South Sudan: Growing Independence
Medair’s Stella Chetham spends a day at Medair’s busy primary health care centre in Melut town.
Angor sits on the bed beside her identical twin sister Nyachan. But the difference between the two children is shocking. Dr. Sarah assists pharmacy staff at the Melut primary health care centre. Tawel awaits treatment for her malnourished daughter, Nyachan (right), while healthy twin sister Angor (left) sits beside her. Dr. Sarah supervises Lul, new community health worker, as he consults with a patient.
At 18 months old, Nyachan is very sick. She lies back listlessly, the skin on her tiny arms and legs hanging loosely in folds. Meanwhile, Angor is healthy and round-faced. She plays contentedly with her older sister and takes an interest in everything around her.
When Medair’s Dr. Sarah Fry measures Nyachan’s arm using a plastic armband designed for measuring malnutrition levels, her arm falls well into the red section, with plenty of room to spare. Red means severely malnourished. Nyachan will need urgent treatment in order to survive.
I’m spending the day visiting the primary health care centre (PHCC) in Melut town with Dr. Sarah, a medical manager for Medair, who regularly visits our clinics in Melut county. She advises, supports, and provides on-the-job training to local health staff.
“Many of our local health workers are keen and enthusiastic, but because of the war, most have not been educated beyond primary school, apart from a nine-month health worker training,” Dr. Sarah tells me. “And before Medair started working here, there was little opportunity for health workers to be trained to serve the area.”
At the start of our day, Dr. Sarah and I make a quick stop-off at the County Health Department, where hundreds of eagerly anticipated boxes of drugs have arrived to be divided up and transported to the health facilities in the county, including seven clinics supported by Medair.
Until recently, Medair has provided drugs and medical kits for all the clinics, but as we work alongside the local authorities, they have developed the capacity to be able to run their own services. Today’s delivery represents a significant development, because the entire supply for every clinic in the county has been provided by the Ministry of Health—a positive sign of growing independence from outside aid.
Upon our arrival, the clinic is already a hive of activity. On our first stop, we meet tiny Nyachan and her sister, along with their mother, Tawel. Their family was referred here from the clinic in Kaka, in the neighbouring county. “Nyachan got sick five months ago,” Tawel tells us. “At first, Angor was sick but she recovered. Then Nyachan got sick, but she didn’t recover.”
Tawel and her family are recent returnees to the area from the north, among the hundreds of thousands of people who have returned to take part in the development of the independent nation of South Sudan. However, the influx of returnees like Tawel and her family has led to rapidly increasing health needs in already underserved areas.
“This health centre means a lot to us,” says Tawel. “We’ve been here five days now. Nyachan is now taking therapeutic milk and ‘Plumpy’nut,’ and she’s improving.” Medair runs an outpatient feeding programme at the clinic in Kaka, meaning that as soon as Nyachan is well enough to be discharged she can continue her treatment from home.
Nowhere Else to Go
During my visit to Melut town clinic, the patients keep coming. We see three patients suffering from kala-azar (a tropical disease), a seven-year-old boy with a stomach ailment, a woman with backache and anaemia, a woman with a toothache, and a mother who has recently miscarried. As I observe them come in one after another, it hits me that these patients with their wide-ranging ailments have nowhere else to go for health care.
“When Medair arrived here there was minimal access to health care,” Dr. Sarah tells me. “These days the clinic is full every morning, and many patients come from far away, as they’ve heard that the one supported by Medair makes you better.”
For four years, Medair has been supporting the Ministry of Health to provide comprehensive health care services in Melut county. In addition to the main clinic, Medair has supported six Ministry of Health primary health care units in remote areas throughout the county. With very few other services for hundreds of kilometres around, this network is the only health care available for most of the population.
“It’s so different from working in the West,” says Sarah. “Here, we are starting from scratch. When health workers here can learn to recognise the main symptoms of common illnesses and give people the appropriate treatments, it’s already a huge improvement on what people had before.”
In the outpatient consultation room, Dr. Sarah supervises Lul, the newest community health worker (CHW) at the clinic. Like many CHWs, Lul’s nine months of training for the role only equips him to diagnose and treat basic conditions, but he and the other health workers display a great enthusiasm to learn.
With Medair’s system of training and supporting local staff, improvements are gradually being seen. For example, following nine months of focused training and supervision, more children are being treated correctly for common diseases (malaria, pneumonia, and diarrhoea). Only 40 percent of children were receiving the best treatment at the beginning of 2010; this had improved to 73 percent by the end of 2010.
“I’ve been working here since 2008 and now we are doing so many new things,” says Margaret, the Sudanese nurse in charge of the clinic. I ask Margaret if her knowledge has improved since working with Medair and she nods emphatically, then proudly reels off a list of skills she has learned, such as how to insert an intravenous drip, how to recognise anaemia, and how to take patient histories.
“Last week, a man was brought to the clinic, wailing and delirious with high fever,” Dr. Sarah tells me. “In the past, something like this would often have been misdiagnosed by local health staff. But our Sudanese supervisor James immediately recognised it as cerebral malaria, and worked with the staff to help them provide the correct treatment. By the next day, the man was well enough to be discharged.”
In this all-but-forgotten region of South Sudan, the work I’ve witnessed today is truly a labour of love. Establishing a fully functioning health system to cover such a vast, undeveloped area—where scarcely any services have previously existed, where disease and poverty are endemic and education levels surprisingly low—is nothing short of a herculean task which many might have written off as hopeless. But Medair’s team have risen to that challenge and, slowly but surely, they are seeing undeniable results. “The whole team of health workers across the county gets continuous training, and we hope that knowledge will stay in the community once we leave,” says Dr. Sarah.
“Medair has a very good system, sending people from the local community for health worker training,” says Margaret. “It’s helping a lot. Patients are recovering. If there was not this care, I don’t know what would happen.”
Medair supports comprehensive primary health care in both Melut and Manyo counties in South Sudan. We are planning to extend our support for the primary health care system to two new, underserved locations in South Sudan. Please make a donation to Medair today.
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Medair’s PHC work in Melut county is supported by the Basic Services Fund, the Common Humanitarian Fund, Swiss Solidarity, and private donors.
This web feature was produced with resources gathered by Medair field and headquarters staff. The views expressed herein are those solely of Medair and should not be taken, in any way, to reflect the official opinion of any other organisation.
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