CMAJ • November 18, 2008; 179 (11). doi:10.1503/cmaj.081666.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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News

Dispatch from the medical front

Somali symbiosis, part 1: what I saw

Dr. John Barnhill

Beletweyne, Somalia

You see first through the filter of your own judgments, so I saw disarray.

I saw a place without a functioning state government, in a steady state of chaos, with little in the way of a health care system, heavily reliant on the 15 projects that Médicins Sans Frontières runs throughout Somalia, like in the one that I worked at during a 3-month stint as a volunteer general surgeon in Beletweyne.

People would present to us from far away, with illnesses and wounds that were advanced, with symptoms from diseases that were entirely treatable, if detected early. Snake bites. Tuberculosis. Appendicitis. Ulcers. Infections that resulted in prolonged courses of care, amputations and loss of life.

I saw pregnant women with high blood pressure, seizures, obstructed labour and undetected twins. Despite the valiant efforts of our excellent Australian midwife and local midwives, these undetected conditions resulted in urgent cesarean sections, destruction of vaginas, preventable hysterectomies, dead babies and families without a mother. The trauma to the birth canal from obstructed and prolonged labour leads to fistulas, and, in turn, to incontinence and complicated social ramifications, often resulting in the mother being ostracized from the community and rejected by her husband.


Figure 17
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  		A local physician weighs an infant at the Médicins Sans Frontières clinic in Beletweyne, Somalia. Image by: Sara Barnhill

 
I saw the effects of a nonexistent educational infrastructure. Without schools, idle youth have time and cause for frustration and are vulnerable to recruitment for armed conflict, which feeds the community's instability. Most people lacked safe running water, fuel for cooking, electricity and an income. The roads were difficult to pass at the best of times.

The crumbling agricultural and security infrastructure yields predictable outcomes: starvation, malnutrition, frustration, desperation, violence. Curious children often run towards the sounds of gunfire and are maimed. They lift, or jump on, shiny metallic objects and soon have parts of their hands, arms, legs, eyes or genitals blown apart.

I saw people recover from illnesses and injuries that I could not imagine were survivable.

I saw resources stretched far beyond their limits by the thousands of vulnerable people relocated to our area to escape fighting in their hometowns, deposited into massive refugee camps. They were separated from their jobs, from families, from their land and their clans. Their presence is a source of stress in many ways. And there are severe limits to international aid. Other than Médicins Sans Frontières, most humanitarian organizations have withdrawn because of security concerns.


*    Footnotes
 
CMAJ invites contributions to "Dispatches from the medical front," in which physicians and other health care providers offer eyewitness glimpses of medical frontiers, whether defined by location or intervention. Submissions, which must run a maximum 400 words, should be forwarded to: wayne.kondro{at}cma.ca






This Article
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