The summer of 2011 was a busy one for Matthew Horning, MD, primary care
physician at St. Luke's Chequamegon Clinic. He was finishing his medical
residency in Duluth and planning to marry a fellow physician, Monica Lee,
MD, in August. He also decided to work abroad with Doctors Without Borders/Médecins
Sans Frontières (MSF). Doctors Without Borders delivers emergency
medical assistance to people around the world who are affected by armed
conflict, epidemics, malnutrition, natural disasters or exclusion from
health care. "They had a strong reputation for doing good work and
going where other agencies wouldn't go," says Dr. Horning. He
sent in his application, and in May of 2012, he got the call to go to
a refugee camp in Yida (pronounced Yee-da), in South Sudan.
The Journey to South Sudan
Since it became a country on July 9, 2011, the Republic of South Sudan
has experienced violent conflicts that have displaced 300,000 people.
It's an inhospitable land with scarce water during the dry season,
and it becomes a flood plain during the rainy season. The refugee camp's
population had quadrupled to 60,000 people between January and July. "Doctors
Without Borders sends you all the information they have on the country
and weekly reports on patients, the hospital, disease states and mortality
rates. And they have developed protocols to guide the optimal treatment
of various conditions in resource-limited settings," says Dr. Horning.
His journey began with briefings at the Doctors Without Borders offices
in New York City and Paris. When he reached Juba, the capital of Sudan,
he was apprised of the needs at the refugee camp. "From there I took
a prop plane. For much of the flight, we flew over the White Nile, which
was beautiful," he says. They landed at the Yida refugee camp's
dirt airstrip and Dr. Horning helped load medical supplies onto a truck.
Then they went to the hospital compound, which was little more than a
series of canvas tents.
"You're On Call tomorrow"
"Right away they orient you to the hospital," says Dr. Horning.
"They said, 'You're on call tomorrow, here's the ward,
here's how it works'." The lead doctor had been with Doctors
Without Borders for two years. "He's in charge of the medical
team and he did a lot to help me get on my feet," he says. "We
shared all the inpatient care duties, including rounding in the hospital
and every other day on call, in addition to seeing all complicated outpatient
consultations." The most common conditions Dr. Horning treated were
malnutrition, diarrhea, pneumonia and respiratory tract infections, and
malaria. He says, "I was able to help and treat some very sick people
with limited resources. I left feeling I had worked hard, and that I did
my best to alleviate suffering and reduce preventable morbidity and mortality."
Working in a Community
"When I came back, it was easy to see how the experiences helped me
grow," says Dr. Horning. "I think the big take-away for me was
that here in Ashland, I'm in a community of neighbors, coworkers and
friends. I'm accountable to my community. In Yida, everyone does the
best they can to make a difference, but there is much less accountability.
The refugees have little recourse if there is no clean water, no clean
latrines, etc. If I think there's a public health issue in Ashland,
I can work to improve it. But in a refugee camp, people are disempowered.
There is no one to go to. Here, we have a culture that allows us to work
for change if change is needed."
Dr. Horning loves living and working in Ashland, and he's excited that
his wife joined him at Chequamegon Clinic in December. "We went to
medical school together," he says, "and it's nice having
her here in the clinic." They have a new baby, John, who was born
in July. Dr. Horning's experiences in South Sudan, while challenging,
have made him appreciate life in Ashland all the more. "I've
struggled to make sense of my experience since I've gotten back,
he says. "I was doing what I could to help the people inside the
camp, and I think we helped a number of people. But, I continue to struggle
with the idea that sometimes, unintentionally, humanitarian aid can do
as much or more harm than good... In Ashland, I am accountable to my community
and my patients; and it feels good to be engaged locally, as a neighbor,
as a citizen, and as a family doctor."
BELOW: Dr. Matthew Horning with his wife, Dr. Monica Lee, and son, John.