Rx for Survival — A Global Health Challenge

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Global Health Champions

Remko SchatsLina Gustin

Remko Schats, MD and Lina Gustin, RN

Doctors Without Borders

Remko Schats and Lina Gustin are two of a bold cadre of 2,500 volunteers who make up Médecins sans Frontiéres (or Doctors Without Borders), an organization that delivers medical care and supplies to some of the riskiest, most remote places on Earth. Founded in 1971 by a group of French doctors, MSF is the world's largest independent medical relief agency, frequently the first on the scene when catastrophe strikes. Schats and Gustin are both working on six-month assignments with a small team at the Farchana refugee camp in western Chad, providing basic public health and medical care for 17,000 refugees from Sudan's Darfur region.

A physician from the Netherlands, Schats explains how he became involved with Doctors Without Borders: "I went to Ghana, to West Africa, and there I got 'infected' with the tropical medicine virus. Since then I like to work in tropical countries and make myself beneficial to the poor people in the world."

Gustin, a native of Sweden, is on leave from a full-time job as an intensive care nurse in a large city hospital. Now on her second mission for Doctors Without Borders, she enjoys the contrast of her two, very different professional challenges: "At home I have two patients, and we have all these monitors and ventilators. Here I have 40 community health workers who take care of 17,000 sick people."

Schats is the only doctor at the camp's small health center, but he trains a team of Chadian health workers to make examinations and treat simple illnesses, like diarrheal diseases and chest infections.

While lack of water and hygiene are constant problems, here there are also the mental traumas suffered by victims of violence, such as a patient who witnessed her father killed and her village destroyed. She is brought in, apparently in a coma, but Remko thinks she may have retreated into a psychological state of shutdown as a result of the violence. There is not much Remko can do for her, other than give her food and water and a place to rest: "We cannot offer her psychological care here. You see the people suffering, and it's frustrating sometimes, because you cannot treat all the cases. But you can make a difference. So that's a good feeling." After three days at the health center, the woman is speaking and eating, and her vital signs are good, so she is released to join her remaining relatives.

One of Gustin's most important responsibilities is training community health workers to give measles vaccinations. "When you don't have well-built latrines or showers or ways to take care of the garbage," she says, "it's very easy for epidemics to spread. Measles can kill a lot of people, but you can also vaccinate against measles, and no one has to die of this disease." While measles vaccine can be provided for as little as 26 cents a dose, it is a major challenge to keep the vaccine cold on the long, scorchingly hot drive from the hospital in Adré, 25 miles away, over unpaved roads prowled by armed bandits and Sudanese militias. It is a great relief when the truck arrives with the cold chain unbroken: the vaccines are safe. As the camp children converge on Gustin, she says: "One thing that I love is just the welcome response you get from everyone. I get so much energy from these children."

Gustin trains community health workers, often refugees themselves, to spot problems among their neighbors, especially malnutrition among children. As she does rounds in the camp, she finds a malnourished child. "It is really hard to see the small, small children," Gustin says. "The small children you will never forget." The team helps the children take gentle nourishment from specially prepared foods, as a normal diet would overwhelm their hunger-ravaged digestive systems.

The United Nations estimates that 30 million people are now living in temporary situations, driven from their homes by war, persecution, and manmade and natural disasters. They are, in terms of their health, the most vulnerable people on Earth. The Doctors Without Borders volunteers offer them emergency health care, hope, and respect, in many cases putting their own lives on the line to do so.

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