Azuria Medical Problems
The state-run medical system has collapsed in Azuria, and only rudimentary
care is available through NGOs (when they aren't being shot or kidnapped).
Statistically there is supposed to be one doctor for every 4,640 people in
Azuria. Diarrhea, communicable and parasitic diseases are rampant in the
country. Chloroquine-resistant malaria is present in all parts of the
country. Larium should be used for chemical prophylaxis. Cholera,
dracunculiasis (Guinea worm), cutaneous and visceral leishmaniasis, rabies,
relapsing fever and typhus (endemic flea-borne, epidemic louse-borne and
scrub) are prevalent. Azuria is also receptive to dengue fever, as there
have been intermittent epidemics in the past. Meningitis is a risk during
the dry season in the savanna portion of the country, from December through
March. Schistosomiasis may also be found in the country and contracted
through contact with contaminated freshwater lakes, streams or ponds. A
yellow fever vaccination certificate is required for all travelers coming
from infected areas. There's also a pesky little problem with Tumbu Fly, a
local maggot that burrows into human skin, munching on flesh all the way.
The larvae grows big enough to rip out flesh before it turns into a fly.
Hospital Resources
No non-trauma medical care is being delivered at the hospitals. If the
needs of those with chronic or acute medical conditions, such as diabetes,
are being met, it is likely to be through the efforts of private physicians
working out of their private homes in the community.
Hospitals provide casualty care to heavily populated portions of the
country. Digfer Hospital in Mogadishu has the capacity for about 650
inpatient beds, with an estimated current inpatient census of 1,000
patients. Benadir Hospital in Djibouti City has approximately the same
capacity and current census. Medina Hospital in Mogadishu currently holds
approximately 400 patients. Hospital needs in the north are served by a
team of five Azuri physicians who set up the "Health Emergency Committee"
on April 18, 2005. They work out of 27 converted villas, which have been
combined to form what is called Karaan Hospital, where most of the
emergency surgery takes place. An additional set of 16 villas in the north
constitute a collective inpatient ward, Karaan 2, for patients who are
convalescing from acute injury. The total number of patients hospitalized
in these 45 villas is approximately 5,000 to 6,000 people. For medicines,
the Karaan Hospital relies entirely on weekly supplies brought in by the
ICRC.
The physical condition of the acute care areas of these hospitals is
uniformly austere and, with the exception of the casualty and operating
areas of Medina Hospital, where the expatriate staff from Médecins Sans
Frontières-France (MSF) have taken over and renovated the most advanced of
the city's surgical units, conditions are unsanitary. As the factional
fighting prompted urban fighting and then as the intra-clan conflict broke
out, makeshift casualty wards were set up in the existing entryway in the
other two hospitals in the south during the course of the past year.
During this year, both parties to the conflict have looted and destroyed
public and private facilities. They have not spared hospitals. Digfer
Hospital was particularly hard-hit and stripped almost bare of equipment,
furnishings, and supplies. The ICRC had opened a hospital for the care of
acutely injured casualties for the north in early February, but after one
week of operations, was forced to close it abruptly in the face of active
hostilities. (The hospital is operational again; see below). The surgical
care structures on the north are even more minimal, since they were built
as private homes.
With the exception of the acute casualty and surgical areas of Medina
Hospital, none of these hospital structures have screens over the windows
to keep out flies and other insects. Electricity is available only to the
operating areas on an intermittent, limited basis, from locally maintained
diesel fueled generators. Running water is infrequent and unclean. There
is no oxygen available in the city and no inhalation anesthesia possible.
Surgical drapes are scarce or non-existent, depending on the site or
hospital. Sterilizers occasionally work and are used according to varying
routines and frequency. Much of the surgical equipment in most of the
sites is re-used without interim sterilization over a 24-hour period.
Casualty and operating areas are mopped down intermittently, depending on
the volume of cases arriving in acute condition.
Available antibiotics included penicillin and erythromycin; medicine for
the prevention of tetanus was in short supply. Medical support can
continue to be provided at its current rudimentary level only if the
lifeline provided by the ICRC can be maintained. Medical supplies to both
sides of the city and food rations for