Donkeys, “primary” healthcare and complexity

After the quiet significant detour of being transferred to be lead doctor in a field hospital ofa refugee camp, three quarantines, an enforced holiday to Ethiopia and more than weeks waiting a travel permit I was finally on a UN plane to Nyala, Darfur. The donkey-based project I had originally be earmarked for. The UN plane was something that, predictably, sounds much more exciting than it is, saying that, Khartoum domestic terminal was an experience, much more akin to a chaotic bus station than an airport, with families cramping huge plastic bags through tokenistic security with on the vaguest suggestion of a queue amongst the throngs of people

Arriving at another, marginally less hot, Sudanese city, with a slightly smaller market than in the east, and for some reason Hyuandi people carriers are the vehicle of choice down here. Two more frustrating days waiting to get back in the field before 2 hours drive out of town, and then another hour off road to reach the small village that is the location of a twice weekly market; where the people of the Jebba Marra mountains travel by donkey and camel to sell crops and buy sugar, oil and consumables. Whilst there they are very keen to take advantage of MSF free primary care services.

In Europe, primary care means the services you go to when you have minor or chronic ailments. Here, it means, for many, the first healthcare they have had in many years. Due to conflict, remoteness and the shear degree of poverty this is the first healthcare many of these people had experienced. It is truly humbling to have a lady and her two children travel 6 hours by donkey to come and have a 5 minute consultation with you.

So they come, with little concept of what we are or are not capable off. Sometimes expecting cures for chronic back pain, sometimes with easily treatable debilitating conditions, always immensely grateful for the little that we can do. The true value of this place is not in the medicine. It is providing a service to people who have been systemically ignored, unable to access to the few government services that do exist and mainly appreciating that the outside world cares about their existence even a little a bit.

But doing this is not easy. Well the medicine is. If you only have a handful of medications, no real inpatient service and pretty basic referral location it is less complex than I am used to. But everything surrounding the medicine is difficult. The staff have to more from the nearest town, then live and be fed locally. Moving things around has to be co-ordinated with drivers and camel herders (if that is the right term from them; camel drivers? Camel riders? I Should have asked). These things have to taken through the governmental military checkpoints, and then the rebel armies checkpoints after this. Luckily the team is on excellent terms with everyone from the Sheikh, to the rebel commander to the soldiers at the checkpoints. I have not shaken so many hands in my life, nor felt quite so welcome.