Refugee camp coordination meeting

7th September. The sky tonight was clear enough. The new moon was shining upon us and I was finally able to see the starry sky of Darfur. Insects love light. Therefore, after supper we usually lit candles instead of turning on the light bulbs powered by generator. I was looking at the candle flame. The candle burned very quickly. The flame was very bright in the beginning and it slowly became weak and died out. I was contemplating its similarity to the life of a human being. At that moment I was thinking also of my mother. Then the Satellite phone rang. The expat doctor, who is a surgeon, called from Habila. They had a 50-year-old man presented with intestinal obstruction. So the phone was passed to me. I discussed with him the condition of the patient, whether there was any immediate life-threatening emergency, whether he would survive the 5-hour journey on the road to EG, and also the possible benefit to him of any surgical intervention. To initiate any car movement we would not only consider the medical condition of the patient, but also any recent events on the road contributing to the safety of our journey plus logistician support arranging drivers and cars. All these factors would have bearing on the decision. So we decided to continue conservative management of his intestinal obstruction. Meanwhile the logistician would plan a car movement. The Habila doctor and I agreed to talk again early next morning and make a final decision on transfer. But the surgeons at the hospital would not carry out any surgery without having reserved blood. As I mentioned before, owing to the belief that blood is life, local people are very reluctant to donate blood. So there was still a chance that even if the patient were transferred to El Geneina, no surgical intervention would be carried out due to lack of a blood donor. So far, the blood groups of the patient's sons had not yet matched. I didn't sleep too well this night, because I was anticipating a job early next morning. At 06:30, when the sky was still completely dark, I picked up the Satellite phone and was ready to call Habila. Our logisticians were up even earlier to prepare the cars for the anticipated movement. No blood donor yet, but transferral of this patient was agreed upon. Here in El Geneina, we were expecting this patient to arrive in the afternoon. So I went to the refugee camp coordination meeting, which took up most of the remaining of morning. It was the first time the population met with all the NGOs working for them at the camp. Different NGOs had different responsibilities. For example, some were in charge of providing health care, some water and sanitation, some children care, some elderly care, some with their focus on women. The population was divided into big households and each house was represented by a sheik. There were at least 20 sheiks attending the meeting, most of them wearing traditional Arabic outfits. The meeting was carried out in a straw shelter, rattan mats were placed on sandy ground and everyone was sitting on the mats. All NGOs had a chance to present their latest activities in and utmost concerns for the camp. In turn the sheiks voiced their problems living in the camp. Their problems included violence and attacks inside the camp, particularly by people coming from outside of the camp. Some women in the camp, in order to make ends meet, brewed alcohol at home and sold it for money. This attracted people from outside, and when people became drunk, physical assault or even sexual violence resulted. There was minimal control in the camp by the police. Therefore once it became dark the camp was a dangerous place to be. Women concerned groups responded by trying to organize other income-generating activities. Another problem was lack of 24-hour medical service in the camp. It took about 20 minutes by car, which most people did not have, to travel from the camp to the local EG hospital. The medical institutions serving the camp had been trying to apply for permits to travel to the camp after the official curfew but so far the answer was still no, due to security reasons. This discussion was heated because there was a representative from the Government attending the meeting. Anyway, the medical NGOs still had to lobby on getting a 24-hour permit. In the afternoon, the Habila patient with intestinal obstruction arrived. He had been put on a nasogastric tube. A lot of bile was coming out. He had taken nothing by mouth and had an IV fluid in place. I supposed due to the bumpy road journey, that on the way he had passed a large amount of stool with numerous worms. So I considered that worm infestation was possibly the cause of his intestinal obstruction. But on palpating his abdomen a mass could be felt in his right lower abdomen. What could this be? Well, at least he had arrived without danger and let's see from there. 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.