Life and Death in Darfur

By Dr. Jill John-Kall

Photo by: Bethany Morehouse

Dr. Jill John-Kall cradling a young TB patient

Today I arrived in Mujkar, one of our remotest sites in West Darfur. I dumped my gear and went directly to the clinic where I joined one of my colleagues and his team. I always look forward to my field trips because I am extremely proud of our staff. Their hard work and dedication are the backbone of all our programs and without them, innumerable lives would be lost.

The observation room was filled with little patients. The first girl I saw was a 24 month old who was dying of malnutrition. Looking at the way she was breathing and the way she would lapse in and out of “sleep” without even the strength to close her eyes fully, a sense of foreboding slowly crept over me. I tried to reassure her mother that in the morning we could try to transfer her to the nearest hospital, which is four hours away, but in the meantime we could feed her through a naso-gastric tube. I almost believed it myself.

While I started saying a little prayer for her, we were called to see a pregnant woman whose high blood pressure led to convulsions. While we struggled to give her medicine and stabilize her, a staff member came to tell us that the little girl was crashing. My colleague ran to resuscitate her while I stayed with the pregnant woman. In a few minutes he came back, having succeeded in reviving her. Of course, I think we both knew that it was just a matter of time.

After stabilizing the pregnant woman and reassuring her family, we were asked to see a three year old boy that had fallen from a great height. Upon seeing the child, my heart froze – here was a child with a history of a fall, who was limp and “sleeping” in his mother’s arms, taking very shallow breaths. Immediately, we tried to wake the baby. I just needed to hear him cry. I pinched him cruelly while the other doctor applied sternal pressure. He continued silently mocking us. I pinched harder and asked for a needle to give him a little jab. Luckily, he started crying. We were all relieved for a few moments until we realized how shallow his breaths still were. We listened to his lungs and they were tight, lots of wheezing with very minimal air moving. I ran to the office where I had left my inhaler. We improvised making a chamber out of a small plastic medicine bag and having the baby inhale the medicine. The problem was that his heart was already racing trying to cope with the work he was putting in with each breath and if I gave him too much of the inhaler, his heart would race even further pushing him right over the edge. After giving him some antibiotics and steroids, we left him with his mother, hoping for the best. As I type this now, I am waiting for someone to come and tell us that he died. Deep in my heart, I know he won’t last long, not with the way he was breathing…

Photo by: Dr. Jill John-Kall

A baby in the therapeutic feeding center in Darfur

As I stood there in the clinic watching the little boy, I thought that I wouldn’t wish this feeling on anyone on the world, the notion that after seeing a child, you just wait for the bad news. The feeling that as you lay your hands on a child, listen to him breathe, watch his eyes and listen to his heart, you leave him in God’s hands because you know deep inside, that he will not live long. My thoughts are interrupted as the nurse comes to tell us that the little girl with malnutrition has died. The family is distraught, I weakly say to the mother “malesh, malesh-sorry, sorry.” I feel like the lowliest creature on earth. What an inadequate statement to make, “sorry, sorry.” Am I sorry that she lost her child or am I sorry that we didn’t save her? Is my “sorry” in empathy for her or is it asking forgiveness for me? As I hold the crying mother, I can feel her tears on my arms. And then we are called to see the little boy.

He is worse, trying desperately to breathe through his little lungs which are smothered with invisible invaders. I know that he too will not make it and it is unbearable. I am wrestling with my own demons. As a doctor, my hands should be healing hands. My mind should be able to come up with some answers, something to attack the vile bacteria who have invaded his body. An asthmatic myself, I have a soft spot for anyone who can’t breathe and he is no exception. I give him some more of my inhaler and silently beg him to get better. We leave him in the observation room and I head back to the office. It’s 7:15 p.m.

As I start working in the office, I look at pictures of Um Dukum, where I was about two weeks ago. If it’s possible to imagine, Um Dukum is a place even further away than Mukjar, bordering Chad and Central African Republic. I’m looking at these pictures for work but subconsciously, I’m looking at them to remind myself why I’m here in the first place. We have recently taken over a little rural hospital there and it will soon be a beautiful program. It’s currently a little shack of a hospital, give or take 20 beds with a primary health care component. We do outpatient consultations, immunizations, reproductive health, health education, nutrition surveillance and outreach work. I am in love with this little shack of a hospital. It’s amazing how many lives are saved there and how many more will be saved. Women get emergency C-sections, conflict victims get sewn together, children get measles vaccines and we even treat the common cold. This is such an important location because it not only serves the local population but it also serves the IDPs within Darfur as well as the refugees that come in from Chad and CAR in times of their internal conflicts.

This hospital is a Godsend for people in this area because referrals to the nearest hospital – another four hours away – are almost impossible. Any travelers by road are frequent victims of hijackings and theft and in the rainy season, the dirt roads become rivers of mud, impossible to cross. But even though the hospital is simple, it is a shining example of how minimal efforts can go a long way in the midst of Darfur. My mind drifts back to Mukjar. Last year referrals were much easier because the roads were safer. However, since December, more and more aid agencies have been targeted by bandits, hijackers, Janjaweed, government troops, rebels, all part and parcel of any relief team working in Darfur.

Photo by: Bethany Morehouse

An IMC staffer schooling a villager at a new clinic in West Darfur on some basic tenets of primary health care. Initiatives like this one help maintain Dr. John-Kall’s hope that she can make a difference in the lives of people struggling to stay alive in Darfur.

It’s almost 8 p.m. and I’ve just been told that the little boy has died. Inside, I am screaming curses while outside I remain calm since it was expected anyway. My eyes start to water and I can’t see the keyboard anymore. It’s hard when you lose a patient, even harder when they’re kids and today we lost two. I think about the inconsolable families, left with huge voids in their hearts. I think about those little kids who will never see tomorrow. I start questioning myself and what I thought I could ever achieve here. In the midst of this self loathing, self hating mood, the realist in me shouts “I told you so!” The cynic in me shouts “I told you so!” The optimist in me is quiet. I am uncomfortable because I worry that I am slowly losing my soul. I glance over to my pictures of Um Dukum. The optimist whispers, “You can still try.”

Dr. Jill John-Kall serves as Medical Director for International Medical Corps in Darfur, Sudan.