Next stop: South Sudan

I will be leaving Mali sometime in the next 2 weeks, once my replacement arrives and we can do a handover, going to South Sudan.  Here is another MSF press release, this one concerning my new assignment:

South Sudan: health deteriorates in Yida camp

Date Published: 13/07/2012 03:29
Close to 500 people a day are crossing the border from Sudan and arriving at Yida camp in neighbouring South Sudan. The United Nations High Commission for Refugees (UNHCR) reports a total of 63,500 refugees in an already overcrowded camp originally intended for 15,000 people.

Having walked for days, and sometimes weeks, across the Nuba Mountains fleeing conflict and food insecurity in South Kordofan in neighbouring Sudan, the refugees arrive in extremely poor health.

Hospital mortality
“Most of our patients are in shock, and hospital mortality is going up as the camp’s population increases,” explains Dr Mego Terzian MSF emergency desk manager.
“Given the sheer number of patients, we have to focus our attention on those whose lives are at risk and children suffering from diarrhoea, severe infections and malnutrition.”
The majority of patients in the MSF-run hospital are children under five years old. The number of children admitted has doubled over the past month, increasing from 104 to 209.

Malnourishment

The percentage of malnourished children seen in consultations has also gone up and hospital mortality has more than doubled in a month from 7% to 15%, mainly due to diarrhoea and severe infections, including pneumonia. MSF teams are doing their utmost to help parents recognise the symptoms that call for a child to be brought to hospital as quickly as possible.
The number of people in Yida has more than tripled since April 2012. The rains have already started and the water and sanitation supply are simply insufficient. Despite the efforts of the organisations working in the camp, reception and living conditions for the 63,500 refugees are utterly inadequate.

Waterborne diseases

“The majority of consultations in MSF’s medical facilities are for waterborne diseases that could be contained if there were enough latrines and adequate access to drinking water,” explains André Heller-Perrache, MSF Head of Mission in South Sudan.
To respond to the ever-increasing needs, MSF, the main medical organisation in the camp, has stepped up its activities by increasing hospital capacity to 60 beds in three additional tents in the hospital. MSF is also reinforcing its team of already 80 people.

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MSF in South Sudan

MSF has been working in Yida in South Sudan's Unity State since November 2011. It runs a hospital in the refugee camp and a consultations service, as well as providing medical care at the camp registration point. In June, MSF vaccinated over 14,000 children under 15 against measles and continues to vaccinate children aged from six months to five years at the camp registration point. Other MSF teams provide assistance to Sudanese refugees in Upper Nile State.

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Mali: MSF maintains its presence in Timbuktu

This is a press release issued yesterday by MSF to Agence France-Presse, concerning the project on which I am working:

Date Published: 12/07/2012 10:15
A Médecins Sans Frontières/Doctors Without Borders (MSF) team is providing health care in Timbuktu despite the destabilising, ongoing violence in the north of the country which has displaced thousands in recent months.
Since the beginning of April, Timbuktu has been in the hands of Tuareg rebels and armed Islamist groups. The city is the scene of pillaging and has rapidly lost a large share of its population: two-thirds of its approximately 40,000 inhabitants have fled toward other regions of Mali, or to neighbouring countries.

Health centres pillaged

An armed rebellion took hold of northern Mali in early 2012, leading to the displacement of large groups of people. © Foura Sassou Madi/MSF

In the surrounding villages, some health centres have been pillaged. Since then, a latent tension has pervaded the city. Sporadic fighting has flared up among armed groups and, recently, sacred sites around the city have been destroyed.
“Bringing aid to this destabilised region is a challenge, but it’s also a necessity,” says Dr Mego Terzian, MSF Emergency Desk Manager.
“The instability impedes the access of humanitarians, and the north of Mali remains blocked to westerners. Nonetheless, because the situation remains volatile and could deteriorate at any time, we are maintaining our presence in Timbuktu’s hospital and in the surrounding villages.”
MSF is one of the few humanitarian organisations present in the region. Five expat volunteers along with the remaining local staff are providing medical care in the city hospital’s departments of paediatrics, medicine, gynaecology and, since mid-May, in the department of surgery.

Fuel shortages

Like the city's inhabitants, some of the medical personnel have fled, and those who remain are not paid regularly. Sporadic fuel shortages disrupt the supply of water and electricity, which in turn impedes the hospital’s operations.
Furthermore, the hospital lacks medicines. In two months, more than 300 patients have been admitted to the hospital and over 1,500 consultations have been performed by our teams.
In recent days, restrictions have been placed on vehicle movement within Timbuktu as well as movement out of the city. Nonetheless, MSF teams continue to provide medical care in Niafounké, Goundam, and Gourma-Rharous outside of the city, and limit medical referrals to the Timbuktu hospital.

Malnutrition

Over the past two months, more than 6,300 consultations have been performed. The primary diseases observed are respiratory infections, diarrhoea, and skin conditions, often related to a lack of water and poor sanitary conditions. 
MSF teams are also paying close attention to the nutritional situation since they have observed pockets of malnutrition in the region. Malnutrition is a chronic problem, and one that becomes more critical each year at the onset of the “hunger gap” – the lean period that falls between two harvests.
Nearly 800 malnourished children have already been treated by MSF. However, due to the security situation, which is having a detrimental effect on the economy, the nutritional crisis is in the region is likely to become worse.
MSF is also working in the country's south. Teams are providing nutritional treatment and pediatric care in five health centers and in the Koutiala hospital.

Bamako

Things are good in Bamako.

The budget for our project has been submitted and reviewed in Paris.  Most of the accounting has been entered, up through the 27 June.  I have developed my expense follow-up template.  Our employees are entered into the database, and they were paid for the month. We are getting the expatriates we need for the program.  And we have made a proposition for additional staffing to improve the medical care for our patients and are now negotiating with headquarters for the approval to hire them..

But the situation in northern Mali is still tense.  The Ansar Dine and the Mujao, the more extreme factions in the occupation of the north, have taken control from the Touaregs of all the main cities, including Gao and Timbuktu.  The Malian government, which is still in a transitory stage after the latest coup, is not in a good position now to try to recover the north.  The Ramadan fasting period starts in a couple of weeks, and we are watching to see if anything will happen before that.

Mali has been, until recently, a very touristic country, but with the current troubles this important source of income has dried up.  Hotels and restaurants which were thriving before are now closed.  This reduction in income, as well as the conflict and the instability in the government, are making it very hard on the population, both north and south.

The hospital in which we are working in Timbuktu is functioning, but we are currently not going out to our ambulatory sites because of the insecurity.  This hospital and two other health centers are running because we can provide the drugs necessary and can pay the staff, most of whom are no longer receiving salaries from the Malian health system.   Insecurity is rife.  Vehicles are frequently requisitioned, including one which was carrying one of our staff – he was left alone, but he lost all his luggage and papers which were in the car.  We are still able to move people and medical supplies, but only with extreme caution and careful planning.

Bamako is calm and very wet.  The rainy season has started, and it rains some nearly every day.  Last weekend it poured!  I spent my Sunday afternoon in the Mali National Museum.  It is in the national park, which is beautiful.  They have some interesting artefacts, including some incredible wooden carvings.  There is also a very interesting exhibition of Malian textiles.   

The park is old, so there are some big trees there, but apparently it was in ruins until recently.  It was restored in the last few years.  It is adjacent to the zoo, which is closed now for extensive renovation, to make a better living environment for its inhabitants.

Saturday, I took a long walk of about 3 hours round trip.  We are on one extremity of the city - I did not make it into the center.  But it was good.  I get a better feel of a place on foot than in a car.   It was a good experience, and I will be doing it again.   

Over the last couple of weeks I have been into town quite a bit, to set up flights, get visas, and take care of other business.  I am getting a better feel of the city.  Bamako straddles the Niger River, with 3 bridges linking the 2 sides.  There are a few big streets to get around, but the traffic in the center of town in incredible – cars, trucks, minibus taxis, motorbikes, pushcarts, horses, donkeys, and more.  We don’t drive here – as in most places where we work.  We use either the MSF cars and drivers, or taxis already qualified by the logistics group.  Moto-taxis are forbidden to us. Arghhhhh.

I went to a bar for a beer one evening this past week.  Like a lot of African bars, it is in a courtyard with an enclosed building, but most of the bar is roofed, open sections of the courtyard.  This set up is really agreeable.  I was sitting at the outside bar when the owner came in.  He is a great fellow.  He offered me a beer, and I think it surprised him when I afterwards offered him and his 2 employees something to drink.  We talked for a while.  And before I left he offered me 2 bronze statues, each about 3 inches high, a man and a woman.  I was really surprised.  He says he has thousands of them, but I was still touched by his gesture.  From what I have seen so far, this generosity is typical of the Malians.

Mali is known for its music.  It is a very vital part of the western Africa music scene.  This very bar I mentioned has live music 3-4 times a week.  I hope to go one evening soon.  But the music starts late, and I get up early.  I will have to find a way to have the experience without upsetting my work schedule.

A car just arrived from our regular program in the south, bringing back our chef de mission and assistant medical coordinator who were consulting with the team there last week.  I missed them – it is good to have them back.  And to my surprise, two of my old colleagues from previous projects arrived in the car also – a logistician from Congo-DRC and a doctor from Ivory Coast.  It is great to catch up with both of them again.  The logistician is going home on break, and the doctor is going for briefings in Paris.  I have two more former colleagues working in the regular programs here that I have not yet seen. 

The only frustrating part of my time here is that I cannot go to our project, because of a fear of kidnappings of whites$$$.  Working at a distance complicates things a lot.  But all in all, I am really pleased to be here.  I am happy that we can provide health care to the population of Timbuktu and the surrounding area, who would have no access to it if we were not there.  And I enjoy my life here in Bamako.   

For those of you following this blog, you probably remember that this is my first assignment in a 1-year contract with the Emergency Pool of Médecins Sans Frontières (Doctors Without Borders) – French section.  It is a whole new ballgame as compared to the “regular”, longer term projects in which I have worked.  I have now been here for a month, and will be here at least one more month.  Then, who knows?  Maybe more time here, maybe some other hotspot in the world.  All depends on the situation of the world.  And with the world as it is, I am pretty sure to have a job in the humanitarian field for a long time.