Interview: Working with urgency in West Darfur, Sudan

Isabelle Defourny, MD, spent three months in the West Darfur region of Sudan with Médecins Sans Frontières (MSF). She worked initially as a physician in the program that was opened in the town of Zalingei, where nearly 40,000 displaced persons are gathered. Later, she took on the job of coordinating all MSF's programs in the city of El Genina. © stefanpleger@yahoo.com Click image for larger view "The principle is simple. Twice a week, the children come to the therapeutic feeding center (TFC). They are weighed and measured, nutritional aides confirm that they are eating the peanut butter (a therapeutic nutrient) distributed to them, they all see a medical assistant, and the most troubling cases are seen by a doctor, who may decide to hospitalize them. Otherwise, they remain at home, taking a ration of peanut butter with them until their next visit. In addition, we distribute a family survival ration to each child who comes for a medical visit." What did you do in El Genina? "Our general agreement with the Sudanese authorities regarding our overall activities in West Darfur provided for MSF to start up surgery again in the El Genina city hospital. When I arrived, the hospital was half-empty. People had to pay for medical care, which was not always of high quality, specifically around the lack of drugs. There was an armed guard stationed at the entrance to the hospital, and even visitors — who were absolutely necessary because the hospital did not provide patients with food — had to pay to enter. "I quickly realized that the urgent task was not so much to resume surgical activities as it was to drastically improve access to medical care for the displaced people. So we renegotiated our agreement with the authorities, adding management of the emergency and pediatric departments to the task of restoring the operating room. "It took a little time for that to happen because in spite of the improvements we made to the hospital, patients did not always come to see us. So we went to find them in the camps, where the horrible living conditions (precarious shelters, lack of drinking water and latrines, etc.) were conducive to the spread of disease. That is how we ended up caring for many malnourished children." How did you tackle malnutrition? "Over the course of barely 10 minutes during my visit to the Abuzar camp, set up in an El Genina school, I identified eight children suffering from severe malnutrition. I quickly referred them to the hospital. Then, word-of-mouth led families to bring their children to us on their own. At that point, our priority was to increase the hospital capacity. We set up two 80-square meter tents and several smaller ones, but also built two buildings, giving us 100 additional hospital beds. We very quickly had 80 hospitalized children. "But when Epicentre (an MSF affiliate that does epidemiological evaluations) conducted its survey, they estimated that there were between 500 and 1,000 severely malnourished children. To treat the children without hospitalizing them systematically, we set up outpatient feeding centers, as we have done in our other programs throughout Darfur. "The principle is simple. Twice a week, the children come to the therapeutic feeding center (TFC). They are weighed and measured, nutritional aides confirm that they are eating the peanut butter (a therapeutic nutrient) distributed to them, they all see a medical assistant, and the most troubling cases are seen by a doctor, who may decide to hospitalize them. Otherwise, they remain at home, taking a ration of peanut butter with them until their next visit. In addition, we distribute a family survival ration to each child who comes for a medical visit." What is the security situation? "The displaced people do not go out at night because it is too dangerous. During the day, the women have to leave in search of wood for cooking or additional food, but the violence is ongoing. Pro-government militias still control the outskirts of the camps and most of the rapes and violence occur during the day. "Violence is clearly always present, but it is difficult to quantify. Every week, when we see patients in Mornay, we see a dozen victims of violence, including two or three female rape victims and women with marks from whippings or blows to the ankle from a club. But we know for certain that not all the victims come to us."