Vol. 3 No. 1 Specials

Dr. Jonathan Spector is a pediatrician living in Boston, MA, where he works as an attending physician at M.I.T. Health Services. He is currently pursuing an MPH in International Health at the Harvard School of Public Health, and will soon begin a Newborn Intensive Care Unit (NICU) fellowship at the University of Massachusetts. In the summer of 2004, Dr. Spector participated in a medical mission with Doctors Without Borders (Médecins Sans Frontières, or MSF) in Darfur, lending his services in the area of pediatric nutrition. Dr. Spector was stationed in El Geneina, the capitol of West Darfur. At the onset of the Darfur crisis, 100,000 people lived in El Geneina, but with the influx of displaced persons, the city doubled in size. Eleven camps were set up on the periphery of the city to deal with this population increase, with 1,000-2,000 people per camp.

Could you describe an average day of your work in Darfur?

Our project was to manage a large therapeutic feeding center with an inpatient nutritional rehabilitation unit and an adjoining pediatric ward. At any given time, one hundred children were in the center. I worked in conjunction with local staff, including a physician, nurses, nutritionists, admissions personnel, etc. An average day began at 8 A.M. First, we would tend to any acute crises that had developed overnight. Then we started our formal rounds, beginning with the sickest kids, and working our way through the rest of the patients. After morning rounds, we would return to the very sick children and also see new admissions. Because of security concerns, we did not have an overnight presence in the center. As a result, we had to eyeball every kid before leaving to look for high fevers or severe illnesses so that we could treat them appropriately, thereby keeping them alive until morning. After work, we would go back home, have dinner with the team, and go to sleep. We were not allowed to leave our living compound after dusk. So, unfortunately, we did not have the option of going back to the hospital in the case of an emergency.

What were the major public health concerns at the camp?

The major public health concerns arose from the very extreme environmental conditions endured by the 80,000 displaced persons living there. People were living in shelters with dirt floors and roofs consisting of tattered pieces of cloth held up by sticks. Some of the lucky ones had plastic sheeting to help keep out the rain. Major public health problems included access to food, shelter, and clean water. Lacking these resources, the camp-dwellers easily contracted infectious diseases, including diarrheal and respiratory illness and malaria. These are typical problems, common to most IDP [Internally Displaced Persons] and refugee settings.