Part 2 of 2: What our clinic treats every day in Darfur
A two-part series with Dr. Matthias Hrubey, an MSF volunteer from Germany working in Darfur, Sudan.
Part 1 can be read here: MSF establishes first medical care for thousands in Darfur village, Sudan
On a typical day, I get up at seven to be in the clinic at eight o'clock to take care of some administrative duties and then begin doing consultations right away. Now we are usually seeing about 150-180 patients per day. If I do only consultations all day, I see about 70 patients myself, but now with the observation area I also see the very ill emergency patients who come in. Usually we work straight through until five or six in the evening. Only this week did we start to have the time to take a short lunch break which was just not possible before.
"We treat a range of problems from aches and pains to really life-threatening conditions. The most common ailments we see are diarrhea, respiratory infections, and also a lot of stress-related diseases like gastritis. There are also a lot of old wounds, skin infections that have gone untreated, as well as chronic illnesses that have never been treated.
"Today a little boy came in who was severely anemic and in such great pain he could barely sit on the bench in the consultation room. His mother told us that he had suffered from severe attacks of pain that lasted from three days to a week several times a year. I believe that he has sickle-cell anemia.
"In Germany, a child in this condition would go straight into intensive care in a hospital and be given a blood transfusion and special medicines to reduce his pain and build up his blood. But here all we can do his see him for ten minutes, give him some medicine to get him through this attack and then send him back home again. Maybe we will see him again, maybe not. His mother told us this was the first time he had ever received any treatment for his pain.
I know from my past experience in Sierra Leone that, in three or four days, they can be very normal children again, playing and eating. But if you did not treat them, they would have a high chance of developing cerebral malaria and dying in a few days.
"Now that the rainy season is ending, we are seeing more and more cases of malaria. There are sometimes children who have been waiting outside in the line who we can pick out when we do our screening because they have a high fever and diarrhea and are very sick. Often they cannot breastfeed or eat any more. We do a quick test and, in ten minutes, we can tell if they are positive for malaria or not and start them on an effective treatment immediately. I know from my past experience in Sierra Leone that, in three or four days, they can be very normal children again, playing and eating. But if you did not treat them, they would have a high chance of developing cerebral malaria and dying in a few days.
"From what people tell us, the biggest challenge for people at the moment is that they still feel very insecure and don't know what will happen tomorrow or even next week. This really puts a lot of stress on them. Our feeding programs and the general food distributions have at least improved the food situation a bit. But, knowing that everyone is fully dependent on outside food and assistance, it is hard to tell what is going to happen. And the situation is still very fragile. The hygienic conditions are also still very poor although we have managed to make some improvements by building latrines and setting up safe water points. But it is still very basic.
"It is sometimes difficult to tell what is troubling a patient because of the cultural differences in the way people here express their feelings, but in addition to many severe medical problems, I think we are also seeing a lot of health problems and complaints that are related to the stress that people are under. People are extremely worried and often depressed about what will happen to them in the future and I believe that this can really affect their health.
It is very sad to see that often the atmosphere is quite depressed and you hear only from stories that people tell us of how it was before the war; how they liked to sing and dance. But at the moment there is nobody singing or dancing.
"Without a translator it would be very hard to do a good job because I didn't speak any Arabic at all when I arrived here. And then there are many people who only speak the tribal language Fur. I have picked up enough words of Arabic to do a basic consultation, but I would still be at a real loss without a translator.
"Right now I have a very good one. He lives in Khartoum, but his family is originally from Darfur. When he heard the news about what was happening in Darfur, he decided that he wanted to come here and help and that is how he ended up with MSF. We have a great rapport and he is totally dedicated to the work we are doing. He tells me every day how important it is that we are here.
"People really appreciate MSF being here. Many people tell us that this is the first time that they have been able to see a qualified doctor and receive treatment without regard to their origin or ability to pay. They also feel very strongly that our being here is important for their security. A lot of people have told me that they don't know what might happen to them if we were not here and there were no international witnesses to what they are going through.
"The people here are extremely friendly and very open, so it is very nice to work with them. It is very sad to see that often the atmosphere is quite depressed and you hear only from stories that people tell us of how it was before the war; how they liked to sing and dance. But at the moment there is nobody singing or dancing. But when people open up a bit to you, you can feel how lively they would be if they didn't have so many worries.
"At the moment I am living in the pharmacy with about 30 boxes of medicines and sharing a room with a visitor and some mice. It is quite difficult because you really lack any privacy and you cannot find a place where you can just sit in quiet. At the beginning it was big problem to find food in the market and every day we ate the same thing and were even eating high-energy nutritional biscuits from the feeding center when we were really busy. But we've been improving the living conditions little by little.
"My original plan was to stay here for six months until the beginning of January, but I might extend for a couple of months. When you build up something from the beginning, it is especially hard to leave it. The work is very interesting and although it can be very frustrating at times, it is also very motivating. You can see everyday that it makes a real difference that MSF is here.