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FROM UGANDA Dr Tonia Marquardt is from Melbourne and is working as Medecins Sans Frontieres’ field doctor in the nutrition unit in Soroti, Uganda for 6 weeks. This is her fourth mission with the agency, following previous postings in Malawi, Abkhazia and Liberia. Just a quick update of life here in the field of Soroti, Uganda. Basically arrived to a bit of a nightmare. Mortality for the kids under the age of 5 years old was apparently 22 per 10000 per day (in other words about 10 times the emergency level). In our feeding centre we had 15 deaths in the week that I arrived. I am NOT used to the children I'm trying to treat dying like this and it was all a bit of a bad way to start. Basically the main problem was that a measles epidemic was about half way through and we were seeing all of the complications (pneumonia, severe croup, malnutrition, neverending diarrhoea and some of the worst stomatitis I ever want to see in my life!) The town was full of people who had been displaced over the months since June when the rebels started to attack them. In getting the history for the malnourished children as I admitted them I was overwhelmed by the number of times I heard that the father (i.e. breadwinner) had been killed during the attacks. Really incredibly depressing. These families consisted of about 10 children a mother and a grandmother left behind trying to manage as best they can.... Half the time they were missing out on the paltry one bag of rice and beans that was being handed out intermittently to some of the displaced people. In the evening the hospital grounds and streets of the town were full of people. They could all be seen walking into the town with possessions bundled up on their heads. They are mostly women and children, who head out during the day to try and get some wood and beg for food and now they are heading into the safety of the town’s streets to sleep at night. To add to the situation most of the people had taken over the school buildings and since then school has gone back, so there are school kids in uniforms running around everywhere mixed with these displaced people and there's increasing malnutrition at the same time! In the feeding centre the kids were the sickest I've seen, and really didn't respond to anything we gave them - strong antibiotics, strong antimalarials and still they couldn't breath and still their bodies were burning up! We have some oxygen now that helps a bit, but is getting a reputation amongst some of the women - they run away when we say their child needs oxygen because 'the oxygen is killing them', i.e. the survival rate of those in whom we use the oxygen is not good! Things are improving now! (dare I say I'm not sure they could have been worse) although a fair percent of the improvement is the population leaving the town to try and get home (?to get some food). The food distribution has improved and the measles epidemic is really slowing down. In the five weeks that I've been here we've admitted about 300 children with severe malnutrition to the feeding centre. For the measles we had about 100 cases in two weeks in the hospital (and these are only the severe cases - for total number throughout the town the estimate is between 500 and 1000). To be honest I would like all the "conscientious objectors to vaccination" to come and see the outcome of measles. It really is a medical nightmare that can be prevented by good vaccination coverage. December 2003
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