Doctor Describes Scene in Darfur
MADELEINE BRAND, host:
This is DAY TO DAY. In Darfur, Sudan, despite a peace agreement the fighting and the deaths continue. I'm Madeleine Brand.
ALEX CHADWICK, host:
I'm Alex Chadwick. Two and a half million people have been forced from their homes. Hundreds of thousands of others have died in the last four years. No one knows how many of those deaths were from violence or from hunger and disease, in themselves results of that violence.
BRAND: Joining us now is Dr. Jill John-Kall. She is medical director of the International Medical Corps in Darfur. And she spent the past two and a half years treating patients there. Dr. John-Kall is here in our studios. Welcome to the program.
Dr. JILL JOHN-KALL (Medical Director, International Medical Corps): Thanks very much.
BRAND: Describe where you work. What does it look like?
Dr. JOHN-KALL: I'm based in a place called Nyala in South Darfur. Nyala is more of a city than you'd imagine. But we do have sites that our other teams are working in and those places are really remote. You're talking about sand, no roads, shelters that people are living in made out of local materials.
BRAND: And no hospitals out there?
Dr. JOHN-KALL: Depending on where you go. There are some sites where they have government hospitals. But when you say hospitals, they're definitely not like our hospitals here. They are very small, they're understaffed, they're underfunded, but they get the job done.
BRAND: So when you're out in the field talking to the people of Darfur, the people who are the recipients of your aid, what do they tell you that they need and what do you see firsthand when you're out there?
Dr. JOHN-KALL: I've seen a lot of really upsetting things, to tell you the truth. I recently went to one of our programs in Mukjar(ph), which is way out there, and we saw a little girl. She must have been maybe about two, but you can tell by her breathing that she was really sick. She could barely close her eyes all the way.
And as the day progressed, you know, a couple of hours later, another little boy came in. And his parents brought him in kind of almost unconscious because they said he fell from some height. And so I went to try to wake him up and he just wasn't waking up.
So finally we were pinching him and poking him and prodding him. And finally he started crying, and both myself and the other doctor were really relieved until we heard how he was crying, because he was barely crying. And then we listened to his chest and his chest was just filled with, you know, all kind of bacteria that was just - there's no air moving. And you know, we tried to give him some medicine to make him breathe a little bit better.
But both these kids kind of weighed on my mind for a while. In the back of my mind I thought, you know, it's going to be tough for them to survive. And sure enough, you know, within like an hour and a half of my being there, the little girl passed away. I went to the mother and I just sat there and I was just saying sorry, sorry, but that seems like such a weak thing to say when someone just lost her child, you know? I felt that we kind of disappointed her because she must have had so much hope when she came to our clinic. You know?
BRAND: Did you feel responsible?
Dr. JOHN-KALL: Yeah, to an extent I did. You kind of think, oh, if I just have this or if I just have that or if they had gotten here a little bit sooner. You know, I went back to the office and I started typing some stuff up and doing some administrative work and they called us back to the clinic because the little boy had passed away. That day was really hard for me because I thought, god, I just got here and we already lost like two kids.
BRAND: You know, when you think of a war zone, you think that the patients coming in to see doctors are suffering from traumatic injuries, bullet wounds, for example. But really what you're describing is something a little more, you know, I hate to use the word mundane, but everyday illnesses that become deadly.
Dr. JOHN-KALL: We do see some conflict injuries, but the majority of our patients, number one, they're women and children. And number two, as you said, they're everyday illnesses that we take for granted because, you know, if one of our kids have diarrhea, we just go to CVS and get something. But out there diarrhea is something that can actually kill a child, and then you have this vicious cycle that happens and it's very hard for them to recover.
BRAND: What are the biggest health problems?
Dr. JOHN-KALL: The biggest problems that we're seeing currently is the rates of malnutrition. They've been stable up till now, but in the recent couple of months we've seen kind of like an upswing. So we're really trying to get out there and do active case finding, which means that we're trying to get kids before they become severely malnourished to come in and get, you know, their adequate treatment and refer them to the proper places. In rainy season malaria is huge. Pneumonia is also a huge issue. Diarrheal diseases, all the time. And then we might have outbreaks of things like cholera or measles or something that we have to respond to very quickly before it really becomes like a whole epidemic.
BRAND: How many doctors are working with your organization?
Dr. JOHN-KALL: In Darfur we have about three expat doctors, but we have many more national doctors. I think we have about 10.
BRAND: So 13 doctors?
Dr. JOHN-KALL: Yup.
BRAND: That's it?
Dr. JOHN-KALL: Yeah. If you'll look at the overall situation in Darfur, there's just not enough doctors to go around. And the way the ministry of health set-up is, is that they kind of try to save their doctors for their hospitals. And in the rural communities what they do is they send out more medical assistants. And some have a pretty good knowledge of, you know, medical diseases and how to treat them, and some don't, and so it's our job to actually train those people because when the conflict is over, they will still be the ones to actually be out there in those rural areas.
BRAND: So when a doctor is out there in the field treating patients, what is a typical day like? How many patients does that doctor see? They must feel overwhelmed?
Dr. JOHN-KALL: Yeah, I can definitely agree with you there. Some of our clinics are seeing about 250 patients a day. We were working in a camp called al-Salaam(ph) in Darfur, and at the beginning of this year the population was about 4,000 or 5,000. And in the next like three to four months it went up to 35,000, and we had to learn how to very quickly respond to that. But our doctors did a great job. They sat there and they divided, okay, I'm going to see the women and children first. You're going to see the under-fives first because they're really vulnerable. And they made it work.
BRAND: So in a typical day, let's say you're out treating people; as you say, 200, 300 a day come to your clinic, can you describe what that's like?
Dr. JOHN-KALL: The typical scene would be kind of if you go out to the camps at about like 8:30 or 9:30 in the morning, the first thing you'll see right outside your clinic is just a massive amount of people. You can have like up to 200 people just sitting there and waiting. So our teams basically, they go in there. They start with triage to see who are the sickest people that they need to be seen first. When I used to see patients, it was really overwhelming. But what I learned to do is not look out into the waiting area because the crowd never gets smaller. So I learned how to focus on the person that's right in front of me and deal with them and just see them one by one by one.
BRAND: You're here in the States taking a break. When do you go back?
Dr. JOHN-KALL: Well, I'm actually taking a longer break than usual. I'm going to do a master's program in London for a year in tropical medicine and international health.
BRAND: And you're going back to Darfur?
Dr. JOHN-KALL: I will go back to wherever they need me.
BRAND: So this is your career; you're going from disaster zone to disaster zone.
Dr. JOHN-KALL: Yeah. I guess I could have had a much quieter career if I stayed home in New York, but this is the path I've chosen. And I don't regret it at all. You know, I'm happy.
BRAND: Well, Dr. Jill John-Kall, thank you for joining us.
Dr. JOHN-KALL: Thank you very much for having me.
BRAND: Dr. Jill John-Kall is medical director for International Medical Corps in Darfur, Sudan.