week, 1 expat midwife (currently vacant), 5 midwife assistants
3 outpatient clinics (including a mobile clinic, and remote clinic)
7 medical assistants, 1800 outpatient consultations per week
1 inpatient feeding centre, 30 kids, 10 admissions/discharges per week
3 outpatient feeding centres, 150 kids, 20 admissions/discharges per week
1 expat Field coordinator, 1 expat Logistician, and a big team of administrative and support staff.
Kids
Every day I walk slowly to work and pass dozens of kids who wave and call out ‘khawadji’ (roughly translated as foreigner). Some of them are filling up water bottles from the bore well, jumping up and down and using all their little weight to pump the handle. Others are playing with marbles on the ground, or arranging sticks into little houses. Some kids race down the dirt road using a forked stick to role the lid of a tin can along the ground. Others are walking or riding to school dressed in neat uniforms and carrying their books protectively under their arms. When they see me they wave energetically or come over to say ‘salaam’ (peace greetings) and shake my hand. Sometimes one child will take my hand and walk along with me (this is followed by a dozen other kids running up to hang off my arms). I am told that the Persian mystic Rumi always made a point of greeting and blessing children, seeing them as particularly sacred. I like this idea. Imagine if every adult greeted every child with the respect and attention that they greet other adults with.

In the hospital one of the best parts of my job is looking after the sick kids and seeing them get well. It is also the hardest part when they don’t get better. So I was excited to find out last week that I have been offered a job at the Royal Children’s Hospital in Melbourne next year. It also made me think what a different life kids here have compared to the kids I will see next year. It will be nice to work in a place that has such a high quality of care – specialist doctors, all the blood tests, X-rays and scans imaginable, no worries about running out of essential medications. But will I also resent the fact that there is so much excess and waste in Australia? I don’t just mean seeing the bloated bellies of malnourished kids here replaced by the bloated bellies of obese young Australians. But also all those little every day excesses in the home, at work, in the hospitals. Those unnecessary things we convince ourselves are ‘needs’.

Children are one of the world’s great reminders of what is valuable and necessary in life. Things like nutritious food, clean water and sanitation, schooling, safety, shelter and time to play and just be kids. There are dozens of reasons why children here may not enjoy these things that most Australian kids take for granted. Conflict, famine, population displacement, child labour, child soldiers, deceased parents, child-headed household, family illness, poverty…

These are all big, complex issues. But they are also all issues that we in the rich ‘west’ can help to relieve (or perpetuate). From the individual level up to the level of international policy, diplomacy and economics, we can all do something. Maybe it is simply donating to MSF or other relief and development organisations. Maybe it is signing a petition to make essential drugs more accessible to low income countries. Maybe it is lobbying for greater awareness and action on the food crisis being exacerbated by international economic stressors. Maybe it is writing to your member of parliament urging stronger action on alleviating poverty among the neighbours of our global village. Maybe it starts by picking one issue to become better informed about.

The west will not be able to ‘fix’ these problems (indeed, the west has done much to cause and perpetuate them through colonial, economic, social and political misadventure). Real change and development is always indigenous. But there is so much more that can be done to empower disadvantaged communities around the world to make this change. So before I step off my soapbox I unashamedly challenge you to find one small thing you can do to contribute before we reach the end of this year.

Heart of Africa - Darfur

Normalisation - A Day in the Life (2) – Profiling ‘Ali’ – Rich Africa

Normalisation
I have been here in Darfur for almost two months now and continue to experience a crazy mix of exhaustion, exhilaration, frustration, anticipation, despair and hope. But things have also become very ‘normalised’ (a psychological coping strategy that I am sure all humanitarian workers experience). So, when does normal become extraordinary?

-Malnourished child with sepsis and severe dehydration = Normal (give fluids, antibiotics, supportive care – next patient).
-Four such children, one dies = Crap week (review case, look for improvements, keep trying).

-Eating dinner and then hearing gunshots = Normal (pass the pizza please).
-Machine gun fire continuing after the pizza is finished = Hmm, unusual (keep radio and satellite phone handy, call UNAMID, inform HQ).

-Pregnant lady dying from Hepatitis = Normal.
-Three deaths from liver failure (including one child) = Bad week (wish we had more investigations, could have done more, stay alert for epidemic).

-Two doctors for the whole hospital and outpatient referrals = Normal.
-One doctor for the hospital, feeding centre and >200 outpatients = Damn, not again (work overtime, take shortcuts, turn patients away, coerce a medical assistant to work their day off).

-Government officials delay arrival of staff by weeks = Normal (cover job by other staff, be patient).
-Our only nurse, midwife, lab technician and other doctor denied entry = only in Sudan (stretch staffing, trim activities, keep sweet-talking authorities).

Working here is a huge balancing act just trying to do the best within our limitations. I am frequently reminded that we can only do so much, we cannot save the world, and that without us there would be no access to health services at all. It is very true! But it can also be used as an excuse for the rich world neglecting their moral obligations to the less fortunate - a way of making ‘universal human rights’ selective and relative.

A Day in the Life (Part II)
Last letter I began to describe the nuts-and-bolts of daily life as a medical humanitarian aid worker. I left the story at the end of the hospital ward round, so will pick it up from there now.

…By the time the ward round is finished it is early afternoon. Usually I take a lunch break, but it is the fasting month of Ramadan now so I convince my translator to skip his break and promise we will finish up early. By now there is a line of patients waiting outside the doctor’s consultation room who have been referred by the medical assistants in the outpatient department for review. I admit a child with pneumonia, a man with hepatitis, and a woman with pyelonephritis. Another child comes with suspected appendicitis, so I arrange for him to be transferred by taxi to Zalengei hospital, 2 hours to the west. I lance a big boil on a boys leg, review a couple of nasty wounds, and find the other referred patients can be treated without needing admission.

After reviewing a few of the sick patients from the ward round I handover to the other doctor and collect together all the patient files to collate for the statistics. Today I am pleased to handover by 3:30pm (usually it is closer to 5pm) and get back to the office to start on the stats. As the expat doctor (the other 4 doctors are all Sudanese) it is my job to do the stats and medical reports (as well as organise medical education, look after staff health and supervise the hospital, nutrition program, outpatient department and mobile clinics). This is a time-consuming and mundane job, but I do get a geeky thrill out of seeing all the morbidity trends and looking out for epidemic trends. Maybe one day I will bore you with some of the results (-:

I try to get all this finished by 6, though today we have the end-of-week team meeting that stretches a bit later. This last week has been particularly busy as we are short-staffed and my big reports were all due. So I have been burning the midnight oil to push out a 75+ hour week (finishing each night in the dark as the generator switches itself off at midnight). This is certainly not something I plan to make a habit of! I promise myself no paperwork tonight and a full day of rest on Friday (our one-day weekend).

I return to the living quarters throw down my gear, have a wash and do some cooking (we have cook who prepares our evening meals, but I usually like to cook something extra myself). Sunset is around 7:30pm, and during Ramadan I have made a habit of joining the other non-local Sudanese staff (who live in the same compound as me) for the evening breaking of fast. We kick back, eat, drink tea and chat - I hear all about upcoming marriages, how life is away from family, which villages they are from, and what their plans in life are. It is always intriguing to hear common human aspirations and life experiences presented with their unique cultural and individual expressions.

By the time we finish chatting it is after 9pm and I am ready to wind down and go to bed. So after my evening exercises, reading and meditation I duck under my mosquito net and drift to sleep.

Profile: “Ali”
In response to my last email, a friend has asked me to tell the story of one person “so we can juxtapose their situation with our own”. He commented that many Americans/Australians/westerners want to “hide behind the notion that they are ‘middle-class’, not really wealthy, forgetting that they are fantastically wealthy in comparison with the majority of the people in the world”. Very true! So, in an attempt to personalise the experiences of Darfuris I offer the stories of some of the extraordinary ordinary people I have had the privilege to meet.

Ali Abdullah Musa, 35-year-old father of 6, husband, and my extremely talented translator (English/Arabic/Fur).

Ali grew up in a small village in west Darfur – a self-sufficient agricultural community who lived in simple mud huts without piped water, electricity or any other ‘modern’ amenities. After finishing school he worked as a teacher, got married, started a family and was planning to go on to university. In 2003 his village was pillaged by a group of armed militia he (and other IDPs) calls ‘Janjaweed’. While he and his family got away safely, many of his neighbours have never been seen again. They made their way to Niertiti as part of the first big influx of IDPs (internally displaced persons).

Ali is one of the most motivated, positive people I have met and tells me passionately of his future plans “when there is peace in Darfur”. Like the thousands of other IDPs he has had to put the past behind him to create a new life for his family here. However, unlike most of the other IDPs, he does not seek to forget this past and has written down his own story and recorded the stories of dozens of other IDPs (a growing manuscript that would make an absolutely fascinating book!).

In the 6 years since arriving here Ali has done so much for himself, his family and the community. His self-constructed ‘house’ now has three rooms, a separate cooking area, and a small courtyard that is full of pot-plants and a steady flow of visiting neighbours. This small, mud-brick, thatched roof hut is one of the most homey, welcoming houses I have ever been in. Water is collected from a hand-pump around 100 metres away, and they share a toilet facility with three neighbouring households. His salary goes to support both his household (wife, 6 children, mother-in-law) and assist his extended family and neighbours.

Ali started work with MSF (Medecins sans Frontieres) as a ‘Home Visitor’ when MSF first set up in Niertiti in 2004. [HV’s are the key link between the community and MSF, providing communication on security, health, environmental, logistical and cultural issues back and forth.] After doing this job for a few years he began acting as a translator and is undoubtedly the most fun and talented translator I have ever worked with. Employment with MSF has ensured Ali a secure income and given him a relatively comfortable life compared with most of the other IDPs. [Most IDPs depend on UN food handouts and self-employment (doing such things as collecting wood, making baskets) with most of the more profitable and skilled occupations dominated by the original Niertiti townspeople.]

Ali is a daily reminder for me of the human capacity to find hope and direction in the worst of circumstances. In many ways he is a poster-boy for what an intelligent and educated person can do in tough circumstances with motivation and a bit of luck (and yes he has been much luckier than many of the other IDPs here). It is also a good reminder of the capacity of the ‘poor’ to create a future for themselves - and how the ‘rich’ can play their part in helping them realise it.

Rich Africa
A friend reminded me by email of the richness of life in Africa – “a richness not defined in dollars, cents and possessions…”. It is a blessing to be working in such an environment (and without the unnecessary necessities of my car, house, mobile phone, career, shares, technology etc.). And perhaps it can also be a reminder to all of us about what is truly important and necessary in life.