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Archive for the ‘Health facilities’ Category

I’ve left Sudan.

The Haiti earthquake happened and Tearfund offered me a job working on the Haiti relief response, starting immediately. Before I knew it, I was on a place heading back to London and I’m still reeling from the speed at which it all happened; let alone the change itself. 

I may be in London, but I’m not ready to leave Sudan behind altogether. You can’t put your head and heart into a place and then expect to extricate yourself from its – oft’ oppressive – embrace, overnight. Not to mention the fact that I had too much still to write about.

I wanted to write about the day the Russians and Moldovians arrived in Motot with their bright yellow Caterpillar diggers and their vodka. They were building a road from the State capital and it was to take in Motot on its way. Day by day, inch by inch they piled high the silty, sandy earth and steam-rollered over it, compacting it into a smooth, hard mud road – which one can only assume will melt away come the rainy season’s onslaught; but perhaps I am wrong. I hope so -because  a road will change everything.

Giant, shiny yellow machines and white faces ploughing through the long grass with mud huts dotted around, was the most incongruous sight. I wondered what the road builders had made of the place they had landed in. Perhaps they gave it no thought at all – after all, they had airlifted in their own little world complete with portacabins and televisions and toilets. But when they sat behind the wheel of their enormous vehicles, bulldozing through nothingness, and looked around them, what did they think? Of the women with their babies in baskets on their heads; of the mud huts and cattle; of the swollen-bellied children. Of the complete absence of anything else.

Road Builders in Motot

 

I wanted too, to write about the day Duol was born. His mother, Nya Pal, had walked for four hours through the night to reach our clinic and delivery rooms. She walked alone and told me that whenever the labour pains were too severe she would stop and crouch in the grass, waiting until she was able to move again.

Women in Wuror County traditionally give birth at home in a mud hut, with the help of  a traditional birth attendant. Home births may be very in vogue in the developed world, but the maternal mortality rate in South Sudan is the worst in the world. Even if you’re lucky enough to get through the labour itself, one in seven children die before their fifth birthday. It’s a dangerous game, being born, for all parties concerned.

When the delivery room was first opened in Motot, it stood empty. No one came to give birth and no one wanted to. But then in November ’09, one of the Tearfund nurses ran a series of mobilisation workshops in the surrounding villages. She gathered together the traditional birth attendants and trained then on safe delivery methods. She gathered together pregant mothers and explained the benefits of a sanitary space to give birth, a clean implement to cut the cord, and qualified professionals who can assist if somethign goes wrong. She gathered together the men and told them that their wives and children stood a better chance of surviving if they came to the delivery rooms. And she told them they’d get a towel, a bucket and some soap if they did.

Days later, the women started to come. These days, there is at least one baby a day born in the unit. For somewhere like Wuror County, the figures are extraordinary.

I had just put my head round the door of the delivery room to ask a question – I was told that the labour had at least two more hours to go. No sooner was I inside, one of the nurses exclaimed, Nya Pal let out a muted groan and over someone’s shoulders I saw the head crown. Seconds later, a slippery pale little body was pulled out.  And so Duol was born. With the cord around his neck, but with a nurse to quickly remove it.


Duol, means ‘meeting’, a name his mother chose as a big community meeting was taking place as she delivered him. It could have been worse: whilst out on a survey I met a child called ‘argument’.

Reuters picked up the story, before I even had a chance to put it on my blog:  http://www.reliefweb.int/rw/rwb.nsf/db900sid/ASAZ-83FK3M?OpenDocument.

Oh, Sudan. Such a frustrating, imagination-defyingly complex and incredible place.

Sometimes it feels as if I was never really there.

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Remember Khot?

I do. The last time I saw him he was dying: a skinny wee thing with blood pouring from his nose and mouth. He lay in the dirt, muddy tear trails on his dirty cheeks, and flinched when you touched him. After much deliberation, we drove him to a hospital a long way away for treatment and I have thought about him ever since.

Today he visited us in the compound. He is back from the hospital; he is well.

His name is Khot and this time he is smiling.

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When I first arrived in Sudan I was astonished to discover that the place was teeming with hedgehogs. They were everywhere! The moment darkness fell, out they would come with their squeaks and snuffles, hoovering up bugs with greedy little snouts and sneaking into our food store and mudhuts. My hedgehog paradigm was momentarily thrown off. Hedgehogs are quintessentially English, surely? Wintery little British garden creatures? Apparently not.

It had also never really occurred to me that people had strokes in Africa. I don’t know why. Strokes seem like a peculiarly Western affliction to me, for reasons I can’t really put my finger on. Perhaps it’s because we associate them with getting older, thus the low average life expectancy in many developing countries means that we don’t hear about them as frequently.

On Saturday, a critically ill, elderly man was brought to our health unit in Motot, carried by men from his village who had walked for hours. I arrived to find him lying on the floor (we don’t have an inpatients facility), paralysed and unable to speak, slipping in and out of consciousness. He was, perhaps, sixty years old and had been like this for two days.

We referred the man on to a medical facility with a doctor able to assess him. A day or so later, they told us that it was likely that he had suffered a stroke; that there was nothing they or anyone else could do. The doctor explained to the man’s wife how best to care for her husband at home, then contacted us and asked us to collect the patient. There are no options for long term care here.

And so this morning, we drove the paralysed man and his wife back to their village. He will live out the rest of his days on the floor of a dark mud hut, though he is luckier than some: he has a wife to care for him.

Some things are universal, it seems; though access to healthcare is not one of them.

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Statistics have swallowed me whole. Writing our funding proposal for next year has taken over our lives of late; whole swathes of the population are reduced to a demographic: malnourished under 5s; returnees; pregnant and lactating mothers, ex-combatants. The extent of the need overwhelms, thus by necessity it is herded into manageable areas of intervention. When you write the words, ’24,000 access local health facilities run by Tearfund’, the people have no faces.

At the end of 2009, we were informed that the one and only medical centre in the county with a doctor and an inpatients facility was to downgrade to a basic health unit in the New Year. We understood the implications of this – no longer would we have anywhere to refer seriously ill patients for treatment in our area of operation. Complicated pregnancies; gun shot wounds; life threatening illnesses: now there is no where to go.

We understood the practical implications, yes, but perhaps not how it would feel to have to tell someone you cannot help them.

A few days ago, a little boy arrived in our health unit, carried by his family. Blood was streaming from his nose and mouth, he could not eat or drink,  his body was stiff and he was in agony. Our health workers are not doctors and short of giving him some paracetamol, could do nothing for him. He hadn’t eaten or drunk for days and was frighteningly thin. I stroked his head and watched him wince as I fed him porridge.

The nearest health centre with an inpatients facility is now in Lankien – a 12 hour walk away for a strong and healthy man. Who knows how long it would take a mother and grandmother to carry a sick 9 year old boy? Our only functioning landcruiser was out in the field delivering food to hundreds of malnourished children. The following day the car was scheduled to do the same again. Do you divert the car, risking the lives of hundreds, to save the life of one? If we take this boy, do we simply stop all our other activities? If we take this boy today, will we be beset by queues of sick people demanding transport to Lankien tomorrow?

So often here, one is forced to move from the abstract to the personal in a flash. From strategy to reality; from policy to life-or-death. And then you have to sleep at night.

We took him to Lankien in the end. Our vehicle had to travel there as part of a scheduled security assessment a few days later and the little boy was still very ill. He was admitted to the centre and is being tested for Kala azar and TB. Perhaps I’ll see him running about in Motot again, one day.

He is only the first in a long line.

His name is Khot.

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As the rainy season recedes, life in Nuer-land hots up. Less available water, more movement, more fighting.

It’s been a busy, volatile and challenging week – a testament to the change in both season and temperament, perhaps. Yesterday morning I was awoken at 5.30am by one of the irritating roosters we purchased recently, crowing extremely loudly, right outside my tukul. I finally managed to get back to sleep only to be awoken again by a barrage of heavy gunfire in the nearby village. At least the gunmen chose a more sociable hour than the cock. My temperament has changed too, it seems: I ate the chicken prepared for lunch with an unusual degree of relish.

At the beginning of the week, our nutrition and health teams journeyed to one of our more distant feeding centres to carry out routine activities. Not long after arrival, the community rushed to them with a gunshot victim and a severely ill old man and the team soon found themselves on an emergency dash through the bush, transporting the patients to a health facility. On the way back, the gears on the larger of the two vehicles failed in spectacular fashion. Somehow, they managed to persuade the land cruiser all the way back to the compound in fifth gear. No mean feat considering there are no real roads and the grass is as tall as the windows in places.

Late the following evening, as we savoured our rice and goat (for a change) in the dark of the mess-area, one of our nurses rushed in. After an arduous labour, a local woman giving birth in our health facilty nearby had produced a healthy baby but had failed to deliver the placenta.  It was late, completely dark and staff were exhausted after a gruelling day, but left until the morning she’d surely die. The decision was made to transport her to Médecins Sans Frontières’ health unit in Pieri where the doctors were standing by. They made it there in time, saving the woman’s life, despite the lights on the vehicle giving up the ghost mid-journey. They battled their way through bush-land to Pieri in pitch-black darkness, guided by nothing more than the light of a torch and the stars in the sky.

Security is heightened due to talk of forthcoming disarmament and our activities are persistently hindered by logistical challenges, but donor reports do not wait. So amidst all the to-ing and fro-ing we’ve been immersed in reports and proposals for which the deadlines are – conveniently – all at the same time.

So I thank God for small mercies: growing friendships; the one and only fan on the compound; the discovery of a tin of tuna in the store; emails from much-loved friends at home and Bombay Sapphire in the evenings under an inconceivably large expanse of sky.

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Fighting has broken out in Motot, a couple of kilometres from our compound. Over the past few days – fearing for their lives if they stay in the area – some of our local male staff have been requesting leave from work. It’s an inter-clan dispute: people were killed, revenge is sought, and so it goes on.

As I type, war cries sound from the village next door. The women are beating their hands against their mouths; horns are being sounded; there is singing and the beating of drums. Soon there will be gunshots. Yesterday one gun-shot victim was brought to our clinic; tomorrow perhaps there will be more. An army vehicle drove past our front gates today, soldiers hanging off the back of the pick-up truck. But the response, indeed the capacity for response, is inadequate, even for this comparatively small-scale violent episode. With a heavily armed civilian population, even the smallest of disputes turns bloody.

We are safe here: the threat is not directed at us and almost never is, but the same cannot be said for many of our local staff who live in Motot and are involved in the conflict. Or perhaps the families they have left behind. I pray that it is safe for them to return soon, but it’s hard not to feel frustrated and a little desperate when in all likelihood, it will happen all over again next week or next month.

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So here’s what my days look like in Motot:

  1. Awake to singing and the smell of wood smoke.
  2. Respond to the radio operator, “Mike Zulu Yankee base, this is …. “, to confirm I have not been eaten by a snake during the night.
  3. Walk through sand and dust/ankle-deep mud to the bucket shower. Evict any unwanted creatures. Shower.
  4. Emerge from shower to find goat being slaughtered immediately outside.
  5. Put on clean clothes, go outside, immediately become dirty.
  6. Spurn the sweet potato prepared for breakfast in favour of expired Fruit and Fibre (picking out the weevils).
  7. Go on monitoring visit to one of our project sites (emergency feeding, immunisations or community health education training).
  8. Attempt to stem feelings of anguish/anger.
  9. Return to the compound dripping with sweat, now covered with extra dirt donated by small children.
  10. Eat rice and goat.
  11. Return to office to assist in editing proposal requesting funding for humanitarian activities.
  12. Type with one hand using the other hand to flick away flies.
  13. Languish in the 39 degree heat.
  14. Team devotions. Participate in horrendously out of tune singing.
  15. Eat rice and goat.
  16. Watch poorly dubbed Kenyan/Mexican soap opera which may or may not include references to kidnap, murder, and bestiality in the space of one episode.
  17. Walk to mud hut with the assistance of stylish head torch.
  18. Read book on my Sony e-reader. Whoop.
  19. Take copious number of vitamin supplements to give the rice and goat a helping hand.
  20. Listen to the occasional gun shot.
  21. Get into bed and spend half an hour fastidiously tucking mosquito net into the mattress.
  22. Realise I need the toilet.

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