Disease and Disaster

Hearing Hawa’s and Ibrahim’s words and seeing Tawila for myself infuriated me, but as an aid worker, I was required to at least maintain the appearance of neutrality. There wasn’t really time to linger over their stories or the ongoing tragedies, or let my anger boil over. There was too much to do. The health of these people was precarious at best. Most were in some stage of chronic or acute malnutrition. Few would likely survive even a minor illness. Their bodies hadn’t the strength to fight off respiratory infections or diarrhea; they needed medical care, immunizations, nutritional screening, access to clean water, sanitation facilities, and a roof over their heads, even if only a plastic one, to protect them from the harsh rays of the sun and the coming rains.

Sudan’s Federal Humanitarian Aid Commission (HAC) decided to move the ever-increasing population of IDPs from the poorly equipped Al Mashtel site to a new, but even more desolate, site called Abu-Shok, on the outskirts of Al Fasher. Adam was involved in designing shelters for the new camp. I would be involved in setting up a health system for the new camp, since it had been decided among the involved NGOs here that IRC would take the lead in health in Abu-Shok.

The endless meetings I’d so dreaded in Khartoum had paid off. I already had a complete pharmacy, supplied by UNICEF, with enough essential drugs to last us about six months. We also had reproductive health equipment, supplied by the UNFPA, and basic clinic equipment, courtesy of WHO, so that we could establish services without delay.

We had many health concerns for this vulnerable community. First among those was the potential for, and intermittent reports of, a measles outbreak in Al Mashtel. Although hard to believe, measles was and continues to be a scourge causing hundreds of thousands of deaths among displaced, dispossessed, and refugee children.¹ It was still the leading cause of childhood death from vaccine-preventable disease around the world. Due to the IDPs’ already precarious health, the spread of measles in a refugee setting is perilously swift and often deadly, not unlike throwing a lit match onto dry brush in a forest.

This region was also part of Africa’s “meningitis belt,” where every year an outbreak of the deadly infection occurs, whose swift spread can be readily prevented or halted with vaccines. Meningitis season was just around the corner; it consumes the summer months when rains make access to health care near impossible. UNICEF had a supply of meningitis vaccine but not enough to cover the region.² Rationing vaccines and ultimately health care was an issue that faced us if more was not made available in time.

And still there was more. Polio, a waterborne disease that usually infects young children, attacks the nervous system, causing paralysis, muscular atrophy, deformity, and sometimes death. It was reemerging, according to WHO.³ Although previously eradicated in Darfur, recent conditions and lack of vaccination campaigns had allowed the devastating disease to reemerge and attack the most vulnerable of the population here.

Aside from the vaccine-preventable diseases, there were other worrisome ailments here in this region. Dysentery, malaria, leprosy, leishmaniasis, guinea worms, river blindness—the list was endless, but most were familiar to me now; long gone was any anxiety on my part when I encountered those diseases. Others, though, would require my full attention. River blindness, another form of filariasis—which results in filariae—the migrating worms I had seen at Kakuma, the refugee camp in Kenya—is transmitted through the bite of an infected fly or mosquito and can cause blindness. It is most commonly found near rivers in Africa where the Simulium fly breeds, hence the name river blindness. There was treatment available, but the government of Sudan controlled that drug supply.

Guinea worms are another form of filariae, although guinea worms are the largest of this species, and the females can actually grow to three feet in length. Guinea worms are contracted by ingesting them, usually in contaminated freshwater. Once they are in the stomach, digestive juices release the infected larvae into the body, where they mature. The presence of female larvae in the human body provokes an allergic and inflammatory response, forcing the worms to break through the skin. They are most commonly seen on the legs but can emerge from any site, including genitalia, arms, and breasts. There are multiple complications, including systemic infection, but they can also emerge without fanfare and fuss, causing only aesthetic distress. There is both drug treatment, which is readily available, and the alternative treatment of making small incisions over larvae sites to allow the worms to migrate out, which is what we had done for filariasis in Kakuma.

Leprosy is another disease indigenous to Sudan. Transmission is insidious and swift—it can be passed by breathing in the droplets of an infected person’s sneeze. As easily as it can spread, few people actually develop the disease. There are several diverse strains of leprosy, each with multiple presentations and symptoms. I only knew that if I thought I was seeing leprosy, I would refer the patient to a center capable of making the appropriate diagnosis.

For now, simpler, more ordinary diseases were our primary concern. Health data revealed that diarrhea, respiratory infections, malaria, and eye infections were the commonest complaints. These seemingly simple diseases could easily prove fatal to this already vulnerable, debilitated population. Access to quality health care and medicines was the remedy, and we were designing our health programs to respond to that need.

Aside from designing the programs, we literally had to design and then construct clinics in the new camp. They would need to be functional in this austere desert environment, and they would have to be erected quickly, literally within days. We had neither staff nor materials to get it done, but fate was with us. One morning, a jovial, potbellied, laughing German arrived at our door and volunteered to help.

Viktor was an amiable fellow who seemed able to do most everything. He sat down and, in a heavy German accent, asked what I needed to run the clinic. He then made some architectural-grade drawings and proceeded to incorporate all of my needs into a simple reed-and-steel structure. He and Adam arranged to purchase the materials, and they hired local workers to build it. Henry supervised and then joined the crew to guarantee the project’s swift completion. In just forty-eight hours, we had a beautiful reed structure, functional, sturdy, and ready to use, but although we had medicines and equipment, we needed staff—local doctors and nurses to staff our clinics. Other NGOs and even Adam, a sudden pessimist, said we would never get staff; I disagreed. I knew we could find well-trained staff to join us. I went to the Ministry of Health (MoH) in Al Fasher with my wish list, the number of doctors and nurses and support staff I was looking for. We were, to everyone’s surprise but mine, inundated with applications and crudely written resumes.