n° 0 • July 2009
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for Critical Care Units
alcon 4 Falcon 4… cardiac arrest in Intensive Care
Unit”. It was ten minutes before midnight, and
someone was calling me on the radio. “Start the
cardiac massage,” I replied as I ran towards the
hospital. Latif, Fahim and Samiullah, just graduated from the Government
School for Nurses at the University of Kabul, and were working the night
shift. The school curriculum offers CPR training. Unfortunately, the quality
of teaching is still very far from acceptable or satisfactory standards. This is
understandable in a country devastated by thirty years of war.
In all of its projects, EMERGENCY strives to provide intensive training for
local staff through daily hands-on experiences with highly qualified doctors
and nurses coming from other countries.
This and other targeted activities provide local staff with current medical
knowledge, and eventually lead to their autonomy. In the first months of 2008,
Daria, Elena, Debbie and I, all international nurses at the EMERGENCY
Hospital in Kabul, have established a Basic Life Support (BLS) course in an
effort to accomplish these goals.
The ABC’s of resuscitation —
Airway, Breathing and Circulation
to rescue a patient who is unconscious, or suffering from cardiac arrest.
Independently from the cause of cardiac arrest, the heart fails to contract and
pump blood to the tissues.
The lack of oxygen supply to the brain cells, known as cerebral anoxia,
causes irreversible damage within 10 minutes of the onset of circulatory
arrest. This implies that the time available to rescue a victim of cardiac arrest
is extremely short before irreversible brain damage occurs.
The goal of BLS is to maintain an “emergency oxygenation” through
artificial breathing and cardiac massage, until more efficient means can be
used to correct the factors that determined the arrest. The BLS procedures
are standardized and recognized as effective by several key international
organizations that provide constant revisions and updates.
To help with memorization, the BLS phases are schematized in three
steps, indicated by the first three letters of the alphabet.
A: Airway – Opening and control of the airway, removal of potential
occlusions (foreign-body, food, blood), and insertion of a plastic tube to keep
B: Breathing – Sustain breathing by ventilation with Ambu bag (if
unavailable, proceed with mouth-to-mouth breathing).
C: Circulation – Sustain cardio circulatory function by control of carotid
pulse, and potential cardiac massage.
At each step, a vital sign (airway, breathing, cardiac pulse) is checked and
restored, if compromised.
Learning to save Minianne really means
helping Gul Arifa
BLS is of utmost importance in the training of health care staff. For this
reason, it is periodically taught to newly hired staff at all of EMERGENCY’s
This latest course was designed specifically for nurses newly graduated
from the University of Kabul, and working in the critical care areas (ER,
intensive care, surgery room).
It is divided in two sessions. The first session illustrates the guidelines of
the Italian Resuscitation Council (IRC), while the second, besides reviewing
previous material, allows students to practice the reanimation resuscitation
Minianne is an inflatable manikin provided by the IRC. It is particularly
Basic Life Support Course in Kabul – Emergency Cardiopulmonary Resuscitation (CPR)
useful in the teaching of lifesaving maneuvers, since it allows effective
simulation of cardiac massage and manual ventilation.
During this session the nurses, divided into small groups, ask questions
and practice until they feel confident with all the maneuvers. The hands-on
nature of the class has guaranteed the expected results.
In fact, the staff has acquired both physical and psychological confidence
with instruments and maneuvers, and it is now ready to effectively cope with
any emergency situation.
It is midnight. Out of breath, I reach the intensive care unit. I don white
coat and shoe covers and I step inside. Latif is by Gul Arifa’s bed performing
ventilation. Samiullah is standing on a step stool, ready to administer a
Fahim, the youngest, looks at me nervously as I come closer. Together we
gaze at the monitor. Gul Arifa’s heart has resumed beating. We smile at each
other. “Great! Well done!”.
Translated by Ada Buvoli
The Consequence of War
e arrived at two in the afternoon on 22 July in a car driven by his
uncle. He had been carefully laid on a thin mattress, wrapped in
a plastic cloth, with stained rags used to stop the bleeding from
Six year old Quadratullah is transferred to a stretcher by ER nurses. He
doesn’t utter a single word and through teary, terrorized eyes watches all the
people who are frantically racing around him.
We remove the rags from his wounds. It is a devastating image. His left leg
is gone, ending just under the knee with two bone fragments protruding from his
flesh. The right leg is still okay, but wounded. His left hand is crushed, and the
right hand is wounded. His back and pelvic area have deep wounds resulting
from the explosion.
We should be familiar with these scenes, but we’re not. Each time, the horror
of these scenes doesn’t allow us to become accustomed to them.
As soon as Quadratullah’s condition is stabilized, he is sent immediately to
the operating room.
What remain behind are two apricots,
and the tragedy of a morning that was supposed
to be a celebration
The boy’s father’s arm (Ajimir Aziz) is wounded. When we ask him what
happened, he takes two apricots out of his pocket, and then breaks down
crying. That morning he had gone with Quadratullah to gather some apricots
in a small orchard near their home, in a village a couple of hours from Kabul.
Quadratullah was so happy because his father was dedicating the whole day to
him. It was their time to play, their moment to be together.
Then he saw some ripe apricots on the ground. The boy turned to pick them
up, meaning to take them to his mother and siblings. But, as he bent down
to collect the fruit that’s when it happened. There was an explosion. It was
instantaneous, like always.
Ajimir extends the two apricots out to me. I face him, not knowing what to
do. The nurses encourage me to take the fruit, he is offering them to me. I take
them into my hands. I look down at them, and put them into my pocket - two
apricots and Quadratullah’s life torn apart.
Translated by Paolo Chiappetta
Six year old Quadratullah, Victim of a Landmine Explosion Arrives at our Hospital in Kabul
n the summer of 2007, just after the re-opening of our hospitals in
Afghanistan, we were contacted by the representatives of the Ghazni
community from one of the areas most impacted by the war, and which
runs along the road connecting Kabul to Kandahar. They made a
request that we open a First Aid Post to be connected to our surgery center in
Kabul where high standard, free medical assistance is provided to everyone
in the area who is injured or wounded.
We had to wait a few months before starting a new initiative and fulfilling
this request since we had to be sure that the entire Afghanistan Program was
back on track.
In April, a delegation form EMERGENCY completed a first assessment of
the city of Ghazni, capital of the province, to select an appropriate location for
the new project. However, the local authorities had no appropriate building
to offer, and to build a new hospital would take too long given the urgent
needs of the population. The generosity of a wealthy individual provided
the solution. The owner of a small supermarket donated the building, to be
remodeled for the FAP. After a couple of months under construction ─ tiling,
windows and doors, painting, construction of lavatories, and the selection of
the appropriate personnel ─ the Ghazni FAP became operative on July 20th.
The official inauguration took place on August 10th at 2:00 PM. Many officials
were present; the vice-governor of the Ghazni province, a member of the
national parliament, the mayor of the city of Ghazni, the director of the Ghazni
hospital, the community leader and many local citizens. Due to worsening
security along the road connecting the capital with the south of the country, no
one from EMERGENCY was able to participate in the opening ceremony.
The distance from Kabul and Ghazni is about 120 miles, and is normally
about a two hour drive. In recent months, with the increase in military conflict,
the travel time has more than tripled to cover that area (the official delegation
that came to Kabul to thank us for the new facility took seven hours), and the
frequent attacks have made any travel extremely dangerous.
In spite of the fact that the media and the international community seem to
have forgotten, the war in Afghanistan continues, along with our commitment
to mitígate, if only in part, the suffering of the victims.
Translated by Michele Isernia
Restarting and expansion
In Ghazni, 120 miles south of Kabul, the local population asks for a new FAP (First Aid Post)
A Flower in the Midst of War
Amongst the Victims Many Children Are Admitted to the Lashkar-gah Hospital
he corridors of EMERGENCY’s hospital in Lashkar-gah remind us
of the human cost and consequences of the war in Afghanistan.
Over the past thirty years, more than one and a half million people
have been killed, the majority being civilians.
Our hospital is the only one in the region which provides completely free-of-
charge surgical interventions.
For the most part, the patients suffer injuries sustained while caught in the
middle of military combat, while stepping on one of the many landmines
spread throughout the region, or as they become victims of violence
associated with the drug trafficking trade. Others are wounded by air raids
conducted by international forces.
NATO asserts that troops do their utmost to take precautions to avoid
civilian casualties. In the cases of civilian casualties, an investigation is
conducted, and under the best of circumstances, civilians become eligible
Our patients come not only from the city, but from all over the region. In
order to reach our hospital, they travel on damaged roads on a journey that
can last days.
Some arrive at the First Aid Post in Grishk thanks to an ambulance service
which is open 24 hours a day. Many never arrive, partly because they die en
route, and partly because after aerial bombing raids the Afghan army blocks
the roads not allowing the injured to pass through.
As in all of EMERGENCY’s hospitals, a red and white sign greets the
public as they enter, “We inform that all medical and surgical assistance is
free of charge for the patients”. The treatment is completely free, only a blood
donation from the families of patients admitted to the hospital is requested.
For victims who are severely wounded, numerous blood transfusions are
required, and the hospital’s blood bank needs to be continually replenished.
Usually after making their donation, parents or siblings of patients often return
a few hours later with friends and relatives to also give blood.
Gullandam, beautiful like a flower, in a Helmand
that can no longer claim to be a garden
Yesterday, an Afghan nurse presented us with paperwork that we had not
seen before. The father of Gullandam, a young girl who was under our care
for the past few days, asked us to complete the paperwork out as soon as
He is required to present the filled-out forms to officials in order to receive
compensation for the explosion that destroyed his family’s home.
We take all the paperwork, and of course will help. As soon as it is filled out
with the relevant information regarding the young girl’s condition, we go with
Paola back to D-Ward, the children’s ward, where we locate the girl’s father,
and return the papers to him.
Gullandam means beautiful like a flower, in Pashtun. She is in the garden
playing amongst the other hospitalized children. At 6 years of age, she has
already bravely faced the amputation of one leg, and many painful medical
procedures to save the other.
And sooner or later, she will have to be told that she has also lost her
mother, and that she no longer has a home to return to.
Translated by Roland Swan
Our Idea of Peace
ver 1.5 million people live in Nyala, most of whom are
refugees who fled the war. They live in camps surrounding
the city. Following a request by the local Ministry of Health,
EMERGENCY decided to build a paediatric centre to offer high
standard free of charge medical care 24/7 to children under the age of 14.
The Centre will address prevalent illnesses such as malnutrition, respiratory
infections, malaria, and gastricgastrointestinal infections.
It will implement immunization programs, and preventive efforts to combat
diseases such as rheumatic fever, in addition to providing health and hygiene
education for families.
The Centre will provide screening for patients suffering from heart disease
potentially requiring transfer to the Salam Cardiac Surgery Center in Khartoum
to undergo heart surgery. Post-operative monitoring and care will also be
The Centre in Nyala will be part of EMERGENCY’s Paediatric and Heart
Surgery Regional Program, with the Salam Centre as its hub. Collaboration
with the Sudanese authorities – both Federal and South Darfur – has been
essential for this project.
The Paediatric Centre will be built on land offered by the South Darfur
authorities, in collaboration with the local Ministry of Health.
Last summer EMERGENCY carried out a feasibility study and assessed the
estimated costs for the structure and start-up costs at 600,000 Euros. This total
became the target amount for our text message fundraising campaign.
The results coming in from the participating phone companies seem
to confirm that we’ve reached the targeted amount. This is an important
achievement since it will help us continue our mission in Sudan and the
neighboring countries. As soon as we have the final results, we will publish the
final tally of funds raised.
In the meantime, we would like to thank everyone who has decided to
participate in helping us build this paediatric centre, working together with us to
concretely achieve Our Idea of Peace.
Translated by M.A.
A Paediatric Centre in Darfur, Another Goal to Reach
The Our Idea of Peace fundraising campaign to begin construction of another EMERGENCY
health care centre, this time in Nyala, southern Darfur, for children under the age of 14,
ended last October. The Centre in Nyala will further expand EMERGENCY’s Paediatric and
Heart Surgery Program in Africa during 2009.
A Comparison Between
Goals and Results
hartoum, July 2008. The temperature outside is about 45°
Celcius (113° Farenheit). The dry heat makes it a bit more
tolerable, but it is certainly not advisable to dwell too long
outside, even in the garden of the Salam Centre — a place
that brings healing to the heart.
This is a familiar place even to the patients of the Centre, who have organized
a creative alternative to ‘outdoor activities’. Every afternoon, once clinical
activities quiet down, a ‘parlor room’ is created alongside the large window
which separates the patients’ wards from the outside world.
The patients awaiting surgery, and the post-op patients who are able to
mobilize, pull up some chairs near this large window, and spend the afternoon
chatting there. Beyond the window, one can see the colorful seasonal flowers,
the trees, the green lawn and bushes. Beyond, it is known that the Nile flows,
and although it cannot be seen, it is “sensed”.
From this large window overlooking
the garden, light comes in as gazes go out
For all of those who have followed the progress, and believed in this hospital
from the very start, from when it was only a ‘crazy’ idea, it has confirmed the
transformation of a utopian dream into a reality - one rooted in the daily lives
of hundreds of people.
I am talking to Raul about this large window.
As the architect, he designed the window with the intention of bringing light
to the long corridor which faces the patients’ rooms.
Now, the patients have chosen it as a place of gathering and relaxation. It
has become a case, one could say, of unplanned consequences to calculated
actions. This novel use was approved and appreciated by the designer
himself, who for the time being does not delve too deeply into discussion
about the ‘diverse nature’ or ‘outcome’ of intended purposes.
Fifteen Months after its Opening — An Update on the Salam Centre for Cardiac Surgery in Khartoum
This space was transformed by the patients into an
area for chatting, a simple act which lightens tensions,
favors understanding, and fosters friendships.
It is where we often stop to talk with the guests
of the Salam Centre
Barring complications, the average length of stay here in the hospital is
about 10 days, which is sufficient time for people to get to know each other.
It is amazing to see the behavioral transformation of the patients after just
the first few days in the hospital. Initally, everyone looks lost, almost afraid.
For many, the arrival to the Centre is like being left stranded on the moon.
No relatives or ‘co-patients’, as they are called here, are allowed to visit
except on the consented days and times.
In the other local hospitals co-patients provide most of patient care, from
food to laundry, from personal care to even medications.
Here, on the other hand, clean pajamas and showers in the rooms, three
free full meals per day, doctors and nurses, are all available 24/7.
The omnipresent white faces of the khawala (‘white’ people) administer to
After a few days, patients memorize names, begin to feel comfortable, and
even begin to trust the khawala.
Children, in particular, are the ones who develop the most immediate
rapport. And there are many children in our hospital, about 25% of the 937
patients hospitalized at Salam through the end of July 2008 have been
younger than 15.
There is a long list of cases, difficulties and problems,
and many solutions that have been researched
The small group of teenagers who have been treated at the hospital since
the beginning of July has truly been diverse.
Wail, 14, arrived from Port Sudan. In addition to his young heart struggling
from the damage of recurrent rheumatic heart disease, he suffers from kidney
and lung problems, so we anxiously await definitive signs of healing.
Enas, is an 11 year-old girl, who weighed just 17 kilos (37.5 lbs) when she
was hospitalized. Our cooks prepared a special diet for her over several days
to help her gain a body weight which she probably never had before…and at
any rate, also to help her gain a few kilos before surgery.
Osman “One” (to distinguish him from Osman “Two”), despite being only
10 years old, is a veteran of the Salam Centre. He has been with us since
February, and has had treatment for his right ventricle. The right half of his
heart wasn’t functioning.
Blood taken from the right atrium through a cannula was channelled back
with a pump to the pulmonary artery, to reach the lungs and to oxygenate.
Now he is ready, well enough to go back home to the state of Sinnar, south
of Khartoum. He will be accompanied by his grandfather, who was staying in
the centre’s guesthouse during his grandson’s hospitalization.
Then there is the trio from Darfur. Saddam, 15, of Genina, West Darfur,
urgently hospitalized for a serious heart problem that was treated via
replacement of the mitral valve and surgical repair of the tricuspid valve.
Curly haired, darke eyed Osmad “Two”, 9, is shy and introverted, and was
one of the last of the group to be operated on.
After surgery he was received with a round of applause when he was
transported from the operating room to the intensive care unit where some
of his friends who had already undergone surgery the previous days were
Ali, the smallest of the group, and only nine years old, is from a small village
near Al Fashir, North Darfur. He also needed a mitral valve replacement and
surgical repair of the tricuspid valve.
Araghes the Ethiopian and Sarawit
the Eritrean: distant is the world that would like
to see them be enemies
The unique atmosphere of the Salam Centre makes sure that not only
do ethnic barriers disappear between the beds in the ward, but that also the
linguistic difficulties due to the different nationalities be overcome.
Proof is the story of Sarawit, a very young girl from Eritrea, hospitalized for
a mitral stenosis, and Araghes, an Ethiopian child brought here thanks to the
initiative of a group of Italian volunteers who collaborate with a hospital from
the congregation of Mother Theresa of Calcutta in Addis Ababa.
Araghes speaks onlyAmarico, hence she had difficulties comunicating with
the foreign doctors and nurses, as well as with the Sudanese personnel. But,
her problems are solved thanks to the help of Sarawit who, besides Tigrino,
also spoke Araghe’s language, and she becomes her interpreter.
They were apart only during surgery and immediately afterwards.
We suggested that they become ambassadors of their respective
governments, which have been at war for about ten years now.
We may have been joking, but… their relationship is no longer a joke,
it is real.
A lesson from our first balance sheet —
something we ‘believed in’, is incredible
After a little over a year since its opening a draft of the activity summary for
the Salam Centre is available.
Despite the continual necessity for precautions to be taken, and with the
inevitable problems encountered, we are pleased with the initial results.
Under the circumstances and given the difficulties, in 15 months time we
have been able to progress from one to three open heart operations per day.
About 30 patients are examined daily for triage.
A third of these patients will then need a specialized visit with the
cardiologist. Paradoxically, given the enormous distances in this country,
news ‘by word of mouth’ has produced unexpected results.
More than 43% of the Sudanese patients in our hospital do not live in
Khartoum, but arrive from one of the 25 states that make up the federation.
Even going beyond the Centre’s data and statistics, and the daily operational
routines, the “life” of this hospital suggests a very comforting evaluation.
From the examination rooms to the office administration, from the labs to the
wards, from the kitchen to the laundry rooms, from the operating rooms to the
pharmacy, one can clearly feel that the premises itself suggests the sense of
being in a special place, in so many unique ways.
More often than not, ‘Incredible!’ is the comment heard over and over by
visitors to the Salam Centre for Cardiac Surgery, from the Sudanese, as well
as from foreigners passing through Khartoum for work or vacation. For us this
expression ’incredible’ reminds us of a daily effort, which began with an idea,
went on to be built, fully equipped and furnished and ultimately completed
with the search and assembly of personnel.
It is an effort that continues on with a myriad of new and diverse problems
(sanitary, logistical, technical) to be overcome each day.
But, after a brief pause by the large window that overlooks the garden, and
an exchange of a few words in bizarre, improvised “mixed” languages with
the national staff and patients, we all become part of the incredible vision
sensed by all visitors.
Translated by Rosalba Perna
First the Children
ince the EMERGENCY Paediatric Centre first opened its
doors in December 2005, the camp has expanded and is now
surrounded by new homes, at best made from mud and plastic
sheeting. They belong to new refugees from Darfur, and to old
residents driven away from areas that are increasingly urbanised - always a
source of homelessness.
From the hospital’s water tower, the grim view of the camp is a vast sea of
shacks, extending as far as the eye can see, with dust and dirt everywhere.
Although only a mere 12 km from dowtown Khartoum, we are very far from
the skyscrapers dominating the heart of the city.
Our Centre is situated in an area of the camp called Angola, which is
populated by roughly fifty thousand people, fifty per cent are children. When
it first opened three years ago, the Centre’s objective was to guarantee free
medical treatment to the more immediate community in the area.
Now, patients arrive from the rest of the refugee camp as well as far off
neighbourhoods. In the Outpatient Ward, three nurses and two doctors work
with a pharmacist, along with a lab technician who performs urgent blood
tests -- all under the supervision of an international paediatric nurse.
Mothers and children arrive at six o’clock in the morning and are seated
under a protected outdoor veranda.
As they await their turn, they are neat, poised and beautiful in their colourful
clothing.Attilia, the international nurse, together with the local nurses carry out
a rapid triage to evaluate any urgent care cases. Patients with malnutrition,
loss of consciousness, fever and severe respiratory problems are given high
It seems as if it were summer. There are clear skies and the temperature
is a dry, 28 degrees Celsius.
But, this is their winter, and illnesses such as bronchitis and asthma are
common, just as in any outpatient ward in Italy during this time of year.
Many are suffering the consequences of living under inhumane conditions
in the camp.
Malnutrition, conjunctivitis, and urinary tract infections are among the most
common maladies. Diarrhoea is a consequence from drinking the water from
the donkey tank. Water is sold and distributed house to house from a large
tank transported by mule. It costs between 200 and 300 dinar depending on
the vendor. Daily wages are roughly 1000 dinar.
An Urgent Transfer Leaves Us
With More Questions Than Hope
Every day our staff examines fifty children, and those requiring observation
stay in the ward until closing time. “The Centre has to close at 4:00 PM due
to security reasons”, explains Attilia. “At night the men get intoxicated on
araki, a distilled alcohol with an extremely potent effect, and it is better not to
stay around the area”. The more severe cases are transferred to the two city
In Just Over Three Years More Than 56,000 Patients Have Been Treated in the Mayo Refugee Camp
hospitals, the Khartoum Hospital and the Bashir Hospital. Thanks to the
working experience with the Mayo EMERGENCY Paediatric Centre, the
government of Khartoum passed legislation that all care for paediatric
emergency medical cases be provided free of charge.
A mother brings in her child wrapped in a colourful cloth. As soon as she
opens her little bundle, his emaciated face reveals that we are clearly faced
with a very ill infant. “He’s not well, he hasn’t been eating for the past week”,
she says. But the skeletal body, and lack of strength confirms evidence of
long term malnutrition. At forty days old, the baby weighs only 2 kg. The infant
is suffering from an infection, running a 40 degree fever, and does not even
have the strength to cry.
“After the operation, he stopped eating, and is becoming more and more
lethargic”. The operation she refers to is the procedure performed by one of
the twenty tribes living in the camp which believe that by cutting the uvula
and palette of a newborn, regurgitation can be prevented. Every newborn
undergoes the procedure. “Imagine a procedure of this sort, most likely
performed in the middle of the street in a place like this, with instruments
being washed in the camp’s water”, says Attilia, who periodically sees these
cases. The ambulance is ready to go, and we immediately transport mother
and child to the Khartoum Hospital.
During the trip,Attilia asks me to try to stimulate the infant by stroking a pen
along the bottom of his feet, while she keeps the oxygen mask ready for use.
No reaction, he keeps his eyes half closed, and does not even whimper. We
arrive at Khartoum Hospital, a chaotic and dirty place where, even for Attilia
who comes here often, it is difficult to orient oneself.
In a large, half lit room, five doctors seated at their desks examine their
young patients surrounded by a throng of mothers coming and going with their
children. One female doctor quickly checks the baby and asks the mother and
Attilia a few questions. He will be admitted and undergo an antibiotic and an
intensive nutrition treatment.They assure us that “he will make it.”
I ask myself how many more times will this little baby have to “make it”
in order to survive life in Mayo Camp to reach age 5, and survive the infant
mortality statistics of this country.
Translated by Roland Swan
CENTRAL AFRICAN REPUBLIC
Good Morning Bangui
News in the Regional Programme for Paediatric Care and Cardiac Surgery
Each day the staff at the Paediatric Centre in Bangui provides free specialized assistance
to forty children. Thanks to periodic visits to the Centre by the international cardiologists,
patients can be screened to determine whether they require surgery at the Salam Centre for
Cardiac Surgery. The required post-operative follow-up care is also guaranteed.
t is Friday, 6 March 2009, 9:30 AM. “The promise has been kept,”
declares Francois Bozizé, the President of the Central African
Republic. Together with the Prime Minister, the President of the
National Assembly, and the foreign ambassadors present in the
country, Bozizé attended the inauguration of the Paediatric Centre in Bangui,
a new development in EMERGENCY’s Paediatric Care and Cardiac Surgery
Programme in Africa.
The government of the Central African Republic had immediately provided
aid and support for the project, granting EMERGENCY use of a centrally
located plot of land near the Parliament buildings. This is where the Paediatric
Centre would be built. Construction began in March 2008. The project was
assigned to a CentralAfrican company that carried out the plans to perfection,
respecting the deadlines and the predetermined budget.
Finally, the Paediatric Centre was ready for its inaugural opening. With
its red and white coloured external walls, its surface area covers 550
square meters. It includes an internal patio transformed into a play area
with an imaginary grassy plains mural filled with toy crocodiles, rhinoceros,
The Centre, which is open 24 hours a day, seven days a week, offers
medical assistance to children up to 14 years of age. Immunisation and
health and hygiene education programmes are also offered.
international specialists come to screen and evaluate patients suffering from
heart disease to determine those in need of transfer to the Salam Centre
in Khartoum for treatment. After surgery, the patients are guaranteed post-
operative check-ups at the Centre in Bangui.
In Bangui, Like Goderich and Khartoum: Malaria
and Diarrhoea are the Most Common Diseases
News of the opening of the Bangui Paediatric Centre spreads rapidly by
word of mouth. In a scene similar to those in other EMERGENCY Pediatric
Centres - such as in Khartoum, Sudan and in Goderich, Sierra Leone - from
the early morning hours mothers and children crowd the entrance of the
hospital, awaiting their turn to be examined.
Each day, Paola a paediatric nurse, and Mariella a paediatrician, assisted
by local doctors and nurses, examine forty children on average. With six
beds in the Centre, the doctors are able to admit serious cases overnight,
as needed. Just one day after its opening, the first patient was admitted.
His name was Jonathan, who at 22 months was weighing in at only 7 kilos.
He arrived suffering from dehydration due to severe persistent diarrhoea. As
soon as he reached the Centre, doctors immediately initiated oral rehydration
treatment, and proceeded with blood tests for Malaria, which came back
positive. Together with his father who accompanied him, Jonathan will
christen the clinic’s new toys with the hope of going back home soon.
Translated by Roland Swan
Against Violence, Landmines and Accidents — Three Stories of Human Resistance
A plastic surgeon details his encounter with a few patients he treated during his work at the
of war, and facing new cruel realities.
hree girls — three stories from this ill – fated country’s history
spanning half a century.
The experiences of these three girls would be very unlikely to
happen in Italy, but if they were to occur, the detrimental effects
of the injuries sustained would be treated through an advanced health care
system, and their lives would be supported by social and public assistance.
In Cambodia these social infrastructures do not exist, at best there might be a
fragile, and not always available family support system to help.
Already faced with difficult lives, these three young women, having
undergone physical surgical reconstruction and prosthetic rehabilitative
training now find themselves facing the added burden of not having full use
of their own bodies. EMERGENCY assisted them in their rehabilitation, and
then when feasibly possible, in job placements, or by some small donations.
But the biggest feats were overcome by their own courage, which was key
to their recovery.
A disfigured face due to jealousy —
Then surgery and a job towards a new life
only half of her face was visible. Like most young Cambodian women, she
had fine, gentle features. She kept the other half of her face oddly concealed
with a towel which she uncovered as soon she entered the examining room.
What was revealed was a disfiguring two centimeter thick scar, banning
any type of facial movement. Her eyelids were now non-existent due to the
disabling scar, and the eye was wide open, with no protection of an eyelid,
and already covered with sores. Her lower lip was fused to her chin, as was
her upper lip to the side of her nose.
She was only 19 years old. Three years ago, Nhom was raped and
impregnated by a man in her village, who then decided to marry her. In the
two years following the birth of her first child, there were two more births.
And then, all of a sudden the man announced that he was going to Thailand
to find work. Left alone, Nhom Vun found work in the rice fields. But once
the harveting season ended, she had to find other work. She began to pack
and sell sweets, and earn good wages compared to the average Cambodian
salary. The husband, who had actually moved in with another woman in
a nearby village, now revealed a renewed interest in Nhom, and her new
In order to prevent any type of reconciliation between the two, the jealous
lover attacked Nhom by thrusting a bottle of acid over her face. At our initial
consultation, I informed Nhom right away that one procedure would not be
enough to restore a normal physical appearance, and that there would really
be no hopes to totally erase all the effects resulting from the acid burns. I
began the surgical intervention with the reconstruction of her eyelid, in order
to try to avoid loss of the eye. Removing the scar tissue, I realised that some
that some of the muscles of the eyelid had been damaged, but still existent.
So I began to reconstruct the eyelid with strips of tissue and cartilage from
behind the ear. The few remaining muscles would allow movement of the
eyelid, thus restore opening and closing of the eye.
The second procedure began by removing the scar tissue over the lips,
where I would have to proceed with a skin graft taken from the back of the
undamaged ear. Her lips began to regain some mobility, even though she
would need further corrective surgical intervention on her lower lip.
Returning to Battambang this year, I encountered Nhom Vun in the hospital.
She wasn’t there for a check-up, but as an employee. She was hired there
as an orderly. EMERGENCY frequently employs its patients to help them
socially reintegrate, especially those patients having undergone particularly
The medical coordinators say that everyone is extremely happy with her
work, and the patients really appreciate her. Every time we pass each other in
the corridor, she shares with me the gift of a beaming smile. The reconstructed
half of her face is not as graceful as the other [undamaged] half, but mobility
is close to normal. I am happy to have been able to contribute to providing this
young woman with the chance to a social life.
An accident at the beginning of a new life —
Landmines don’t know when war has ended
Den Srey Mao is 20 years old, and she has only been married for a few
months to a man so tall and athletic that he does not seem Cambodian. Their
families had given them a small parcel of land with a few animals (chickens,
ducks and goats) as a wedding gift in order for them to begin their new lives
together. They were farming vegetables on the land to sell at the market so
that they could earn enough to buy a pig at the end of the year.
One day while walking to it along the pathway which had undergone
landmine clearance two years earlier, and which she had passed through
countless times before, the young woman saw something strange on the
ground. It was too late, she was unable to avoid stepping on it. It was a
landmine which had been washed onto the path by heavy rains in the previous
days. Dan Srey arrived at the hospital with traumatic amputation of both her
lower limbs, loss of an eye and various wounds to her face.
The amputations were corrected by our orthopaedic surgeons in order to
allow fitting of prosthetic limbs. I was responsible for the reconstruction of the
orbital cavities. Two operations would be necessary: removal of scar tissue,
and enlargening of the ocular cavitiy for fitting of a prosthetic eye.
Three days before my departure Den Srey received her prosthetic eye,
a necessary step in restoring her face with a certain degree of physical
normalcy. While waiting for her leg stumps to heal so she can be fitted with
prosthetic limbs, her husband takes her home - where another new beginning
Two wigs for Proeung
Even hair becomes a form of treatment
Proeung Sreyrotha was 16 years old when I met her last year. She was
harvesting rice when she got too close to the fanbelt of a threshing machine.
Her entire scalp was ripped from her skull - from her eyebrows to her cervical
vertebrae. In the West, depending on how intact the affected skin is, we
treat these cases by surgically reattaching the ripped scalp, and through
microsurgical anastomosis, re-establish the blood circulation to the damaged
However, in Cambodia, the proper surgical apparatus for microsurgery is
unavailable. So in order to treat Proueng’s condition, she had to undergo
in Europe for over 40 years. After 6 operations and much painful medication,
we finally managed to cover Proeung’s skull with a layer of hairless tissue.
Some time later, in a very moving and emotional ceremony of sorts, we
presented her with two gifts. We gave her two wigs - one with short and the
other with long hair - so that she can continue to carry out her life as a normal
Translated by Roland Swan
Malnutrition and undernutrition are some of the effects of a global imbalance that has caused
recent alarm in the political world (under pressure from the speculative push to finance
raw material and consumer markets) especially among those where access to basic food
resources has been undermined.
hen the cost of bread rises excessively, revolts break out
for tortillas in Mexico, and mud cookies are baked in Haiti,
then we know that we are facing the disastrous effects of
a global financial manoeuvre that threatens the health and
even the lives of a large portion of the global population.
Even now, according to the Health World Organization, half of all human
beings – about 3 billion people – suffer from some form of malnutrition, a word
with various, but always worrisome, meanings.
and other factors necessary for a healthy life; this could be undernutrition – lack
of proteins vitamins or minerals, or overnutrition. In developing countries, one
person in five suffers from the worst form of malnutrition: hunger.
Grains produced for livestock feed rather
than human consumption
It is well known that malnutrition is due mainly to unequal access to food
resources rather than to insufficient food production. In fact, current agricultural
production could easily nourish the entire world population. The problem is
certainly underestimated, considering that a large portion of food resources is
diverted to animal feed instead of being utilized as food for the hungry.
Agricultural strategies adopted in recent years have resulted in complete
failure. Public and private institutions have actively promoted large-scale cattle
ranching in developing countries for production of meat and milk, without
considering that farmed animals consume more calories than they produce in
the form of meat, milk and eggs.
When the quarrel about biofuels and conversion of crops for their production
had not yet started, it was already evident that cereals were produced and
introduced in the market in large part to raise cattle rather than to satisfy
human nutritional necessities.
Official statistics, from FAO (the Food and Agriculture Organization of the
United Nations) and WHO (the World Health Organization) in particular, clearly
point out that a shift in cereal production for human consumption to animal feed
has forced developing countries to import grains at high cost, greatly worsening
the problem of malnutrition. In fact, in developing countries, staple foods are
mainly cereals and legumes, which provide the majority of carbohydrates and
proteins necessary for survival.
In a paradox, this diet that could be adopted in industrialized countries with
great health advantages, is now overlooked even in its traditional countries
of origin. Those who can afford it prefer a more occidental diet, where the
majority of the protein requirement derives from meat.
Food subsidies help donor countries and undermine
Non-governmental international organizations that fight world hunger are in
ferment to counter the steady increase in basic food prices.
Oxfam and CARE, for example, are running worldwide campaigns to raise
awareness and increase political pressure.
In fact, the forecasts of their experts indicate that predicted Eastern and
Western African tragedies could be avoided by immediate action on the part of
governments of wealthy countries.
“Food aids can save many lives”, says Ariane Arpa, responsible for
the Spanish Intermón Oxfam, “Unfortunately, the interests of Western
governments, tied with those of powerful agricultural groups and packaging/
shipping companies, frequently cause aid to arrive too late, at very high prices,
often destabilizing weak local economies”.
The humanitarian organization Oxfam has posted suggestions to remedy
these issues at www.oxfam.org.
In summary the suggestions are: increase donor as well as local
governments investment in small-scale agriculture (especially in sub-Saharan
African countries), cut incentives for biofuel production, and convince the USA
and EU to review their emergency food aid policies and focus assistance on
countries suffering the most serious consequences.
Translated by Ada Buvoli
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Every year war and poverty destroy the lives of millions of people.
In contemporary conflicts, 90% of the victims are civilians.
Since 1994, over three million patients have been treated in EMERGENCY’s
clinics, hospitals and rehabilitation centres located in war-torn areas.
EMERGENCY is an independent, neutral and non-governmental organisation
that provides free medical and surgical care to the victims of war, landmines
and poverty worldwide.
All EMERGENCY hospitals, clinics and rehabilitation centres are designed,
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train national staff.
The articles featured in this issue were translated from articles that
appeared in EMERGENCY’s magazine, issues 48, 49 and 50:
Training for Critical Care Units, September 2008 (48): 2-3
The Consequence of War, September 2008 (48): 4
Restarting and Expansion, September 2008 (48): 5
A Comparison between Goals and Results, September 2008 (48): 8
Worldwide Malnutrition, September 2008 (48): 14-15
Our Idea of Peace, December 2008 (49): 12
Good Morning Bangui, March 2009 (50): 2-3
A Flower in the Midst of War, March 2009 (50): 9
First the Children, March 2009 (50): 10-11
Cambodian Triptych, March 2009 (50): 14-15
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Collaborators on this issue Marco Antonsich
(MA), Ada Buvoli, Marina Castellano, Paolo
Chiappetta, Graziella B. Costanzo, Nadia
Depretis, Maureen Cairns, Robert Dvorak,
Janet Garcia, Anna Gilmore, Simonetta Gola,
Michele Isernia, Rossella Miccio (RM), Angelo
Miotto, Rosalba Perna, Dada Pisconti, Paolo
Santoni-Rugiu, Roland Swan.
Images Emergency’s Archive, Piergiorgio
Casotti, Cosimo Maffone, Samuele Pellecchia,
Graphic and pagination Angela Fittipaldi,
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