3rd September, my forth day in El Geneina, Darfur. In the afternoon, a rainstorm came. It lasted for at least half an hour. Some people sought shelter back in their rooms. I held fort on the veranda in the middle of the compound. When it was over, we received a radio call from the Clinic. One rooftop was a bit damaged. So we all hopped into the MSF cars and went to see the situation. On the streets, people continued with their daily life as if nothing had happened just minutes ago. I thought that a rainstorm this magnitude in HK would bring upon the red rainstorm signal and everyone would be excited. I thought about the refugees living in the camp, with only plastic sheeting covering their heads. Could the shelters weather this storm? Arriving at the refugee camp, there was nothing abnormal. There were no shelters blown over. The rooftop of the Clinic was only slightly damaged. There was no water leakage. So we were all relieved. Back at the compound, it was time for dinner. As soon as we thought the night was over, Kerenck team called via the Satellite phone saying there was a man with gunshot wound. The woman travelling with him had been abducted and her whereabouts were unknown. I spoke to the Kerenck expat nurse, the only medical personnel in their project, trying to find out the patient's condition. He was stable at the moment. Due to the recent upgrade of road insecurity, we decided to reassess his conditions and road safety before deciding on another road movement. This was not over yet. Just as we were all about to go to bed, the radio buzzed. The night duty nurse of the Clinic was calling. A pregnant woman in her second trimester just came to the clinic with vaginal bleeding. Her vital signs were stable. Because of curfew, neither the midwife nor I could go to the Clinic. We ordered close monitoring of her vital signs and intravenous fluid. First thing the next morning was to go to the Clinic with the midwife to see how the pregnant woman presented with vaginal bleeding was doing. She had a lot of bleeding, possibly a threatened abortion. So we decided to send her to the hospital for observation. There is a Sudanese gynecologist at the hospital that might have been able to do more for the patient. Inside, the Medical Ward was crowded with patients and their many caretakers, I tried to locate the anemic woman we had sent in the previous day. Due to the road insecurity, the kiss movement had been delayed one day. When the Habila anemic woman finally had arrived at the hospital, her general condition was very bad. I searched around but couldn't find her. She had passed away just that morning. Nothing had been done for her in the Hospital. No blood transfusion was possible due to lack of blood donors. There was no blood bank in the Hospital. And here people were very reluctant to give away their blood, due to the belief that blood is life. So I saw the husband weeping with his dead wife wrapped in a blanket, ready to be taken for burial. I just wished that I were more involved in the management of the hospital patients. But given the limited resources available, would I have been able to do more? Back at the Clinic, some patients were waiting. Donkeys are very common animals in Darfur. But they can cause a nuisance. A donkey bit a man on his forearm 5 weeks ago in Kerenek. He applied some herbal medicine to the wound. But soon it became worse and discharged pus. His hand swelled to the degree that he couldn't move his fingers. He was transferred to the El Geneina hospital for further treatment. After a few days of antibiotics he was discharged. When I saw him, while he was waiting for an MSF car movement to take him back to Kerenek, he still had pus in his wound. So we continued to give him antibiotics and dressings. Another poor lady, who had suffered a burn injury in a fire 5-6 months ago, came to the Clinic. Due to the burn she had contracture in her arms. She was also pregnant. A few days ago she had also fallen off the donkey she was riding. Her left elbow was injured. Traditional wisdom told her that application of rabbit skin over the wound would make it better. So that's what she had done. But now she was suffering from a lot of pain in the elbow wound. The rabbit skin had become so dry that it stuck to her elbow. The wound was discharging a lot of pus. We soaked the rabbit skin with saline, softening it before removing it from the wound altogether. The wound was bad. We gave her antibiotics and painkillers. We were hopeful that if we continued to clean her wound meticulously it would heal. At the end of the day, I was exhausted and very hungry. I decided to give myself a treat. I took out one of the cup noodles I had brought from HK and ate one. It was very GOOD. Arthur
Dr Arthur PANG obtained his first degree in Biochemistry in Canada in 1991 and graduated from Faculty of Medicine of University of Hong Kong in 1998. He started his first mission with MSF in December on an HIV/AIDS project in Xiangfan, Hubei, China. In August 2005, he packed again and left for another mission in Darfur, Sudan.

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