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What Is Ailing Southern Sudan?

By Sara A. Fajardo

It's 10 a.m. in the village of Lualdit, and health care worker Elijah Lual Makuei, 32, has already seen 12 patients. His latest arrivals are a woman and a toddler donning a pink bunny-eared hat. The mother is concerned: Her daughter suffers from recurring fevers. In a part of the world where malaria kills more children under age 5 than any other disease, even a slight spike in temperature is a cause for worry.

Elijah Lual Makuei

Community health worker Elijah Lual Makuei stands in front of the health center in the southern Sudanese village of Lualdit in Jonglei State, where muddy roads 6 months of the year make it difficult for people to get health care. Photo by Sara A. Fajardo/CRS

Elijah rattles off a list of questions. The center's bare facilities lack even basic diagnostic tools—thermometers, stethoscopes and a microscope. He must rely on the training he receives from Catholic Relief Services partner Sudan Medical Care. The mother shuffles her mud-caked feet as she answers each question in Dinka, the local language.

It rained the evening before, inundating the village of mud huts and outdoor classrooms. Although a welcome ally in growing crops, rains turn a prolific mosquito population into an even greater health menace. Pools of water dot Lualdit, where insecticide-treated bed nets are a rarity. Drainage canals have produced small lakes, and even four-wheel-drive vehicles cannot navigate the muddy, unpaved roads. To get to the health center—the village's only concrete building—Elijah had to take off his shoes to wade the 150 yards from his traditional tukul home to the front door.

One last question about the young girl's appetite confirms the mother's suspicions. The diagnosis: malaria. In much of Sudan, malaria is as common as a cold. Unfortunately, it is far more deadly.

Laundry List of Ailments

Elijah reaches for tablets from a limited collection of bottles of mild painkillers and potent antibiotics. Electricity and running water have yet to reach Lualdit, and the instruments of care on hand are sparse, but Elijah makes the most of what's available.

He drops a 3-day supply of malaria pills into a small, yellow envelope and hands it to the mother. He then turns and writes in careful block script the girl's name, her symptoms and her treatment regimen.

Elijah with the ledger

Community health worker Elijah Lual Makuei, right, attends to a young patient in the southern Sudanese village of Lualdit. Workers receive training in disease prevention from CRS partner Sudan Medical Care. Photo by Sara A. Fajardo/CRS

The ledger, which spans months of patient care, offers a quick glimpse into the maladies that plague villages served by the center. Malaria, acute diarrhea, parasitic infection, anemia, malnutrition, whopping cough, tetanus and measles are just some of the ailments in this laundry list of preventable diseases.

Still CRS and SMC health care workers do what they can to help communities bolster their fledgling health care system. Using Elijah's meticulously kept ledgers, SMC staff identify where to focus their disease prevention efforts. And SMC-trained health care leaders, who are elected by the community, share good health practices such as hand washing.

Symptoms: Dirt Roads and Illiteracy

CRS and SMC also built both the three-room building in Lualdit and the adjacent well—the village's only source of safe drinking water. The center is one of the few health facilities in the rural state of Jonglei, Sudan. An estimated 719 health centers, often lacking vital equipment, serve all of southern Sudan—a population of more than 8 million.

"We're not going to reinvent the wheel," says Dr. John Kok, SMC's program director. "The tools we need have already been invented; all we have to do is select from the existing [medical] technologies. We want to improve the overall health situation of the community and not focus so much on curing ailments."

If the doctors running SMC were to examine what is impeding progress to a robust health care system in Jonglei, they would find these symptoms: the lack of paved roads, a shortage of trained medical professionals, a limited supply of medications and rampant levels of illiteracy.

More than two decades of conflict in the especially hard-hit area of Jonglei have severed the already tenuous connection between health care providers and ailing residents. Expectant mothers, for instance, turn to largely untrained traditional birth attendants for delivery. These attendants sometimes cut umbilical cords with blades of grass plucked from thatched roofs and use other unsterilized tools.

A woman and her daughter visit the village of Lualdit's community health center.

A woman and her daughter visit the village of Lualdit's community health center. Centers like this one in southern Sudan strive to prevent diseases such as malaria, the number one killer of children under the age of 5. Photo by Sara A. Fajardo/CRS

Without adequate access to proper prenatal care and vaccinations, some newborns in southern Sudan contract tetanus during the birthing process. As a result, southern Sudan has one of the highest infant and maternal mortality rates in the world. Vaccines in that region are a crucial component in safeguarding the health of women and children.

Prevent More, Cure Less

For much of the 6 months that rain pelts the landscape, large swaths of southern Sudan are cut off from the rest of the country. Carrying boxes stuffed with ice packs and immunizations on their heads, health care workers must slosh through thigh-high water to reach health centers. There, dozens of mothers wait for workers to vaccinate their children.

Despite SMC's tenacity, during the rainy season, health care staff can only give vaccinations in areas a day's walking distance from the main city, Bor. Longer trips are impossible, because the ice packs will thaw, rendering the vaccines useless.

Well aware of the daunting health care problems in southern Sudan are SMC's leaders, Dr. Kok and Dr. Mayom Deng. As young boys, the doctors fled violence in Jonglei for refugee camps in Ethiopia. Later, they received their medical training in Cuba.

They know the people and culture of Jonglei. Like many in the community, the doctors can tell which cows are local and which are from Uganda by size and pelt color. They know that a health care facility in this region must be built on higher ground to protect it from flooding and that a fence will keep freely wandering livestock from overrunning the courtyard.

And, to make progress in improving health care practices and disease prevention in southern Sudan, they know they must first work with the community elders before they will reach anyone else.

"We want to prevent more and cure less," says Dr. Kok. "That's how we envision things."

Sara Fajardo, CRS' regional information officer for eastern and southern Africa, is based in Nairobi.

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