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Faith and Medicine - thoughts on the health care situation in South Sudan

by Melissa Burton (Melissa Burton is a member of the Board of Directors)

31 May. 2011

Two weeks ago I returned from my second trip to the Aweil area in South Sudan. As with last year, through our partnership with Giving Children Hope, a shipment of medicine was sent to Juba, and we brought it on the U.N. flight to Aweil, and set up a (very) mobile clinic - first in Aweil, and also in a village in East Aweil county.

Going there, seeing the patients, and listening to their stories, is such an intense experience that it's best if I start at the beginning, that is, with an explanation of the partnerships that make this possible. Giving Children Hope provided a shipment of medicine: antibiotics, anti-malarial, anti-fungal, vitamins, and anti-worm medication. St. Matthews Church and the ACC MSSP did fundraising for the shipment of the medicine to Juba. Bishop Wilson of the ACC in Aweil did a great deal of work as well, making travel arrangements, arranging for the participation of local health officers, and determining which villages were most in need of health care. An important consideration is this: how far can the patients walk to get to the clinic in Aweil? Is it more than a day?

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We knew, from last year's trip, that many people were malnourished, that we ran out of vitamins and certain other items quite quickly last time, and that the local health officers were lacking in basic supplies such as thermometers and blood pressure monitors. So, in addition to the medicine from GCH, I brought a big suitcase with vitamins, ibuprofen, more antifungal cream, Betadine, plastic bags to use in distributing the medicine, thermometers, two blood pressure cuffs, gauze pads, and other needed items, which were purchased at COSTCO and a local pharmacy.

I arrived in Nairobi on May 3, and on May 5 we flew to Juba. The medicine from GCH was waiting for us at the airport. We made arrangements for it to be on the UN flight with us to Aweil the next day, and got some sleep at a hotel. The next day we went to the rather chaotic airport in Juba, had all of our bags weighed - there is a strict weight limits on the UN flights - and made it onto the flight; first to Wau, then to Aweil. One thing that had changed since last year is that Aweil has a new airport, no longer in the center of town. We got a motor-rickshaw (something like a Thai "tuk-tuk") and arrived at the compound, where people were waiting for us.

It was lovely to see people I saw last year. The people there are very gracious and hospitable and kind, even though they are very poor. It was also not very long, maybe a couple hours, before there was a crowd of patients waiting for treatment. Word had gotten out that we were coming, and that we had medicine, so people who had walked from surrounding areas, as well as people from in town, were gathering under a mango tree nearby. Women, children, men, young, old...nearly all of them with no means of paying for any kind of health care, even though many were in dire need of help.

I think of "Faith and Medicine" because both are very much needed in that place.

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Regarding faith: the people there have more faith than I do, more than most Westerners, because without it I think you could not survive there. There are too many uncertainties, too many people doing without basic needs such as sufficient food or access to clean water. Faith shown by all of the patients that walked for hours, some carrying sick babies, in the hopes of being cured of ailments they had often had for years. Faith also because of the difficulty of diagnosis when you are working through a translator, without access to basic laboratory testing, and having to consider local/cultural ways of describing illnesses. The local health officers were of great help in this regard. I had the Tropical Medicine handbook and two years of graduate school studying infectious diseases, and they have the ability to speak to the patients in their own language, day to day experience seeing these ailments, and in some cases they were familiar with individual patients and knew something about their situation.

Regarding medicine: it is in very short supply. There is an MSF clinic in Aweil, but I was told they only take pregnant women and babies. There is a hospital in Aweil and some local clinics, but they are not well supplied, and they sometimes run out of medicine. There is a Catholic mission in Malualbai that can diagnose and will treat (free of charge) leprosy and tuberculosis patients, but apparently not year round. There are very few doctors in Aweil. Many are from the North, and I was told some of those doctors are now returning to the North due to the upcoming secession in July. The local hospital, I was told, does not have the capability to test for diseases such as tuberculosis, leprosy, or even diabetes. Most of the patients have literally no money, so it is impossible for them to buy medicine, or even pay for a "taxi" (motor-rickshaw) to take them to the clinic. Medical records seem to be kept, when they are kept, on dog-eared papers the patients would hand to me, some partially written in Arabic and several years old, describing tests that had been done, or previous treatment. Many if not most of the patients were illiterate. Many had been ill for several years and had never seen a doctor. Some had seen a doctor last year or four years ago, but either a) were not told their diagnosis, b) did not know what medicine they were given, c) were given an inappropriate treatment, d) were unable to pay for the treatment so did not get it, or e) all of the above. There are pharmacies in which medicine can be purchased, and we supplemented the GCH package with some additional items such as azithromycin and artemesenin-based anti-malarial. However, sometimes the pharmacies also run out of key items. Most patients we saw did not have money to buy medicine at the pharmacy, though some could do this, if given a prescription.

Aside from the lack-of-money obstacle and the lack-of-diagnosis obstacle, many people cannot go to the clinic because the clinic is too far away. So, on the first day I was there, we treated patients in Aweil. The second day, we drove out to a village in East Aweil county, where Bishop Wilson has a congregation. Word had gone out ahead of us, and there was a large crowd of patients waiting for us there; again, people who had walked all day from surrounding areas. We noticed that the crowds did not diminish as the day went on, but rather kept getting larger.

We spent three solid days seeing patients. There was a great deal of malaria and also typhoid (some had been officially diagnosed, some not). Many people had bladder or kidney infections, some for years. There were babies with diarrhea. There were many, many people, women but also men, who appeared to be anemic. Many people had chronic conjunctivitis and some of the patients with that were exhibiting other signs of trachoma, such as clouding of the cornea and loss of vision. There was dysentery. Many people had worms, most with "garden variety" worms (pinworms, for example) but I did see one patient who said they had a guinea worm in their leg, and another patient who may have had a guinea worm or perhaps something not in the medical textbooks - I intend to do some research on this.

Another disturbing case I saw was a man with a large infestation of maggots on his leg. He had had this for years, had been to several clinics and at least one hospital, none of which were able to treat him. Unfortunately, we did not have the means to treat this infection, as in this case it might require surgical excision. The diagnosis here is cutaneous myiasis, or tumbu maggots.

I saw a lot of women who had been losing babies, either through stillbirth or miscarriage (in many cases due to chronic infection), or baby was born dead, or three babies in a row died after birth and the fourth was a miscarriage, or they had a miscarriage some months ago but the baby never came out and they have had a fever ever since, or they had a miscarriage, a fever, then their periods stopped, and so forth. In many cases, the mother had given birth at home, had a post-partum infection from one birth (an infection that became chronic), then the second (or more) baby was born sick (or dead), and then they stopped menstruating or were no longer able to conceive, and wanted to know why. One woman brought her ten day old infant who was very ill with a peeling rash all over his body and she told me the baby had bloody diarrhea. I asked if she had gotten a fever after she gave birth and she said yes. The baby had been ill for 5 days. This was a home birth. We gave her money to get to the MSF clinic, due to the severity of the baby's condition. Puerperal fever is very common. One man came to see us for help for his wife who could not walk after having had a miscarriage several months ago. All of the women I talked to who were miscarrying, not conceiving or whose periods had stopped were subsisting on a very limited diet of only sorghum or ugali - no vegetables, and no meat, for months or more.

After two days of this I was very happy to see the old man who appeared only to have a smoker's cough. Also there was a man who had been bitten by a monkey, but the bites were mostly healed. He told me that "if you get bit by a monkey, they say you will be dead in a day, but I am still alive" - this was a month later. He was approximately 70 years old. The people who make it to that age are tough old birds, indeed.

The good news and the bad news is that most of the diseases are curable and/or preventable. Bad news because so many people are suffering from preventable illness, good news because something CAN be done about it. Access to clean drinking water would be of great help, particularly in reducing worm burden, dysentery, and infant diarrhea. There are vaccines for typhoid and meningococcal meningitis. Having proper nutrition would help a lot, too. Malaria and malnutrition both cause anemia. Malnutrition weakens the immune system, diarrhea makes malnutrition worse - a vicious cycle.

Back to faith again: I was amazed at the stoicism and dignity of the people we saw living with such serious illnesses. Many of them have a good sense of humor. They wake up singing hymns. They carry on. We can learn from this, we who have more than enough of everything. I was very distressed upon returning to see the news about Abyei. As if the people there are not suffering enough - not enough food, no access to health there is displacement and threat of war. Please pray for them.