The neglected population

In Darfur, the day started early, with everyone getting up around 07:00. People were supposed to finish work at 16:00, but most of the expats worked in the office until the night began to set in. By the time we got back to the compound, it was already 19:00. There was no TV, no English channel on the radio, no internet. We spent the evening creating "lavish" dishes for supper, given the limited varieties of food available in the local market. We mostly had rice, potato and bread as carbohydrate supplies. Spaghetti was possible in some local shops. For meat, it was mostly chicken and beef. The chicken was very thin and skinny, so you could tell that the eggs were also very small. There was not much green vegetation available. Tomato and eggplants were the regular choice. Over tea and coffee after dinner, we shared with each other about our previous missions, people we met or worked with on different missions and the offices. The most common phenomenon in MSF was that there was always someone you knew, that someone else from another part of the world also knew. It gave you this feeling of a tight network and the sense of a big family. Other topics included foods that we really wanted to eat now in the field, romance and gossip. Inevitably we would end up talking about work in the office, patients in the clinic and the hospital. Some went to bed early, as it had been a long day of work. Some enjoyed the evening of insects hissing and the cool air after the generator's switched off, relaxing in the dark. There was a curfew in El Geneina due to security reasons. For MSF, from 21:00 to 06:00 the brick walls with no movement possible outside surrounded us. Watchmen working in shifts guarded the compound 24 hours a day, without firearms. And another day began. The MSF Clinic was located just outside the Riyad refugee camp. Riyad camp had a population about 12,000. People lived in shelters built of straw and plastic on muddy land. We used the same materials to build the Clinic, except we also used wood and bamboo. Since a lot of other NGOs were also providing medical services in the area, MSF clinic had shifted its focus to providing health care to women, the forgotten population. Given the predominantly Islamic background of Sudan, men were allowed to have many wives. Local women enjoyed a social status barely comparable to men in this society. Additionally, many women and their children in the camp were the only survivors of many households. Most men and older boys had been killed during the violent attacks. 1st September, the second day after I'd arrived. We received a call from Habila. There was this female patient, 30 years old, presented with anemia. She had a haemoglobin of 3.3, with shortness of breath and low blood pressure. There was no doctor in Habila at that moment. So over the satellite phone I tried to assess the patient's condition from the information given by the nurse. She did not have any active bleeding. There was mild ankle swelling. She was probably suffering from heart failure due to severe anemia. The cause of her anemia was still not yet known. After discussing with the field coordinator and the logistician, we decided to transfer this emergency patient to El Geneina the next day. Because of the long journey and for security reason, car movements needed to start at 07:00. Any patients from the El Geneina, Kerenek and Habila projects requiring secondary care would be referred to the El Geneina Hospital. MSF cars would transport them. If they were fortunate enough to be discharged, MSF would again provide transportation to take them back to their home towns. These car movements were major operations for our logistics team. Given the road conditions and uncertain security, cars had to travel in convoy and performed a 'kiss' movement. A kiss movement meant El Geneina sent 2 cars to meet the other 2 cars from either Kerenek or Habila. As the cars met in the middle of the journey, the passengers were exchanged and the drivers went back to their starting points with the same cars. Also, the people involved were not just the drivers and patients, but also included caretakers and medical personnel. So the next day our car movements began at dawn. Things were running smoothly until the afternoon. We received a report that there was a violent attack on the road between Habila and El Geneina. All of a sudden our alert was stepped up and the whole team discussed a contingency plan. Finally we decided to abort the kiss movement and send the patient to a medical establishment of another NGO at a nearer location. The next day, early morning began with an assessment of the safety of the road. We gave the green light to our patient from Habila to continue on another two-hour journey to El Geneina. In the afternoon, the convoy informed us by radio that they were entering El Geneina, so I went to the EG Hospital to receive her. I waited at the Emergency Department. It was nothing like the Accident and Emergency Department in Hong Kong. There were long queues of patients waiting outside. Some were moaning in pain, others with various wounds over their bodies with flies enjoying a meal in the wounds. There was no lighting, no wheelchairs, no stretchers, no oxygen, and no dressing sets. There was no doctor to be seen anywhere. Of course the doctors did not carry pagers. Finally the Habila anemic woman arrived. Her general condition was very bad. She was very pale and was breathing with great difficulty. I tried to locate the receiving doctor. A nurse went to his house nearby the hospital to find him. After 20 minutes he arrived. After looking at the patient briefly he admitted her. When I tried to discuss with him about the patient, he simply said he would run some tests for her. No discussion allowed. I left feeling a bit lost, thinking what I would have done for this woman if she were in a hospital in Hong Kong. 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.