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FROM SUDAN New Zealander Jacqui Tong is currently working as Medical Coordinator in Darfur, West Sudan where a humanitarian crisis of enormous proportions is unfolding. Over a million civilians have been displaced by violent attacks on their villages and are living in overcrowded and insanitary refugee camps with minimal food. Médecins Sans Frontières' teams including 162 expatriate volunteers (including 11 Australians) and 2,000 local staff are working in 24 locations providing care for an area inhabited by 490,000 people. "The violence that has occurred in Dafur, North Sudan is yet another humanitarian crisis where images of despair flood our TV screens and provoke a sense of outrage against the injustices of the world. Secondary to this outrage is a feeling of powerlessness in the face of such great suffering. Until recently, Dafur was not on the radar screens of the media and was wilfully ignored by most members of the international community. It fell into the category of a ‘hidden’ war. The reasons for the gross violence, and why no one took notice until it was too late for many, are mixed and still under scrutiny. The net result has been a massive displacement of people and large loss of life to violence and disease. Médecins Sans Frontières' teams were working quietly from the end of last year and have witnessed some terrible abuses of human rights and assaults on the dignity of their fellow human beings. Although the violence has decreased, it is still there and people are too scarec to return to their villages. I have been sent as a Medical Field Coordinator to the town of El Geneina, the capital of West Dafur and close to the border of Chad. Scattered over West Dafur we have clinics, hospitals (classic field style – tents, plastic sheeting etc.), nutrition centres and a variety of other medical activities. The displaced population has swollen some towns and villages to five times their normal size. The infrastructure and local authorities have been pushed beyond their already impoverished means to cope. There are pockets of acute suffering, in the nutrition centres we have what is called a ‘Phase 1’ section. This is for the severely malnourished, the pitiful little skeletal images seen in the media. These children receive a specialised milk and other specialised food to beef them up – with plumpynut, a mixture of peanuts and other goodies that the kiddies love and BP5, a dry biscuit that is uninteresting but makes a good porridge when mixed with water. In the first stages it is a delicate operation, as you cannot over load their stressed little bodies. In our world they would be in an intensive care unit. In addition to the starvation, they all have some infections. The next step is into ‘Phase 2’; they have put on some weight and are more or less on the mend. The food situation here is not good, not at all. Despite the efforts of the UN agency, the World Food Program - WFP, the world’s largest procurer and transporter of food - there is a big gap between needs and availability. This is because of the rains (meaning we are on the alert for cholera, shigellosis a killer bloody diarrhoea and malaria will increase), the need for heavy logistics and a lack of money in their coffers to purchase food. Because of the displacement, the next year is crucial, as no one has planted for harvest. To give an indication of how serious it is, Médecins Sans Frontières is undertaking what is known as blanket feeding; meaning a weekly ration to all children under five years old. We only take this measure when the current and projected food supply is seen to be in serious shortfall. It is a preventative measure and coupled with the huge need for specialised food, a very expensive and logistically difficult operation. The emergency supplies come by plane, and follow on stock by ship in to Port Sudan, then by convoys of trucks through dreadful terrain (my last road trip had us digging out our vehicle from a river bed, then ten minutes later a swamp). Another challenge here is the outbreak, believed to be the world’s largest, of a unique variety of hepatitis – hepatitis E. It is ripping through the population and has experts scratching their heads as to what to do. It is self-limiting but has a high death rate in pregnant women (up to 20%) and requires not only a medical response but also a massive logistical one; that of water and sanitation. This means we have had to cover wells, chlorinate all water sources and to make sure garbage collection is done. We have also done large-scale soap distribution and health and hygiene education activities by mobilising a network of community health workers. Through the suffering and despair there are the small miracles. In a field hospital in a town called Kerenek, about 2 hours from El Geneina, a pregnant woman about to deliver came to the hospital. She was in a state of eclampsia – meaning she was having epileptic type fits and in danger of losing her life and that of the child. We don’t yet have the services in Kerenek for difficult deliveries so she was transferred by vehicle to El Geneina. Timing is crucial and along the way a tyre blew out and the trip was delayed. When she reached the hospital in El Geneina, she delivered twins (boy and girl) – then we heard a report she had died. She had captured the affection of the staff here and everyone felt an enourmous sense of loss. Three days later the news came that in fact she was alive and well! On my last trip to Kerenek we transported her, her babies and the proud grandmother back to the town. Our Sudanese doctor refused to believe she was alive until he saw her with his own eyes – her condition had been that critical. For her and others like her that death sentence was lifted by our medical activities. »
Watch › Jacqui Tong features in this BBC storyon the Hepatitis-E outbreak
in Darfur Aug 2004
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