Isameldin M. H. Izzeldin
University of Strathclyde, United Kingdom
Asma E.I. Abdel-Gader
Khartoum Teaching Hospital, Sudan
Khalid M. E. El-Talib
Al-Shaab Teaching Hospital, Sudan
Hatim A. Nagi
National Insurance Fund, Southern Darfur
PURPOSE: This article is aimed at describing activities and findings of western-trained medical specialist visits to Nyala, the capital of Southern Darfur. This remote part of western Sudan is home for many internally displaced people (IDP) following well-known armed conflicts, and is a major financial centre and marketplace in Darfur. Cities and towns in Darfur are over populated, causing an increasing burden on under-resourced and underfunded health services. Activities of these medical missions include provision of specialist medical services and assessment of the existing infrastructure for any possible future development of local health services tailored to the specific areas explored.
STUDY DESIGN: A local healthcare provider planned an ongoing healthcare programme called Visiting Specialist. It was developed and sponsored by the Southern Darfur Branch of National Health Insurance Fund to help people of this remote and deprived region of Darfur. The programme was inspired by the difficulties endured by patients travelling a very long distance to the capital Khartoum at very high costs. Implementation of this seemingly popular healthcare programme narrowed the technical medical sub-speciality and healthcare gaps. These visits are meant to be bridges of communication extended from the centre transferring services closer to people’s homes at the peripheries.
METHODOLOGY: The visiting delegates: Two specialist visits were undertaken in November 2013 and January 2014, including Dr Isameldin Izzeldin, consultant neurologist and neurophysiologist, visiting from the United Kingdom; Dr Khalid Mohamed Eisa El-Talib, consultant physician and cardiologist, Al-Shaab Teaching Hospital, Khartoum; and Dr Asma El-Haj Ibrahim Abdel-Gadir, medical specialist registrar (rotation), Khartoum State Teaching Hospitals. The receiving delegates: the visiting team was received and welcomed by a well-assembled enthusiastic team from the Southern Darfur Branch of the National Health Insurance Fund, including managers of the different serving departments including public health, medical services, pharmacy, laboratory, transport and information. This team was headed by Dr Hatim Adam Nagi, Executive Director, Southern Darfur Branch, The National Health Insurance Fund, Senior and Experienced Consultant in Public Health and Community Medicine. The local team included personnel who normally looked after ongoing medical and health services on the ground, and additional personnel to ensure the success of the two visits and the visiting specialist programme as a whole. Local personnel worked hard to ensure the success of these missions, including the safety and comfort of members of the visiting team. The receiving team was far reaching and successful in managing the visit, starting with adequate advertising and publicity for the neurology clinics held, managing neurology referrals, establishing patients’ registration, administering and running the clinics, patients’ reception and introduction to clinics, trouble-shooting to ensure the smooth running of clinics, attending to the comfort and satisfaction of patients, and establishing a social work and economical assessment to support the poor and needy patients. The visiting team was fully sponsored by the receiving team for travel, accommodation and subsistence, in addition to financial incentives to the visitors. The reception provided was excellent; however, considering the state of affairs in Southern Darfur and the local circumstances of the people, it was indeed an outstanding effort.
FINDINGS: Nyala city is served by a few public hospitals with specialists for the main branches of medicine, but with gaps in sub-speciality medical services catering for complex medical conditions. However, medical laboratories and radiology facilities are reasonable and appear to be in tandem with the capabilities of current local healthcare apparatus. Details of two consecutive visits of western-trained neurology specialist to Southern Darfur are discussed. The local settings, circumstances of local healthcare and issues related to caring for patients with neurological disorders are explored. Patients’ demography, clinical information, presentation and management are discussed. Common neurological problems, mainly pain related and epilepsy, were treated locally and patients discharged; the majority of these were young and productive. This highlighted common neurological problems and identified immediate practical issues in training local medical and nursing staff. Important healthcare issues are discussed on local radio and television in a simple practical approach specific to the local needs and taking in consideration the available resources. This was aimed at raising public awareness on common neurological problems and addressing specific problems facing local people.
CONCLUSIONS: The neurological disorders encountered during these missions were found to affect the young productive members of this deprived population in Southern Darfur, mainly pain and epilepsy conditions. However, the majority of these neurological conditions were treatable and managed locally by the visiting specialist. Objective recommendations were raised to local health authorities to support efforts aimed at enriching patients’ experience, which shall reduce public suffering partly by provision of specialist services and vertical care. This promotes an environment conducive for training medical and nursing staff, possibly assisting with relevant audits and research that would provide future vision, anchoring long-term planning. It is expected that this simple model of technology transfer of specialist medical services and expertise might assist local development and advance understanding of local healthcare problems.
KEYWORDS: Neurology; Internally Displaced People (IDP); Under-resourced; Underfunded; Health Services; Specialist Medical Services; Assessment; Darfur; Sudan.