Archive for the ‘Maternal mortality’ 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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This weekend, I fly back to London for Christmas and I have been wondering how it will feel to be catapulted in to the climactic point of the festive season with no warm up. From the heat and dust of Sudan, to a frosty land of tinsel and lights; mince-pies and mulled-wine; frenetic Christmas shoppers and Wham’s Last Christmas at every turn.

Last Saturday we held a Christmas party for about a hundred of our local Sudanese staff. We slaughtered and barbequed two bulls, cleaned and cooked a veritable mountain of intestines and bowels and distributed bags of second-hand clothes donated by kindly-Americans as gifts. Mid-celebration, I found my reflecting upon how ‘un-Christmassy’ it all was. In this place you cannot hide behind the Christmas tree or lose yourself in the Christmas brandy. No Santa Claus, no carol-singing, no decorations in my tukul; just something which looked a lot like every day life. Do they know it’s Christmas time at all, Bono?

And then someone read the Christmas story.

In a time of insecurity and political fragility, a man and woman travel hundreds of miles to return to the village of their birth in order to register their names for an election.* A heavily pregnant woman walks for days in order to find somewhere to safely give birth.** A woman cries out as she gives birth in a mud-hut; outside the cows low under a night filled with the brightest of stars. A couple flee a country with their new born baby and spend the next few years as refugees, waiting for it to be safe enough to return home.*** A village is raided and burnt; in the morning, the massacred bodies of children are found.****

This is Sudan. Here is Christmas every day.

* Registering for elections

** Giving birth in South Sudan

*** Returning refugees

**** Akobo massacre

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A week or so ago I went to Pieri to assist with the emergency feeding programme. That day, the children who attended were either on our supplementary feeding programme (for moderately malnourished children) or our outpatients therapeutic programme (for severely malnourished children). The worst cases (severe acute malnutrition with complications) get admitted into a stabilisation unit.

Malnutrition is a constant here (the Global Acute Malnutrition (GAM) rate in our county stands at about 22%) and is not a result of a particular event such as a drought or a conflict – rather it is a part of every day life. Only 30-40% of people live within one day’s walk of a health facility; maternal mortality rates are the highest in the world, and one out of every seven children will die before their fifth birthday. That’s enduring poverty for you.

Each week, those who attend the feeding centre are measured and weighed with the results recorded and as you go back week after week, you can see the improvement as the numbers slowly creep up and up on the children’s admission cards (though never reaching ‘normal’). You can literally see the flesh growing on skinny arms and legs. And yet come the hunger season, or the time when we exit them from the programme because their weight for height is deemed to be acceptable, in all likelihood their numbers will plummet once again. This work is so necessary – so lifesaving – and yet so impermanent. Relief work is ever a short term solution, yet stability has evaded South Sudan for so long, preventing it (together with a plethora of other factors) from transitioning into more long term development. NGOs all too often exacerbate the problem of course, by inadvertently encouraging dependency long after a crisis is over.

If you pray, pray for this place: pray for stability, for change, for peace, for strong and committed leaders. Pray that Sudan doesn’t return to all out war next year as so many predict. Pray against the endless cycle of revenge and retaliation which has this place by the throat.

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Last night, as dusk fell over the compound and we walked back to our accommodation, horrific techno music pumped from our Kenyan nutrition nurse’s mud hut. Suddenly, out of nowhere, everyone began to dance in the sand. I say dance, but in truth we are trying to encourage one of our colleagues to lose some weight, so the resulting moves were a heady mixture of aerobics and bump ‘n’ grind. Nya’wich – a beautiful 19 year old Nuer girl who has never left her village, let alone been exposed to the horrors of techno, watched and laughed from the sidelines until she was finally persuaded to join us. She showed a real aptitude for Western dance, quickly mastering the classic side step shuffle, the jogging arms trick, and the occasional hip wiggle.

This morning I went to one of our emergency feeding centres on a monitoring visit. South Sudan has the worst maternal mortality rate in the world and today’s feeding clinic was for pregnant and lactating mothers, many of whom had walked for hours through the mud and water to get there with their babies in Moses baskets on their heads. The women waited to be assessed, feeding their oddly quiet babies under the shade of a tree while men walked past, the occasional Kalashnikov slung over a shoulder. Upper arm circumferences were measured, immunisation cards checked and vaccinations administered before they were given rations of oil and sugar mixed with CSB (corn-soya blend). The blend is for the mothers themselves, to combat malnutrition and help them produce enough milk to feed their children. One mother passed me her feather-light baby girl with long thin limbs and scaly skin. She looked about 9 months, but when I checked her record card, she was more than two years old. For the first time since arriving, the flies were leaving me alone and it wasn’t hard to see what was distracting them – I saw a newborn baby with its face almost entirely obscured, flies feeding on its eye infection.

Life here is an unsettling mixture of the heart-rending and the ridiculous and it’s hard to move from one to the other. The situation changes, but your mind takes a while to catch up.

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