Rx for Survival — A Global Health Challenge

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Dispatches from the Field:

Gail Willlumsen

Like a Pebble Dropped in a Pond

By Gail Willlumsen
Farchana Refugee Camp, Chad

March 28 — April 2, 2005

Three weeks ago, when we determined where we'd shoot our film sequence about Médecins Sans Frontières/Doctors Without Borders for the Rx for Survival public television series, I pulled out my atlas of glossy satellite photos. The views of Chad showed vast arid plains crowned by the Sahara desert — not the kind of landscape that gives people a break, I thought.

Today, in the back seat of a speeding four-wheel drive, inhaling clouds of hot red dust, I'd say my initial assessment was correct. We pass tiny villages ringed by scrubby gardens, an occasional herd of goats, a woman riding a scrawny donkey weighed down with sacks of grain. Life is not easy here in eastern Chad, near the border with Sudan.

And yet this is where some 200,000 Sudanese have sought refuge, after fleeing the terrible violence (genocide, according to many) in Darfur, just thirty miles away. The United Nations' refugee agency has established a dozen camps in the area to accommodate the influx. Our destination is a camp called Farchana, where health care is provided by Doctors Without Borders. As we drive in the main entrance, I wince at the road sign that greets us: "Welcome to Farchana Camp." This may be the bleakest place I've every seen.

An ocean of small tents — once white, but now the same sun-baked red as the dusty ground — fills the mostly tree-less plain. Latrines are enclosed by screens of green plastic sheeting that flaps in the wind. Women crowd around a well to fill large water jugs. Men find shade under lean-to's made of branches and thatch. Children flit and scatter. Once I get over the initial impact of the scene, I recognize that there's order to the camp. Tents are organized into discrete 'neighborhoods.' One large tent serves as a school, run by UNICEF. There's a central warehouse for food supplies.

There's also a health center, a small concrete building that's one of the few permanent structures in camp. Here we unload our gear and meet up with Remko Schats, a young doctor from Holland, who's two weeks into a six-month mission with Doctors Without Borders. He tells us he enjoys the challenges of practicing hands-on medicine, without the fancy technology or bureaucracy that often keeps patients at arm's length back home. "Making myself beneficial to poor people, helping people in really basic conditions, I see this as my long term career," he says. Still, the scale of his responsibility is staggering: he's the only doctor serving the 17,000 people living in Farchana Camp. Won't he be overwhelmed? It's only 9 am, and already, nearly a hundred people are crowded into the shaded waiting area at the heath center. I try to calculate the number of patients Remko can possibly treat in a day — or in six months. Can one person really make a difference against such odds?

I ponder that question over the next few days, as we film Remko at work. Watching him revive a severely dehydrated infant by patiently feeding her mouthfuls of oral rehydration solution. I think: if Remko saves just one life, then he's making a profound difference. But I realize there's even more to Remko's role here.

One of the great strengths of Doctors Without Borders is that, as much as possible, it recruits local people to work and train with its volunteer doctors, nurses and technicians. In this way, the expertise of a single doctor or nurse is amplified and broadcast — passed along to people who will continue the work after the volunteer is gone. It's like dropping a pebble in a pond and watching the ripples spread out.

In addition to seeing patients, Remko supervises and trains a staff of some twenty Chadian health workers to diagnose and treat simple illnesses. The health workers see the vast majority of the patients who show up at the health center, and do triage for Remko, so that he can focus on more serious or complicated cases. And when the need arises for more advanced treatment, Remko can refer patients to a tiny hospital about an hour's drive away.

True, sometimes Remko can offer little comfort. I see his hand rest gently on the shoulder of a man whose daily pain could be erased with a simple operation on his prostate — a routine procedure in Europe or North America, but one that Remko knows only too well is unavailable in Chad. We also watch Remko try to diagnose patients with mysterious symptoms — headaches, visions and 'spells.' Remko suspects that many in Farchana are suffering from a form of post-traumatic stress disorder: "People just don't talk about the violence they experienced in Darfur, and sometimes it pops up in strange ways. Unfortunately, we cannot do much for them because we cannot offer psychological care here."

Still, it's impressive how many patients Remko and his team have treated by the end of the day. As Remko says, "You cannot treat all the cases, but you can make a difference. And that's a good feeling."

I also realize — and not for the first time since I began working on this show — how important it is to recalibrate expectations about the nature of health care that's required in settings like these. Of course, quadruple bypass surgery, angioplasty, and bone marrow transplants are miraculous, life-saving therapies. But the residents of Farchana first need treatment for diarrhea and upper respiratory infections. They need clean and ample water. Pregnant women need prenatal care. Their children need to be vaccinated, and monitored for malnutrition. Remko and his staff show us that this kind of basic health care can be provided efficiently and relatively inexpensively, even in the most dire settings. A small number of committed individuals, armed with basic tools and training can have a profound impact on health. And that's not unique to Doctors Without Borders. We've seen it over and over again as we've filmed sequences for this show.

In Bangladesh, we watched a village health volunteer named Rohima — a woman with a third-grade education, and 20 years experience in community health — persuade a man to be tested and treated for tuberculosis. Not only did she save the man's life by recognizing his symptoms, she helped stop the spread of an infectious disease in her community.

In the Gambia, we profiled an organization, Riders for Health, that provides inexpensive, reliable transportation to health workers — off road motorcycles that carry them into the poorest rural areas far from paved roads. Community health nurse Manyo Gibba used to walk miles each day to reach a few patients. But on motorcycle, she told us, "I can see many more people, and I supervise health care in sixteen villages."

I think of what Nils Daulaire, president and CEO of the Global Health Council, and an advisor on our program, once said: "The forces that influence global health are intrinsically chaotic. The smallest but most strategic inputs can have huge systemic effects. And this idea gives me hope because if global health truly were a linear process, the odds against us might be too great."

Our shoot in Chad is the final one for our show. We finish filming in Farchana on Saturday afternoon, and as we load gear into our vehicles, children gather around, curious and smiling. I can't imagine what their future holds, whether they'll ever return to Darfur. All I know is that Remko and his team will do their best to keep them healthy. And that's something. As we drive out of camp, the children wave goodbye and I feel a moment of despair. So I repeat the simple mantra that has come to me over the course of this long production schedule: In global health, a little can go a long, long way. And one person really can make a difference.

About the author:

Peabody and Emmy award-winner Gail Willumsen is currently producing (with producer Jill Shinefield), directing, and writing Delivering the Goods, episode 3 of the Rx for Survival series. Willumsen has produced long-form documentary programs on anthropology, archaeology, science, and technology for National Geographic Television, the WGBH/NOVA Science Unit, Vulcan Productions, the Discovery Channel, and others.

Producer Gail Willumsen visiting with African children

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