With its large staff of 250 caring for roughly 7 500 outpatient visitors a month, they call the sprawling Médécins Sans Frontières compound at Akuem ”classic MSF” or ”pure MSF”.
By that they mean it is remote, serves a vast population, and is indispensable because there are no other comparable medical facilities nearby. It is not a hospital but it can handle every basic health problem affecting civilians in conflict zones: tuberculosis, malaria, malnutrition, and high infant mortality.
The advance description certainly matches what you see on the ground. Set in the far north-west of south Sudan, the Akuem clinic, which opened three years ago, is a humming oasis of medical activity in a desert of destruction.
Sudan has been racked by civil war between the largely Arab north and the non-Muslim south for 20 years. Although a ceasefire is in force and peace talks between both sides are close to agreement, 4-million people are still displaced and another half-million have fled abroad.
The front lines in the south, where most of the fighting has taken place, zigzag across a huge area with many towns in government hands. But the countryside is rebel territory. In line with its long-held policy of political neutrality, MSF has projects on both sides of the war. Though Akuem is not far from the government-held town of Aweil, there has been no fighting for about a year.
Remote
The remoteness of the area means that all supplies, as well as the foreign staff, are brought in by air from northern Kenya. Locals walk, and every day before the clinic opens at 8am, a crowd sits under a shaded canopy waiting to get in.
”I took seven hours to get here and had to cross two rivers,” Abuk Akok said as she sat with her six-year-old daughter and her new baby. The older child had just been diagnosed as having malaria. ”We’ll find somewhere to sleep in the nearby village and set off home in the morning.”
The therapeutic feeding centre is one of Akuem’s busiest sections. With around 75 children, it is well below the peak of around 300 which it had earlier in the year, but it still gives an impression of bustling urgency. The most malnourished, who often have other medical complications such as diarrhoea and pulmonary infections, get intravenous feeding in the intensive care unit before moving to the outside area.
There they sleep and sit on mats while mothers, and a few fathers, press orange plastic cups of milk to their lips. ”In the first phase they get breast milk plus a supplement,” says Nancy Dale, a nurse from Canada who supervises the feeding centre. ”Then they move to milk plus plumpy nut, a concoction of peanuts, oil, and sugar, until they reach the target ratio of weight to height.”
Mortality is low, averaging less than two a week. Could it be that only the mildly malnourished come to the clinic, and that hundreds of severe cases are dying at home? ”It’s unlikely”, says Nancy Dale. ”We recently sent five teams out for eight days to survey about 40 very remote villages. They looked at 30 children in each, and found the nutritional level wasn’t bad.”
This kind of outreach is a vital part of Akuem’s work. In the tuberculosis compound, which has two large white tents which are regularly disinfected, Katharine Hagerty, an American nurse from Oregon, says Sudanese staff visit every TB patient’s family when they are discharged.
”They need to check that the medication is being taken properly and see whether anyone else in the family has it who hasn’t been brought in. The staff do a fantastic job, explaining in the local language and with sensitivity to local culture how important it is to take the medication regularly. Part of this programme’s success is the follow-up.”
The TB section started last year, and saw 57 patients. This year it has seen 193, half of them children. ”It’s not that the disease is more prevalent. It’s just that word of the clinic is getting out,” explains Dr Luis Neira, a Colombian doctor.
He is one of three foreign doctors. There are seven foreign nurses. They work with 30 Sudanese nurses and 11 medical assistants, the latter being more qualified than a nurse but less than a doctor. The civil war has had a disastrous impact on education, leaving only one functioning nursing college in all rebel south Sudan.
MSF sees training staff as a vital responsibility. This is why it avoids flooding projects with outsiders, balancing numbers of internationals and locals. Akuem also has a large Sudanese support staff.
As the MSF teams relax after sunset outside the tents where they sleep, with the star-studded sky above and a beer on the rough-hewn table, there are moments when the camp feels like a safari with a mission. But the work day runs from 8am to 7pm and duties are demanding. They require idealism and energy in equally large measure, as well as copious dollops of mosquito repellent. – Guardian Unlimited Â