Note: Hernando Garzon, MD, an emergency medicine physician at Kaiser Permanente in Sacramento, served recently in Nigeria at the request of Medicins Sans Frontieres / Doctors Without Borders. Dr. Garzon’s timely and evocative emails from Haiti in 2010 largely spurred the creation of the Dispatches From Haiti blog. His deployment to Nigeria earlier this year preceded the launch of this blog; with his permission, we’ve repurposed excerpts of his notes back to family and friends, and his photos.
MSF (Medicins Sans Frontieres / Doctors Without Borders) has requested that I go on an exploratory mission for up to 3 weeks to Jos, Nigeria, for escalating religious violence there. I expect to leave Thursday evening.
Since beginning a relationship with them, we have seven E.M. physicians rostered for the KP-MSF Emergency team, and have sent four of those physicians on three separate missions.
We also have said “no” to them for several mission for which we could not provide a physician due to scheduling. This opportunity in Nigeria is specifically for an “exploratory mission” and requires someone with enough field experience to make decisions about security and deploying personnel and material resources. Participating in this mission will further strengthen our relationship with MSF, and increases the role our physicians play in leadership positions with MSF.
If the violence continues, I expect to be making decisions about establishing and running a trauma care facility. I expect to be gone through Feb 8, but, as usual, may have intermittent electronic access. More details to follow.
Have visited two (Christian) hospitals, Muslim neighborhoods, two (Muslim run) clinics, Health Ministry, army general, and a few other things. Movements, even during the day, are a bit calculated, and we’ve had to cancel or reschedule certain appointments due to ‘unsafe to go there’ conditions.
Still have a host of other hospital, clinic, and community leader visits planned. Before even doing any kind of health needs assessment, there are a host of logistical issues and questions that need to be addressed:
- Exact location of public, Christian, and Muslim health service points and their capability (hospital, clinic, dispensary, or chemist) (thank goodness for having GPS skills);
- Cultural and geographic barriers to access that care (are Muslims comfortable going to Christian health centers and vice versa? Do people feel safe traveling to these health centers when security is an issue?);
- How does the health system work (if at all) and how is it paid for? A bit of a large task for a city of about 500,000 people with terrible health system management and record keeping.
So far, the answers are not promising, but expected – No emergency transport system exists, baseline level of health care practitioner training woefully low (many in prior clashes simply bled to death from lack of basic care even in health facilities); once injured, people do not feel safe to travel for care or go to the closest (frequently ill-equipped place), and so on.
Only a few weeks left to figure it all out and make recommendations how MSF-B can best make a meaningful intervention.
Perhaps images (slideshow below) of what I have seen will give you better perspective.
This past weekend there were at least 14 killed and we were largely restricted to our compound for security reasons. Lost about 3 days to work. Still doing assessment, but looking to pull together the first ever meeting of all hospitals and clinics before we leave.
The end is in sight. Am making final and follow-up visits. Have started to write a final report (up to 25 pages so far). Operations Chief for MSF-Belgium is presenting a preliminary proposal to all MSF heads at a meeting in Paris today. Key meeting with leaders of all health care facilities next week.
Found a hospital with a high-speed internet connection to make maps of this area.
More inspired by color today. Hope the images give some idea of this world.
Our last full day in Jos culminated with the first-ever gathering of physician and management leadership from all hospitals and most clinics in Jos, as a preliminary meeting to form a regional Emergency Preparedness Committee. A very helpful start to a long-term process here. Large report with proposal for further MSF participation is essentially complete and is to be presented to MSF operations leadership in Brussels.
I begin a long trip back today, first to Abuja, then a stop for a ‘debrief’ with the MSF offices, and finally home early next week.
The attached photo (just one this time) is from the early part of my trip. I have looked at it often as a reminder of the hope that drives much of this work.