/ 21 January 2011

A land that’s in need of a cure

Hundreds of fat cows with beautiful harp-shaped horns graze on either side of the unpaved and dusty road of Gograil West County. Each cow is someone’s prized possession, but although the animals are well cared for, the health of mothers and children in this parched region is too often neglected.

Aluel Atem Kat (29), a mother of five, sits under the mango trees outside the Médecins Sans Frontières’s (MSF) hospital located in the heart of Gograil. In her arms is her one-year-old baby, Awien Ayam Gum, who is severely malnourished.

Patients like Aluel and Awien congregate in the shade of the trees every day to while away the long, hot afternoons of Southern Sudan’s dry season. These trees are silent witnesses to the grave healthcare situation of many people in Southern Sudan. Hundreds of patients, most from faraway villages, flow into the hospital daily for common and treatable illnesses such as diarrhoea, malaria, severe malnutrition and even infectious diseases such as Buruli ulcers, caused by Mycobacterium ulcerans, and which mainly affects the skin.

Awien’s malnutrition is neither caused by famine nor lack of access to food, but was the consequence of her mother’s health during pregnancy. “When I was still pregnant with Awien, I remember being badly sick. I had a fever for a week, then I recovered, but then the fever came back. I let my sickness take its course and I didn’t have any treatment because it was not available in the village,” says Aluel.

Informal healthcare
Traditional healers, often referred to in their communities as “witch doctors”, are usually the first point of call of patients, a result of a poor healthcare system. Hence, seeking hospital treatment is usually the final option — if it is ever an option at all.

“I brought her to the traditional healer, believing that it would make a difference. They advised me to give a small goat to my grandmother and to make an offering of some chickens and a goat to the gods. I followed their advice, but nothing happened. Awien was still sick and carried on losing weight,” says Aluel.

Southern Sudan is a vast land. Most medical facilities were destroyed in more than two decades of civil war. Now, the dire lack of health clinics, the long distances involved in reaching them, often days of walking and the unattainable costs of care are all barriers to people seeking medical help. In Southern Sudan up to three-quarters of people do not have access to even basic healthcare.

“When I brought Awien to the hospital, she was vomiting without stop. She has been very sick ever since she was born. A year later she still wasn’t better and had even stopped growing,” says Aluel, her voice filled with sadness.

Nonexistent antenatal care
Before starting treatment Awien weighed just 3.3kg and is still as tiny as a two-month-old baby, her serious health condition and that of so many others like her, is a consequence of poor — and sometimes nonexistent — antenatal care.

Awien is seen by MSF’s doctor Prinitha Pillay: “When we got Aluel’s medical history we found out that she had chronic fever during her pregnancy, which was probably malaria. Low birthweight babies are a very common complication of malaria during pregnancy.

“So, as her mother couldn’t get treatment, Awein was tiny when she was born and she is still very sick now. As a one-year-old, she should be standing and starting to try to walk, but she has never been able to catch up on her weight and remains a fragile little infant.”

MSF’s hospital in Gograil, which started in December 2009 as an outpatient clinic, now provides comprehensive healthcare to patients from all over Warrap State and sometimes even to those referred from other states in Southern Sudan. Many patients arrive at the hospital at dawn, having walked through the night; others may have walked for two days to reach it.

‘I walked for five hours’
“One day one of my neighbours in Kuajok, where I live, told me to bring my daughter to Gograil. They told me there was a free and good hospital here and it would make my daughter’s condition better. The next day I walked for five hours in the hope that Awien would be cured,” says Aluel.

Pillay, who is very fond of Awien, is happy with the one-year-old’s progress: “Awien has been in the nutrition programme for six days and is doing reasonably well. She has put on 600g, is eating well and doesn’t have any other complications. As for development, she’s clearly a bit delayed — she’s able to sit, but she isn’t able to stand or walk. We are happy with her progress. Preventative service like antenatal care is so important for the newborn, but also for the woman herself,” says Pillay.

In the hospital the serpentine hallway is designed to ensure that patients queuing for the outpatient department go through all the necessary medical consultations.

Pregnant mothers are given a full set of vaccinations and preventative treatment to reduce their risk of developing health complications like those suffered by Aluel and her baby Awien.

In 2010 alone the medical team in Gograil conducted more than 46 000 outpatient consultations, more than 7 000 of them antenatal care, and admitted more than 1 200 children to its nutrition programme.

Baikong Mamid is MSF communications officer and was in Southern Sudan before the referendum. MSF provides comprehensive primary and secondary healthcare services in 10 states of Southern Sudan, including maternity, emergency obstetric and surgical care