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Archive for the ‘The frightening lack of service provision’ Category

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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A few tukuls masquerading as a market. People’s homes. Nothing else.

Here is Motot in all its glory:

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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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