Saturday, January 13

I am worried about Val, our new gender based violence coordinator from Canada who is based in Tambura. When I left our post there on Tuesday, Val had a serious chest cold. Thursday evening she began having difficulty breathing. By noon Friday her condition had worsened. She had never had asthma. Was it that, or was she was having an allergic reaction? There are no diagnostics at Tambura’s hospital and the medications are limited. At 4 p.m. she was evacuated by a United Nations plane. We wait for word.

The situation typifies the broken medical system here. The war disrupted everything. IMC’s philosophy is to hire local people and train them further. As the lead agency for the Sudan Health Transformation Project, we have developed a string of modest health facilities throughout two counties. The Primary Health Care Units (PHCUs) are staffed by community health workers who generally have nine months of training. They are capable of treating the more common illnesses, such as malaria, diarrhea, coughs and the like. More complicated cases are referred to a Primary Health Care Centers (PHCCs). A person requiring advanced care is sent to the county hospital, managed by the government. However, the hospitals don’t have equipment and aren’t staffed full time by doctors. Traveling to a hospital in Kenya or Uganda is not possible. The only vehicles here are those owned by the United Nations and NGOs. And even if there were vehicles, road travel is long and arduous, particularly when the rains wash out the dirt roads. Only NGO staff has the means to be evacuated by airplane. The irony is not lost on us.

The one doctor and one or two nurses we employ at each of our compounds do not provide direct care; they manage the IMC medical division, ensuring that PHCU and PHCC staff receives refresher training; that the facilities are stocked with drugs; and that the cold chain for the preservation of vaccines is functioning.

One of the largest obstacles to restoring the primary health care system is the dearth of medically skilled people. Men from the ages of 30 to 50 were, for the most part, were not educated in full; they went off to the war. The 20-something set, like our Drs. Nicholas and Alfred, is the first to receive post-war degrees, but they are few and far between in rural areas. A colleague, a nurse who previously worked for Doctors Without Borders, said he was dismayed at the number of people in dire straights waiting in vain for care at the Yambio Hospital. If he were Sudanese, he said, he would have forced his way into the hospital and rendered care. If questioned, he would have said his was fulfilling his duty to his people. But, he is Kenyan. He sees that the Sudanese are numb to death, having seen so many people die during the past two decades. In some ways, the war has never ended.