Medicine Module

Victor is the camp “pharmacist”.  Please see the transcript of his interview.  He took a simple first aid course long ago in Sudan and has set himself up as the refugee camp doctor – and is at least ten times more popular than the Doctors Without Borders hospital nearby.  His medical knowledge is nil – he uses the stethoscope to measure temperature – but he has some idea of dosages and has made a few basic connections – offering parasite medicine for diarrhea (though the problem is often bacterial or viral), etc.  Again, see transcript.  He has gotten quite wealthy from selling the medicines he purchases in Abeche.  He takes quite a bit of time over each patient and is very careful to detail dosages (even though he can’t read French and can barely write Arabic).  He is in truth a really nice guy – though I wouldn’t trust him with a blister – and desperate to learn more.  I spent at least two weeks trying to get MSF to train him informally but they had to refuse for liability reasons.
He treated both Sudanese and Chadian host community equally, though the Chadians were clearly poorer and had more poverty illnesses – parasites, etc.  Most of his patients were babies, which were almost constantly ill.
The room in the back is where he keeps his medicines – a massive supply, and worth an enormous amount of money.  I film several close ups to show what kinds of things he is prescribing.
He also gave many IV drips each day – a popularly requested item.  He did a very good job of inserting the needle, etc. and at least while I was there he used new needles every time.
He used the blood pressure cuff frequently but had no idea what it was for.
It seemed quite normal that he give IVs in a cardboard-covered hut in the dirt using a pillow of dirty plastic.
The colored liquid was vitamins.
Viktor uses the medicine packing boxes to line his walls against the rain, so I filmed some of them.  This can be intercut with earlier footage.  It’s much later in the day so there’s only one woman there.
Viktor also does the circumcision of the seven-year-old boy.  He is a good friend of the merchant, the baker, and my translator.


This is probably the most interesting (and scary) interview of the lot.  His name is Viktor (“the pharmacist”) and I liked him immensely.  He has eighteen children and four wives, which is why he says he works so hard (it also makes him an object of envy for the men in the camp).
There is a great story here – Viktor has the trust of the people and a huge patient base but very little training.  The modern hospital in the camp has the trained western doctors but relatively few clients since they were not yet trusted.  The tension between modern and traditional/ foreign and local is very apparent.  The solution, as usual, is a compromise – tangibly presented in the hospital “ambulance” – which is a donkey cart. 
The last two shots are Viktor’s first aid certificate from Sudan – of which he is immensely proud, but which really only proves that he knows less than your average American first grader.  Once again, I want to emphasize that Viktor was desperate to learn more, understood the limits of his knowledge, and did an excellent job in patient management, dosages, and bedside manner.


This is a mullah – an Islamic wise man.  He (or another Mullah) would normally be the first stop if someone was feeling ill and wasn’t sure what the problem was.  I’ve gone to him to make a gris-gris, the amulets used to ward off bullets and make the wearer invisible.  He very kindly does so, as well as making some sacred water that we all drink.  His name is also Hajj, since he went to Mecca.
He has written out a number of Suras from the Koran (all relating to the same topic, like heart trouble).  He then folds them carefully into a square and sews it together.  He will then buy the leather pouches from the guys in the market (who buy the leather from the tanner) and stuff the sacred words inside.  You are supposed to wear them under your clothes.  You cannot bathe with them, use the toilet with them on, have sex with them on, or menstruate with them on.  The more you wear, the better.
Part two (a different visit – I went to see him over a dozen times).  The Mullah writes on a wooden tablet in black ink and then washes the sacred Koranic words into a bowl with water.  You either drink the water immediately (usually as a medicinal cure) or mix it with flour, which you then dry and reconstitute at a later date to drink when it gets to its intended recipient.
Unfortunately that hut was so small and my presence there so precarious that I was unable to shoot from more than one angle.
Alfadil, my translator, is drinking the water (and myself) and his kids.
If the sick person cannot drink the water immediately, then the Mullah mixes it with flour, puts it on the roof to dry, and hands that off for later consumption.


A small cut – or two – is made near the site of the pain or ache.  A razor is used (same one for everyone).  The horn is then laid on top and all the air sucked out of it, and the end stopped up with saliva and a bit of paper.  Then a long wait, the pressure released and the blood scraped off onto the sand and the process repeated over and over.  The initial cuts are smaller than expected.  You will later see a man who has over a thousand cuts on his torso where he has had this done weekly for years.  I asked if it hurt and he said yes, but that it felt better afterwards.  They only seem to have one cow horn, since I saw it used in over a dozen places.  Note how quickly the blood coagulates in the heat.
I suspect that this fellow has arthritis.
Spit helps to make the seal.
Once they’re done he washes off the leg and then carefully picks up all the blood and buries it, since it is a body part and therefore sacred to Allah.


Another example of bleeding.  This man very kindly agreed to wait for me.  His wife is doing the bleeding.  She has done it for years and years.  First she cuts with a very old razor in the several places that he indicates, then does the usual sucking with the horn.  She said that at first she didn’t want to do it but her husband insisted.  After it is over he feels better for a few days and then the pain comes back.
In the past he had pain in his stomach and the highly scarred skin there shows years of prior bleeding.
I interview her informally while she’s waiting for the bleeding to work and her answers are quite interesting.  She clearly loves her husband.  He says that it hurts quite a bit but that it feels better later on.  And that if she doesn’t do it then his stomach (far from the site of the bleeding) starts to distend.
Look at the close up of the husband’s skin – he has over a thousand cuts, by my calculation – given how often she says she has cut him.  I’m quite surprised that the flies insist on landing on the scars on his stomach, which seem to have healed over completely. 
A few wide shots of the compound they are in to set the scene.  He then points to another place that hurts and the neighbor takes over and cuts some more.  There isn’t much blood loss and the wounds are quite superficial, so no real damage is done unless there is an infection.


These women are all waiting for one of their number to undergo the burning treatment.  This is very common as a traditional remedy in the camp.  Certain “healers” specialize in this – they burn with a hot iron to cure illnesses.  The man whose face you see in close up says his cure is for hepatitis, and that during the height of the hepatitis season he burns 5-15 people per day.  Sadly, there is a vaccine for hepatitis A, but the refugees do not have access to it.
Hepatitis A has several very well established symptoms – notably yellow eyes and dark urine, etc.  He checks for none of these things (and doesn’t know about them) and the girl he is going to cure clearly doesn’t have the disease.  Hepatitis A is rarely fatal (unless the immune system is already compromised) so his patients get better on their own and his burning cure gets the credit for it.
Footage:  he gets coal from his mother’s cooking fire.  She taught him this cure and passed her patients on to him.
He brings it to the mat area that he has already laid out.  He puts the coals in the sand, buries the hand-made tool among them, and puts some cold wet sand on the handle.  He then makes a second burning tool.
The sick woman moves over to the mat.
She sits down and talks to him.  She starts to rearrange her clothes so that he can get at skin where he needs to burn – arms, legs, back.
The man then looks at various points along her hands and arms, examines her nails.  He is actually pointing out the places that he will burn.
He pulls the thin metal wire out of the fire and burns her arm and fingernail.  He is working quickly and abruptly.
It is his mother fanning the fire. 
Pulls out of fire and burns again – two times in each place.  He does both arms.  It really hurts but she doesn’t react much.  The Sudanese are remarkably stoic when it comes to pain.
Now he does other arm.  It is her aunt that has an arm on her shoulder.
Note the woman she has brought with her – it is her aunt and also her chaperone, since this is a strict Muslim society and she should not be in face-to-face contact with strange men.  Also note how she squirms around inside her clothes to show only the smallest possible patch of skin.  In some ways she is more worried about this issue than she is about getting burned.
The symptoms that she describes are general fatigue, ache in bones, and possibly a fever.  He does the other arm several times and one of her toenails.  He then talks to her for a while.  The burns are painful but not too deep.  She covers up and then uncovers the base of her back.  Mom makes sure the brand stays hot.
He then examines the base of her back for just the right spot.  This whole thing takes less than five minutes from start to finish.
He burns her one final time and the woman says “Halass” which means “finished.”
He then gives her some ground up root and bark that he has collected in the forest.  She is to brew it into tea, wait for it to cool, and drink it every day until she feels better.
She has to come back in a couple of days (and pay again) to be checked over.
Woman say she has pain all over her body.
The burner says that the places that were paining her will now go away.