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Join us as we talk with Gillian Burkhardt, an obstetrician-gynecology physician currently on assignment with Doctors Without Borders in South Darfur. We explore the devastating impact of the ongoing conflict in Sudan, which has created one of the world’s largest displacement crises. Gillian shares firsthand accounts of the maternal and neonatal health crisis, the challenges of providing care amidst violence, medical supply shortages, and the urgent need for international support to address these critical issues affecting millions of displaced people.
Gillian Burkhardt is an obstetrician-gynecologist.
She discusses the KevinMD article, “The maternal and child health crisis in Sudan: a call to action.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast. Today, we welcome Gillian Burkhardt. She’s an obstetrics gynecology physician. Today’s KevinMD article is “The Maternal and Child Health Crisis in Sudan: A Call for Action.” Gillian, welcome to the show.
Gillian Burkhardt: Thank you so much for having me, Kevin.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Gillian Burkhardt: So, I’m an OB/GYN currently based in New Mexico for the last eight years. I started my career in reproductive health as a Peace Corps volunteer, actually, more than 20 years ago, working in Madagascar. After I finished my residency in Boston, I began working with Doctors Without Borders and other international organizations in places like Liberia, the Democratic Republic of Congo, and Sierra Leone. I moved to New Mexico about eight years ago and worked for several years at an academic health center here as the medical director of our labor and delivery unit. I was very engrossed in the COVID response, which, you know, had me a little bit burnt out by the time I finished three or four years of COVID. I wanted to return to some of the things that drew me to medicine in the first place and went back to working with Doctors Without Borders about a year ago to really address the crisis in Sudan in multiple different aspects.
Kevin Pho: Alright, so we’re going to talk about that more. Your KevinMD article is “The Maternal and Child Health Crisis in Sudan: A Call for Action.” So tell us what led you to write this article in the first place and then talk about the article itself for those who didn’t get a chance to read it.
Gillian Burkhardt: Yeah. So, as I mentioned, I’ve been working on the Sudan crisis for about a year ago in October, first working on the side in Chad, actually, where people were fleeing Sudan into Chad. In the last couple of months, Doctors Without Borders found that there were alarmingly high rates of maternal death in Sudan. Sudan has become probably the largest humanitarian crisis in the world, with over one in five people in the country displaced internally or fleeing the country to escape violence. As a result, the health care system has completely broken down.
I know there are many crises around the world, both conflict and war and health care systems that are falling apart. It’s hard sometimes when we get inundated with so many, but I felt that having been working in this country and around this issue for a better part of a year, I wanted to be able to share a little bit of what I was seeing in Sudan.
I’ve worked on maternal mortality in many different countries, including South Sudan and here in the U.S., and it is really hard when you have pregnant women who are dying in childbirth or after childbirth, no matter where you are in the world, whether you’re in New Mexico or Boston or Sudan. But I think what I was seeing in Sudan is probably one of the worst that I’ve seen in my career.
Kevin Pho: So tell us, what did you see during your time in Sudan? What are some of the things that you can describe?
Gillian Burkhardt: You know, I think what is hardest about the acute crisis in Sudan, and in Darfur in particular, where I was focused for the last six months, is that women are dying from things that we really do know how to treat in the U.S. People are dying having deliveries at home in part because they can’t reach the facility or because that’s culturally or traditionally where they prefer, feel most comfortable delivering. But then when they have a hemorrhage after delivery, they can’t reach the facility. Women are coming into the hospital where Doctors Without Borders is supporting with hemoglobin substitutes and are really completely in a state of shock—hemorrhagic shock. There’s really nothing we can do at that point when they are so critical.
The most common reason that people are dying in the facilities that we’re seeing is actually sepsis, also from lack of supplies like antibiotics. We are facing really severe shortages of supplies in part due to the conflict and being unable to bring things in. The golden hour of treating sepsis within the first hour is really, really hard to do. So that’s the main reason women are dying and newborn babies as well from sepsis due to the inability to start treatment in a quick, timely fashion.
Kevin Pho: Now, for those who are not versed in the history of Sudan and the history of violence, you talked about this bleak picture inside the hospital and the lack of access to health care and medications and antibiotics and basic necessities. Tell us how that threat of violence has led to this grim health picture.
Gillian Burkhardt: Sudan has been in conflict for the last 20 years, but it really erupted again in April of last year, April 2023. Unfortunately, health care facilities are not immune. They have been attacked and just completely destroyed. The facility that I was working in most recently is the Nyala Teaching Hospital. It’s a Ministry of Health facility that was a 700-bed hospital with 13 OB GYNs, a full ICU, and about 10 operating rooms. Now it’s completely destroyed. There are bullet shellings through the roofs of different buildings. Doctors Without Borders has renovated the maternity and pediatric wards, but people are scared to come to facilities because sometimes they’re inadvertently targets. It’s also difficult for people to move around because there’s concern about attacks as they’re trying to reach the facilities.
Kevin Pho: And for yourself, what was it like to practice there? Did you feel like your safety was under constant threat of potential attacks, and how did that influence some of the care that you had to give there?
Gillian Burkhardt: We could not move around at night, for instance. Doctors Without Borders staff were restricted from movement in the evenings when it was not safe. So if there was a mass casualty that came in at night, there would be staff at the hospital, local staff, but people couldn’t necessarily come in and out to supply support. Personally, I felt overall my security was safe, but it wasn’t without risk. We did have airstrikes while I was there and had to respond to mass casualties of wounded people coming into the hospital. The local staff have been through so much and are the ones who have witnessed this the most, but they are incredibly resilient, continuing to provide care and services that are so desperately needed.
Kevin Pho: And how big was the Doctors Without Borders staff there?
Gillian Burkhardt: Our staff was actually pretty small. In this particular hospital, we had about 50 local staff, but we were supporting the Ministry of Health. I don’t remember the exact number, but we had a couple hundred nurses and doctors that we were supporting—the Ministry of Health clinicians, nurses, hygienists, and administrators as well.
Kevin Pho: In your article, you also wrote about sexual violence and how there were barriers in terms of providing care for victims of sexual violence. Can you talk more about that?
Gillian Burkhardt: Yeah. I mean, we are aware that sexual violence has become a weapon of war in places like Sudan. The actual scope of the problem is hard for us to know. It is very stigmatized, and it’s very hard for people to feel comfortable accessing the care they need after a sexual assault. We have started to see an increased number of survivors coming forward through some community-based models that we’re starting to implement, so there’s a little bit less fear and stigma. But we don’t totally know the scope of the problem. I do know women are scared to move around, particularly at night, because of fear of being assaulted. The perpetrators are both civilian and military, and we don’t know the full scope of what’s going on.
Kevin Pho: And in terms of the message that you want my listeners and the KevinMD audience to hear, other than this grim news that you’re talking about, how can the outside world help? What are some things that we can do to help with this situation?
Gillian Burkhardt: I think the first thing is to recognize that people are really resilient. There are stories of survival that give me hope about doing this work—women who come and travel many hours after delivering in rural mountains, have a hemorrhage, arrive, get a blood transfusion, and overcome these severe scenarios. Being aware of what’s happening outside our own communities while also supporting locally, listening to your communities wherever you are, whether it be here in my home state of New Mexico or in Sudan, is important. We’re all interconnected.
Doctors Without Borders offers ways to support the work they are doing in Sudan and other conflict areas. Their website, doctorswithoutborders.org, is one way to stay up to date on what’s happening and also to support their efforts.
Kevin Pho: And you said that you were in Sudan for a year, correct?
Gillian Burkhardt: Well, on and off for about a year. I was working in Chad first, which was part of the refugee response, and then in two different parts of Darfur on and off. Overall, it’s been a total of about a year. Seeing such dire situations day after day has been challenging.
Kevin Pho: Talk about how that affected you as a physician, just seeing this on a daily basis.
Gillian Burkhardt: It’s hard and sometimes discouraging and tiring, but there are stories of resilience. It’s also about the individuals we care for—whether you’re in New Mexico or Sudan, we are touched by our patients’ lives. That’s what keeps me going. The individuals who come and smile every day despite everything, and the Sudanese people who have been through so much. The Doctors Without Borders Sudanese staff are still there doing all this work without knowing when it will end, but they keep going, keep smiling, and hope they’re making a difference.
Kevin Pho: And do you plan on going back in terms of your next experience with Doctors Without Borders? What are your future plans?
Gillian Burkhardt: I hope so. Working with Doctors Without Borders, it’s hard to know where you’ll go next. I’m going to take a little break here, enjoy the sun and green chili of New Mexico, and go back to my hospital here for a few months. I do hope to be able to go back to Sudan or other places in the future.
Kevin Pho: Now, for those physicians who are listening to you on a podcast and are inspired by your work and the work of Doctors Without Borders, tell us how they can help. What are some of the questions that they should ask themselves to see whether they may be the right fit for something like this?
Gillian Burkhardt: I think working internationally, a lot of people think, “Oh, I can never do this,” but being a doctor is hard work no matter where we are. It requires flexibility, adaptability, and thinking outside the box. Having that mindset makes working internationally feasible for many, but it also doesn’t mean it’s for everyone. There are ways to contribute through supporting organizations or by supporting local communities. Immigrant populations and refugees are coming into the U.S., and supporting them is also crucial.
Kevin Pho: We’re talking to Gillian Burkhardt. She’s an obstetrics gynecology physician. Today’s KevinMD article is “The Maternal and Child Health Crisis in Sudan: A Call for Action.” Gillian, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.
Gillian Burkhardt: Thinking about this, doctors are really privileged that people trust us no matter where we are. Medicine is changing in the U.S. and globally, and we all have our little part to play, whether it be in our small town in rural New Mexico, New York City, or Sudan. I encourage people to keep working on following your dream of why you became a doctor and what inspired you to do the grueling work of medical school and residency. It doesn’t matter whether you’re working in Sudan or in New York City; there are people who trust us to care for themselves and their families.
Kevin Pho: Gillian, thank you so much for sharing your story, time, and perspective, and thanks again for coming on the show.
Gillian Burkhardt: Thanks for having me.
