To Leave

10th September. Day off. I had been in Darfur for nearly two weeks. A sacrifice to pay for working in surroundings with a security problem was to give up freedom. I spent practically the whole day inside the compound. The sun was nice. I spent time reading an autobiography left behind by previous expats on the Rwanda genocide. Thank heaven there was no emergency call on either the radio or the Satellite phone. Everyone could have a good rest. Not until the late afternoon did some of us decide to go out and watch the African sunset. We drove to a small hill just behind the Riyad refugee camp. Over the hill was a valley, where there was a big piece of land with green pasture. There was some farming activity over there. We saw people riding donkeys or on foot, coming back from a day of work somewhere else, fetching water, collecting firewood, etc. At last, the sun completely disappeared over the horizon. I was thinking, that's where Chad is. To the west of Sudan. That's where Sudanese people ran for their life during the genocide last year. Next evening was not very quite. I heard "boom boom". It was a quarter to two and I woke up. Soon I realized they were gunshots. It was my first time to hear gunshots in real life. Then two more shots followed. The noise came from very close to the compound. I was indeed a bit scared. Should I stay in my room or should I go outside and look? What should I do if someone tried to break into my room? I could hear the footsteps of the watchman checking around our compound. After 15 minutes of quietness, the adrenaline in my body dropped and I fell back asleep. The morning came and I felt safe again. When I excitedly shared my experience of the gunshots last night with other people, they all appeared very calm and normal. "It happens every night," they said. Had I really slept so well every night, not hearing the gunshots at all until last night? I went to the hospital to see the patient with intestinal obstruction who had been sent from Habila four days before. I had suspected that the worm infestation was the cause of intestinal obstruction. But a mass in his right lower abdomen could be felt when I palpated his abdomen. Now, four days had passed. He had not improved. He would need surgery. But again the old problem occurred; there was no blood donor. His sons, whose blood groups did not match, visited relatives in El Geneina asking for help but nobody came to the Hospital for a blood test. Time flied and it had been nearly a month. My work in Darfur came to an end. Indeed, it may take six months, one year or even longer to improve the situation here. It is surely not something that I can accomplish only on my own. Take malaria and tuberculosis as example. These were very common diseases in this locality. Most people have at least suffered from malaria once in their life. The population know that malaria exists, but sometimes do not seek treatment until too late, or inappropriate treatment is given by local doctors. For example, malaria-resistant drugs are given, or an inappropriate dose of the drug is used. Crowded living environment, poor sanitation and malnutrition are factors contributing to TB. The Sudanese Government hada national program for TB, but very often because of deficient infrastructure and lack of drug supply, the program was not implemented to its fullest ability. Another disease MSF suspected of having potential to cause significant public health concern is HIV. Traditional culture allows men to have multiple wives. Increasing evidence supports the presence of sexual gender-based violence in the community. Judging by the cases of sexually transmitted disease we saw in the Women's Health Clinic, we believed that there was a certain prevalence of HIV. However the population was not very aware of the infection. Therefore, I tried to develop some basic training on these diseases for our Women's Health Educators (WHE). These WHE were residents in the camp who would visit their neighbours and provide health education during casual conversation. My objective in the training would be on the cause, transmission, treatment and prevention of diseases. Hopefully by raising awareness in the community about malaria, TB and HIV the population will pay more attention to preventing the diseases and present earlier to the health facilities should they come down with any signs of infection. During the time I spent in Darfur, what most impressed me was the locals' attitude towards death. I still remember the pregnant woman with anemia. She passed away two days after being sent to El Geneina hospital. There were no cries of anguish from the patient's family. There was only weeping from her husband. To the locals, death is not something that they can avoid. Have they ever thought of alternatives? Or do they know there can be one? It seems that they are always ready to accept death. After all, there is a lack of resources, manpower and medical equipment. A patient may not have a slim chance of survival even if he is sent to hospital. Very often, nothing can be done there. In the morning I left El Geneina, when I was waiting for the driver, we got three different calls saying that they had patients to be sent to El Geneina hospital. One of the patients from Kerenck had gun wound. Would he end up in the same way as those patients I met in the past three weeks that, though he is sent to hospital, still may not escape his fate? Jumping into the jeep, we headed for the airport. In El Geneina, dressing fashionably is a luxury. Similar to most of the expats, I wore flip-flops and walked on the yellow earth everyday. Putting my chapped feet into a pair of comfortable shoes, the feeling was a little bit strange. Like it will feel to be back from this forgotten country to a bustling city. Arthur

Dr Arthur PANG obtained his first degree in Biochemistry in Canada in 1991 and graduated from Faculty of Medicine of University of Hong Kong in 1998. He started his first mission with MSF in December on an HIV/AIDS project in Xiangfan, Hubei, China. In August 2005, he packed again and left for another mission in Darfur, Sudan.