I visited the shantytown here in Serif Umra, which is where approx two-thirds of the IDPs (Internally Displaced People) live.The others have makeshift reed tukuls in their resident relatives’ brick house back yard. The population in the town is 60,000. It's densely populated. The conditions are appalling, no real shelter, big families, overflowing latrines, and donkey and goat droppings in the living/cooking area. We came across a mother who had defaulted TFC (Therapeutic Feeding Centre) visit. When the home visitor asked her why she didn't come, she looked at him with such disdain, surveying her surroundings as if pleading with him to follow her eyes and telepathically revealing that she does not care when she has one malnourished child on her breast, five snotty malnourished desert roses as kids, one frail severely malnourished gran and a fat patriarch. The obvious blinding inequality and destitution turns my stomach.
Through our medical activities, we can witness a degradation of the nutritional status of the population. The conflict ensured that long-term prospects are grim, so I wait with bated breath for the moderates to flood soon. It is harvest season now, but that holds no hope for IDP's who only work on the farms but don't own the crops. Traditional livelihoods have been dismantled all over Darfur, and are currently being remodelled.I wait for the moderates as I watch school-less children and overly burdened women carry out all the labour that happens in this town. I know it means something that shiny tasty plumpy packet (plumpy nut). This week I sit in ATFC (Ambulatory Therapeutic Feeding Centre) and see the scared look on the baba, try to make her laugh but to no end. End of consult, perched on hip, she sees the shine of plumpy and smiles. So simple this moment that I melt. They don’t even make it 10 meters out of the dispensary gate when I find her cosy up in the enclave of her mom’s dress sitting in the sand in the sun eating her plumpy.
The dispensary consists a 27-bed in-patient department, ANC, ATFC (230 children in the program), out-patient department (between 4,000 and 5,000 consultations per month with three Medical assistants, which means 50 odd consultation per day per consultant). Half of all consultations are IDPs. An isolation unit with 3 rooms. The dispensary has no lab, no possibility for blood transfusions, there is no resuscitation unit, no thoracic drainage tube, no surgical scalpels, not a single piece of equipment for a surgical procedure.
It's true it's my choice to be here, alone – medically speaking, only doctor on call 24 hours a day and seven days a week. I should rest today, my one-day weekend. It's Friday, but I've been at the hospital looking after a sick child. I've decided today that I will work on training the national staff and together with my team find a strategy to motivate them, so that I don’t lose my mind. This is really the hard part.
I feel scared today after our referral car narrowly escaped the group of armed men on the road to Zalingei. I dream of hiding in my wash basket and in my bed I close my eyes, the mosquito net has a strange protective aura and for a second it allows me to fall asleep again. If there is fighting – I'm useless. I can't go the dispensary as it is about a 200m walk from the house. I can’t offer refuge to anyone in the compound. Access for our patients who need referral and surgery are my prime concern. It's just not safe. How do I possibly put our midwife in that car? How do I possibly put the pregnant women unaccompanied? What do I do when I just cannot send them?