Treatment from the governor to the poorest beggar

Russian doctor returns from an MSF mission in Somalia
Kirill Kozhemyakin could have followed a path others had chosen for him and entered the High KGB School in St. Petersburg. But instead he opted for a degree as a general practitioner from the Medical Academy in Moscow. Kirill then took a rare career decision: after his residency at the Sklifosovsky Institute for Trauma, where he gained experience in intensive care, burn trauma and plastic surgery, he joined Médecins Sans Frontières to offer basic medical care to thousands of homeless people in Russia's capital. Inspired by the tales of other MSF volunteers who had returned from Africa, he jumped on an MSF offer last summer to work there. He recently spent six months in Huddur, a village in the heart of Somalia, where he says kids would run after him screaming "Gala! Gala!" (white man). Now the Russian doctor is back among the homeless in Moscow, who all know him by his first name. At the end of a typical day with 50 medical consultations, Kirill emerged from the examination room to recount some of his recent experiences in Somalia. First help in 15 years Interview with Kirill Kozhemyakin "Somalia is a real conflict zone. The territory is controlled by various clans, which often clash with each other. I was in a more or less calm area, and I only saw a few patients with bullet wounds. But what really affected me were the children in Huddur. It was awful to see how they suffered from dehydration, tuberculosis, kala-azar and many other diseases.
  "It was so interesting and exciting for the people of Huddur that half of the village came to the surgery room just to see how we worked."
"There hasn't been any adequate medical assistance in the village of Huddur for 15 years. All the local doctors left because of the civil war and the terrible poverty. I was the only doctor for a village of about 4,000 inhabitants - and there was no hospital to refer patients to. I treated all the inhabitants of Huddur, from the governor to the poorest beggar. I was on duty 24 hours (a day) and had about 100 patients each day. It was a huge responsibility. I had to be a surgeon, a therapist, an epidemiologist, a lab technician, a psychiatrist, a dentist, a traumatologist, a gynaecologist, a paediatrician - all in one. "We found a building, rehabilitated it, and turned it into a medical centre with one room for basic health care and another for children, most of them needing treatment for dehydration. It was so interesting and exciting for the people of Huddur that half of the village came to the surgery room just to see how we worked." Diseases - real and fake "The most urgent need in Somalia now is to provide training for the medical staff. I gave some lectures but the educational level is very poor and they need to learn the basics. Before MSF arrived there was only a single medical worker - a pharmacist - for the whole village, but he did not prescribe proper treatment and took advantage of the Somalis' belief that injections will cure any skin problem. "I was amazed by how many patients came up to me asking for injections against 'essefilito', which means syphilis. They all had official medical certificates showing a positive reaction to syphilis, though most of them didn't have the disease. I inquired and found out the popular diagnosis came from the pharmacist who sold the 'essefilito' certificates for $10 each. I refused to give the injections and used only MSF diagnostic methods.
  "There were so many kala-azar cases that we opened a special clinic for the patients."
"With the children, for a long time I couldn't understand what was going on. I suspected kala-azar, which is a terrible, fatal disease, transmitted by the yellow fly, that destroys the liver and spleen. Anaemia develops and the immune system is destroyed. I did blood tests and sent them to the laboratory in Nairobi. The results were positive. I was the first to diagnose kala-azar in Huddur. We started treating the disease and decreased the mortality rate. There were so many kala-azar cases that we opened a special clinic for the patients. "We saved many lives. There were so many patients that needed help that I had to be tough with those who were simulating or exaggerating their sickness. One of our patients, for example, had been pretending for years to be in a coma. To check if it was real, I performed a simple trick: I lifted his hand and dropped it over his face. If the person is really in a coma the hand will hit the face. It didn't, so I told him that the show was over and sent him home. "I remember one boy who had gangrene and tetanus. His hand was extremely skinny and an amputation was the only way to save his life. But, according to local customs, before such a procedure you must wait to receive permission from the relatives of the patient or from the head of the local clan. While we waited for this permission the boy died. It was hard to work with such customs. "Sometimes the villagers asked for money because we were treating them. I was really angry when they asked us for money while we were giving them vaccinations. They didn't understand that these vaccinations saved their lives, they didn't perceive the danger. Mothers of children with kala-azar - which is fatal if left untreated - just would not bring their kids (to us). They believe that if a person dies, that is 'inshallah' - it is the will of Allah. Such beliefs can be destructive, but sometimes they can also help with life's struggles. I learned some quotes from the Koran and the villagers were quite impressed. By the end of my mission I was beginning to understand Somali." Russia, Somalia, and Monte Carlo
  "In Huddur, when I left the medical centre, I was greeted by the sun, the wonderful smell of flowers, huge fields and smiles. I have no idea why the people of Somalia look so satisfied and happy, though their lives are so difficult."
"We had homeless patients in Somalia as well. One 11-year old boy, Mohamed, lost his parents when he was six. He was a professional beggar. It is so hard to be a beggar in such places, where the people are so poor. He had skin TB and we treated him. We let him stay in the medical centre and he became a member of the MSF family and helped the staff. Once I asked him if he had a dream. He answered: 'I want to have a lot of money and buy a big house and farm'. I asked him what he would do if he were rich and little beggars came up to him for food. Mohamed said: 'I will invite all the beggars to live in my house!' "When I told Somalis that I am from Russia, most of them didn't know where it was. They knew nothing about this country. But I explained to them that the village hospital, which is now destroyed, was built by Russians many years ago - probably in the 60s or 70s. I don't know exactly. "One day I ran into an old person who was providing basic medical assistance to the villagers. I noticed something extremely familiar in the way he worked. Suddenly I understood that he bandaged and treated wounds the same way I did. When I asked him where he had his medical training, he said that Russian doctors in Somalia had passed the knowledge on to him many years ago. He had remembered what they had taught him and used it to save many lives. "Now that I am back in Moscow, when I get off from work and go into the streets it is cold, and snowy. When I take the metro I see hundreds of bitter faces. In Huddur, when I left the medical centre, I was greeted by the sun, the wonderful smell of flowers, huge fields and smiles. I have no idea why the people of Somalia look so satisfied and happy, though their lives are so difficult. I suppose it is just a different attitude. Somalis survive mainly from farming and trading. They eat corn meal, pasta, or rice and live in deep poverty, but they are still joyful. "When I was in Huddur, my homeless patients in Moscow knew I had left and they asked about me. I have no idea why, but they are convinced that I was in Monte Carlo. I guess for most of them Somalia and Monte Carlo are both unknown, mysterious places."

Kirill is now eyeing the world map and looking forward to working as a doctor on another MSF mission, in another "unknown, mysterious" place. He would like to leave with his new wife, Carolina, an MSF logistician from Belgium whom he met in Somalia, and married on the Seashell Island.