1. Belcher, David
  2. Stubenrauch, James M.

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So writes Grace Deveney, BSN, RN, one of two Boston-area nurses traveling the wide-open landscapes of Darfur or being immersed in ravaged villages to help the vast number of people displaced in the unfolding Sudanese humanitarian crisis.


Deveney and Katie Fallon, BSN, RN, are working with nongovernmental organizations to bring basic health care to villages decimated by roving Arab militiamen called the Janjaweed, which are backed by the Sudanese government. Across the 150,000-square-mile Darfur desert, which covers the country's west-central region, they burn and loot villages, often raping and killing inhabitants. As of November 2004, 1.8 million people have been displaced. Many villagers, most of them non-Arab ethnic Africans and mainly Muslims, have fled into neighboring Chad, but thousands have sought refuge in camps of internally displaced people and are facing malnutrition and disease in an unforgiving climate and landscape. (See On the Cover, page 111.)


Fallon and Deveney, who have both worked on general medical units at Massachusetts General Hospital for about three years, are the first nurses to be honored by the Thomas S. Durant Fellowship for Refugee Medicine program at Mass General, created in 2002 in honor of the late Thomas Durant, a physician from the same hospital who provided humanitarian medical aid in countries in need throughout his 35-year career. Those chosen for the fellowship interview with various relief organizations, which then help fund the fellows' expenses in conjunction with the Durant Fellowship program.

FIGURE. Katie Fallon... - Click to enlarge in new windowFIGURE. Katie Fallon, BSN, RN, before leaving Mass General this summer for Sudan.
FIGURE. Grace Devene... - Click to enlarge in new windowFIGURE. Grace Deveney, BSN, RN, of Massachusetts General Hospital, at work in a camp in Sudan.

Deveney arrived in Sudan last summer and has been helping a Concern Worldwide nutrition team in northwestern Darfur to train local staff to help villagers deal with malnutrition. She also works with the American Refugee Committee, and both organizations sponsored much of Durant's humanitarian work.


Much of Deveney's work involves the day-to-day trials of many African villagers, regardless of whether a village has been pillaged, such as finding food, places to sleep, and water. She has not experienced any violence firsthand but has seen the fallout, in terms of looted villages and broken lives. But life has continued; she says that people are amazingly resilient.


"I realize that the most surreal aspect of my time here has been the laughter-I never expected to laugh so much or to hear so much laughter," Deveney writes in an e-mail sent to colleagues at Mass General, who are wearing solidarity bracelets until the nurses return in five months. "When I drove into my first refugee camp I expected to see skeleton-like naked bodies, too weak to move, lying strewn across the sands. I expected wails and tears and heartbreak."


What Deveney found was a determination to survive.


"The children are half-naked and dirty, they have the characteristic swollen bellies and tiny limbs of malnourishment, they live in hovels made of sticks and rags and have the most horrific stories, " she writes. "But somehow, they have found a way to hang on to laughter and smiles."


For Fallon, who arrived in late September, the opportunity to ease the suffering of people in Sudan is an extension of a life-changing trip several years ago.


"When I went on a trip to a very rural and poor area of Peru teaching basic health practices, I realized that life is not about the money you have, the things you own, or what you look like," Fallon said in an interview in October before leaving for the nine-month stint in Sudan. "It's about the simple things like feeding your family."


Much of the work, Fallon said, is basic-but far from unnecessary.


"What I'll be doing is mostly health education-how to get immunizations, the importance of washing hands, and teaching prenatal care," she explained. "But the area is in such a volatile state that we're starting from the beginning-setting up camp, making sure they're out of immediate danger, moving mobile clinics on a truck from area to area."


A community-based therapeutic care approach brings the treatment of malnutrition into the community, in hopes of making extended stays in a hospital unnecessary. Traditionally, a child who is malnourished is treated in a feeding center, which can take months and requires 24-hour care by a family member; this is impossible for many households because there are other children or the caretaker must work. With the new approach, the malnourished child comes to a center at their camp once a week, for a minimum of four weeks, and undergoes a checkup. A week's ration of Plumpynut (a mixture of peanut oil and nutrients that's used to treat malnourished children) and a corn-soy blend are distributed.


This approach frees up health care workers, which allows more patients to be treated, and stabilizing malnourished children in the community prevents overcrowding in the facilities.


"At the moment we are treating up to 500 children at a single site (there are five sites), and the goal is to have the community run the program," Deveney writes. "Hopefully, if all goes as planned, the expatriate team here in Darfur will have worked themselves out of a job."


In the meantime, the basic work of staying alive continues, amid the constant threat of famine and warfare-and the laughter.


"I am in awe of the children who run around with a belly full of worms and play with a plastic bag as though it were the most entertaining thing in the world," Deveney writes. "Most of all I am in awe of the easy laughter of the people who have been driven from their homes with literally nothing but the clothes on their backs." (Go to for these and other observations by Deveney.)


On the Cover

The Darfurian girl on the cover was photographed by Gerald Martone, MS, RN, In 2004 at Kashuni refugee camp in Chad, near the Sudanese border. Marfone, director of emergency relief for the International Rescue Committee (IRC), met the girl and her two younger siblings at an IRC-run therapeutic feeding center In the camp, where more than 50 severely malnourished children are treated each day, "Bringing a starving child back from the brink of death is slow, tedious work," Martone said. "We often rely on family members lo provide the direct nursing care to these children, and it's not uncommon to see older children caring for their younger brothers and sisters because their family members have been killed or are in hiding."


Pictured on this page: three children in Otash Camp in southern Darfur state. The families wait in line for as long as five hours to be seen in the IRCs primary health care clinic.


Marione, a coordinator of AJN 's Correspondence from Abroad column, first traveled to the region last March to assess the public health consequences of the displacement of more than 1 million Sudanese by the Khartoum-backed Janjaweed militias (see "Crisis in Darfur, Sudan," Correspondence from Abroad, July 2004). Since then, public awareness has grown, and many have spoken out against the violence, calling it genocide.

FIGURE. No caption a... - Click to enlarge in new windowFIGURE. No caption available.