Alone at home

For most of the past week, I’ve been here in the compound all alone, like a big boy. (Ok, there are two guards on duty at all times, and the office is full of national employees during the day.) Anyway, we are in between the departure of several members of the coordo team and the arrival of the new ones. Effectively, I am the coordo team during this period.

The most important thing I’ve had to do during this time is facilitate the arrival from some stuff across the Chadian border. Get ready; it’s a long story.

As you know by now, West Darfur is full of camps housing internally displaced populations (IDPs) from the countryside since 2003. These people have fled their home villages due one conflict or another (it’s complicated) and continue to do so in some areas. As they no longer have a livelihood, they are dependent on humanitarian organizations for all their basic needs. Food distribution is done by some of these organizations on a monthly basis, but new arrivals sometimes get left out of this process. And sometimes, the families might sell part of their distribution to pay for other basic needs. Add onto this the lack of rain this year, which means a reduced crop harvest.

We are seeing a higher level of malnutrition cases in our clinic in Zalingei than last year, especially in the age group of under five years old. This is alarming because kids in this age group who are undernourished are much more vulnerable to other pathologies than kids who are in a normal weight/height range. In other words, they are much more likely to die. We have set up an ambulatory treatment center to help combat this malnutrition. Even we have been caught unprepared for the number of patients arriving for treatment. The result: we are on rupture of the product we use to treat these kids.

Up until recently, these cases had to be treated in hospital conditions, because the product used to help the kids get back up to their proper weight was a powdered, enriched milk product, which must be prepared fresh (at least four times a day), using clean, disinfected water (which is usually not available at home). Recently a new type of treatment came out. It’s a ready-to-use therapeutic food (RUTF), which is also based on powdered, enriched milk, but in a long-conservation paste form, with the taste of a rich peanut butter, in a foil pouch. It can be distributed and taken at home, freeing up hospital resources for treatment of the more complicated cases.

This product, called Plumpy Nut (ain’t that cute? Plump-peanut!), is what we are short of. We can order it (it’s made in France), but the shipping and customs clearance time is over a month. It turns out that our colleagues in MSF-France in the neighboring country of Chad have a stock of Plumpy Nut that they don’t need right now, that they can give us. The Chadian border is about 50 kilometers from here.

That’s where my work came in this week. This product is classified as a drug, so it’s importation across borders, as in any country, is highly controlled. I drafted a letter this week, which was signed by the general director of the state Ministry of Health, asking the federal Humanitarian Aid Commission in the capital of Khartoum to ask the aid of the federal customs office in clearing 1500 boxes of Plumpy Nut for entry into Sudan from Chad. You must remember that Sudan is Africa’s largest country and has a pretty poor communications system. So once the letter was signed, I had to find a scanner in town (found in one of the UN agencies), send a scan of the signed letter via internet to our capital office in Khartoum (fortunately, it was one of the two days this week that high-speed internet worked – a scan is pretty big!), send the original letter by plane to Khartoum, and ask one of our staff to take the letter to the Humanitarian Aid Commission, who was expecting it. The state director of the Ministry of Health is great! Not only did he sign the letter, he is also taking it upon himself to work with the local customs officials to simplify the importation. So we are hoping to have our treatment arrive within about a week.

That was my big task this week, but there are a myriad of other small ones; like checking on the refrigerators. Certain drugs, like vaccines, need to be kept between 1°C and 8°C at all times. All the electricity in the compound is provided by generators, which run from 8:30am-12:00pm, 2:00pm-6:00pm and 8:00pm-11:00pm. With all of these cut-offs, we chart the temperature twice a day. If we approach the outer ranges, we need to quickly prepare another solution to the storage.

And I needed to remember to make the radio contacts twice a day. We contact each of our sites by shortwave radio at 8:30am and 6:00pm every day of the week, and 12:00pm on Fridays and holidays. Some general info is passed on (for example the times of U.N. helicopter flights between sites – we are forbidden to take most roads outside of towns for security reasons), but the main reason for these contacts is to make sure that everyone is okay. Today, not one site responded! Since the mobile phone network wasn’t working either, I finally got each of them via satellite phone. Everyone’s ok! One site was tied up in a meeting and forgot. Another had turned down the volume of the radio so they could have another conversation on the satellite phone. And the radio on the last site didn’t capture my signal because of atmospheric conditions.

These things, along with my day-to-day tasks, kept me hopping. I have a lot of longer- term issues that I need to attend to, but they must wait. Sandrine, our pharmacist, returns from her break tomorrow, so we can split some of the tasks, including necessary meetings with the other humanitarian organizations in the region. The new Head of Mission, Medical Coordinator, and Logistics Coordinator should arrive at the beginning of November.

There are some advantages to being here alone. I was invited by the guards and the driver on duty today to join them for lunch. I know about five words of Arabic, and their English is about the same, but they had prepared a real feast. It was a pleasure to share a good meal and some time with them.