Reducing Mortality in Darfur
by Leslie Tate
Tulane graduate Caitlin Meredith recently returned from an assignment in the Darfur conflict region of Sudan with the international medical humanitarian agency, Doctors Without Borders/Médecins Sans Frontières (MSF). Meredith arrived in Darfur last December as one of 200 international volunteers and approximately 2,500 national staff MSF has based in the region, making it one of the largest humanitarian assistance programs in Darfur. As an epidemiologist working out of Nyala, the capital of South Darfur State, Meredith tracked trends in diseases with epidemic potential, implemented mass measles vaccination campaigns, and helped advocate for internally displaced persons (IDPs) within the camps and villages where MSF works in meetings with the local Ministry of Health and with health-related UN agencies working in the region. The conflict in Darfur began in 2003 and quickly devastated civilian lives; tens of thousands have been killed and millions displaced. MSF provides health care to nearly 1.25 million internally displaced people in 27 locations throughout Darfur, almost 78,000 patients each month. Prior to her work in Darfur, Meredith worked for two years in Kenya doing HIV/AIDS research and programming in diverse communities for various local NGOs as well as for the United Nations High Commissioner for Refugees (UNHCR) in camps for Somali refugees in the far northwest region of the country. She obtained her master's degree in public health from the Department of International Health and Development at the Tulane University School of Public Health and Tropical Medicine in 2002 with a focus on HIV/AIDS in Sub-Saharan Africa. In Darfur, Meredith witnessed the durability of the human spirit that persists in the harshest of conditions: violence against civilians, torrential rains, dust storms that obscured visibility within minutes, and an abundance of logistical difficulties and medical problems. In a crisis situation such as Darfur, epidemiologists use rapid assessments to determine a community’s most immediate needs. For instance, a common method to assess the malnutrition level of children under the age of five is to measure their middle upper arm circumference (MUAC). According to this simple measurement, it can be determined if a child needs treatment for sever acute malnutrition. Along with a project nutritionist, Meredith would analyze the results from such assessments in newly settled or previously unreached populations to form a snapshot of the community’s overall health status. Meredith carefully monitored the camps that house people from many different regions and tribes. While a rate of one death per 10,000 people per day signifies an emergency situation, the rate in Darfur hovered around .78, requiring careful monitoring by Caitlin and her colleagues. One of the most successful interventions Meredith experienced came after community health educators reported an unusually high mortality rate among children under five years old. When clinic data indicated that the incidence of diarrhea among under-five children was abnormally high, they recognized the immediate need for a mass-level oral rehydration therapy (ORT) infusion into the camp. Within a day, the MSF headquarters office in Nyala delivered necessary supplies from their emergency preparedness stock to construct ORT distribution points throughout the camp– and almost immediately, the mortality rate in the camp dropped to normal levels. Meredith will continue working as an epidemiologist with MSF this spring in the Democratic Republic of Congo (DRC), where people are enduring emergency conditions throughout the country. Meredith will investigate contributing factors among the communities in which MSF works in order to improve their health education, increase access to care, and reduce mortality. | 
