Our Medical Mission, December 2009

Brigitte Augustijn, Jérôme Oude Nijhuis, Sándor Öry, Loes de Vaan en Ashraf Ahmed

 

The boxes differ a lot in weight and size; some small and heavy, others huge and light. The contents: aspirin, microscopes, malaria tests, needles, urine sticks, medication and other supplies donated by Sudanese business men and pharmaceutical companies. Three buses packed with medical students, lab technicians and doctors arrive in Al Damazn, a small village in Sudan’s Blue Nile state. It is two o’clock in the morning and a buzzing chaos of people and buses erupts. The boxes are brought from the buses to empty school buildings. This is the operating base for our 5-day medical mission.

Sudan is the largest country in Africa. Military regimes favouring Islamic-oriented governments have dominated national politics since its independence from the United Kingdom in 1956. The country was embroiled in two prolonged civil wars, conflicts rooted in northern political, economic and social domination of non-Muslim, non-Arab southern Sudanese. In 2005 negotiations for peace succeeded between the two battling groups. Health services, already underdeveloped before the war, deteriorated significantly under the influence of the conflicts. The recovery of this disrupted health sector poses many challenges.

 

 

Firstly, during the decades of the civil conflict, four million people were displaced. The return of refugees and displaced persons to their hometowns resulted in fluctuating population figures and stress on the already depleted health, water and sanitation services. This created ideal conditions for cholera outbreaks and other diseases. Another problem is the lack of infrastructure and the major destruction in large parts of the country. Great parts of South Sudan are only accessible by plane, boat or foot, especially during the rainy season. This affects the access to medical care, which is below 25% for the whole population. Therefore, 60% of spending on humanitarian health programmes in Southern Sudan is devoted to air transport of medical supplies and personnel working in the health sector. Furthermore, 40 years of war have led to under-education in several generations, resulting in a shortage of doctors, nurses and personnel working in the health sector. Overall the effects of Sudan’s postcolonial history have negatively influenced the development of the health system. Five years after the peace agreement was signed, and despite the international drive for improvement, Southern Sudan still has the worst health statistics in the world.

 

 

During a two hour journey to the village, the landscape changes from lush green fields irrigated by the Nile to dry fields with camels walking in the burning sun. The team leader divides us into four groups for the clinic, the laboratory, the pharmacy and the health education work. An overview of the diseases endemic in the area of today’s medical mission is provided. Upon arrival in the village three small school buildings are quickly transformed into a small hospital. The clinic is the first stop for the crowd that is hastily flocking in from all directions. A quick consult and physical examination determines the need to run a lab for blood, stool or urine samples or medication. Our supplies quickly diminish as long lines form in front of the pharmacy. In the clinic, a wide variety of medical syndromes, from simple urinary tract infections to tropical diseases pass by. Poor physical conditions as a consequence of malnutrition and low hygiene further complicate the clinical picture. The last stop for the residents is our health education team. Since the medical missions are unable to provide consequent follow-up of chronic conditions, this is an essential part of the mission. Although the evening falls, the crowd outside the clinic steadily grows. The doors and windows have to be closed to prevent people pushing through. It is hard to realize that there is a great number of people waiting, who will not get the chance to see a doctor or get proper medication.

Besides Sudan’s conflict rich past ecological and geographical factors significantly contribute to poor health conditions. As in other developing countries, communicable diseases largely dominate Sudan’s epidemiological profile. Remarkable is the high prevalence of neglected tropical diseases (NTDs). Of the fifteen NTDs recognized by the WHO, twelve are endemic in Sudan. 

Malaria is the main cause of death in this country. An estimated 75% of the population is at risk. Another frequently encountered tropical disease is visceral leishmaniasis (kala-azar) and is transmitted through the presence of its sandfly vector. High temperatures and humidity, even more challenging due to climate change, have facilitated the spread of many of these vector borne diseases. Food insecurity makes both acute and chronic malnutrition a big problem. The influences of conflict, ecological and geographical factors mentioned before led to dispiriting health statistics in South Sudan. One in seven children dies before the age of five, mainly from treatable diseases like diarrhea. One in seven women dies from complications during or after childbirth as only 9% of all deliveries are assisted by trained personnel.

 

 

Realizing the impact of the statistics mentioned above, 40 years ago medical students from Khartoum University started an initiative to improve health knowledge in rural areas. This form of education was concentrated on the prevention and management of tropical endemic diseases. Currently medical students organize medical missions five times each year, targeting different parts of the country. About 200 students, lab workers and doctors participate on a voluntary basis, and about 500 people are seen and treated on one day.

About the authors

The authors are Dutch medical students who participated in the STEP mission of 2009.

 

Further reading

• www.unsudanig.org
• http://workplan.unsudanig.org/chf/
• http://www.who.int/countryfocus/cooperation_strategy/ccs_sdn_en.pdf