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From Old Fangak to JubaLetter # 8 Travel from Old Fangak to Juba was both a surprise and a road less travelled, particularly since there are no roads…nor regular flights, boats, or anything else, for that matter. While in Nairobi and en route to the US an email arrived: would I please rush an updated CV to Liverpool and would I possibly be interested in a consultation in Juba, the capitol of the Government of South Sudan? Of course I would; that was why I took the Health Consultancy Course in Liverpool in September of 2008, with the proclaimed intention of wanting to help with the work in South Sudan. My quick reply brought an even quicker response and a request for a telephone meeting, which we had almost immediately, with a public health physician. Multiple exchanges ensued over the next few days, and within a week of landing in the US I was headed back to Nairobi, then on to Juba. I still don’t know what to think about the timing, not really believing in divine intervention, nor alignment of the stars impacting my ordinary life. But if I see a burning bush… The consultancy assignment is to assess a program designed to reduce the very high, perhaps highest in the world, maternal and neonatal mortality rates. A curriculum was created in 2006 to train community midwives--it has both a public/community health focus as well as a midwifery focus. At this point I am two weeks into a five-week assessment, working with the highest levels of health care administration, and with a possible return consultation within the following month. After 23 years of war, and a tentative fragile Comprehensive Peace Accord in 2005, South Sudan is attempting to raise itself up from the rubble. The good news is that there is some funding for rebuilding; the bad news is that there isn’t enough to really do the job completely or quickly, the emergency assistance funds for health care are drying up and NGOs –that have been the bedrock of health care to the poor and disenfranchised—are leaving in droves. Many of those organizations were funded by grants, and with the economic downturn, there have been similar downturns in grants. As the kala-azar epidemic begins diminishing in Old Fangak, partly because the season is tapering and partly due to double drug therapy shortening the treatment course, the question of ‘what next’ seems to naturally arise. Recently Jill’s calculations showed a 6% over all mortality rate for the epidemic. Sure, we would like 0%; but some come so late and so sick that they are practically dead on arrival. Without the experienced brilliant planning of Jill and Sjoukje and the funds provided by you, our private donors, the death rates could have been so much higher, so much worse; without any intervention the death rate from kala-azar can reach 100%. From Juba I get a different perspective than from Old Fangak. Right, who would think otherwise? Along with the conveniences of air conditioning that sometimes works if the power works, and flush toilets and a shower, even if there isn’t any hot water—one pipe—go figure—I see another view of a system that fails to deliver what is needed in the bush, and see that it is challenged to deliver it even in Juba, its capitol. With the downturn in economics around the globe that included a drop in oil revenues, upon which countries like Sudan are vitally dependent, many of the fledgling starts fell from the nest and lie bruised on the ground with few to notice and fewer to help lift them up. From here I understand why the vitally needed medicines for malaria don’t make it to Old Fangak and why the medicines that are supposedly available if we just drop by and pick them up from Juba—a monumental and expensive task—are actually not available even if we could do the almost impossible fetching required. Medicines arrive without labels from companies not approved and can’t be accepted; how could they be sent out? Why pick them up from Juba? Because the medicine storage facilities in Malakal, which would just be a boat-ride up the river from Old Fangak, are still in the construction phase. Change and the immediate response to the needs of Old Fangak and most of Sudan will not occur quickly, certainly not over night, or even in the short term. I would like to think in my lifetime…. Jill and the Sudan Medical Relief project ‘inherited’, if you can call it that—sorta like inheriting a debt—the functioning of the Primary Health Care Center, including a much bigger payroll and responsibility. After 1 ½ to 2 years of searching for an NGO to pick up the pieces, there are no takers. We are grappling with how to manage, how to sustain it, particularly as the epidemic winds down—not that we are at the end, yet, for this year. There are so many needs! And as the epidemic winds down, so will the justification some agencies ‘need’ to warrant sending in, say things like FOOD! Or necessary medicines! Recent communications with Jill and Sjoukje, who are the most knowledgeable about the vagaries of the early functioning of the government, is that it will be years, perhaps many years, if ever, before the country or the people are able to support the work in Old Fangak. The low level of education and development conspire against self-sufficiency. We are only beginning to think toward the future and how to keep the project afloat. Like the Little Prince, now that we have loved them/saved them from death, aren’t we also responsible for them? Jill kind of nailed it in an email about why we have to keep doing what we are doing: “They have a passion for finding a niche that funding for health care is available for. We have a passion for helping the poor and sick. It is a different passion.” Unfortunately, that ‘niche’ erodes pretty quickly and funding dries up, then the NGO disappears. After 10 weeks on the ground, literally, in Old Fangak, I observed and understand the passion that Jill describes, and was totally engulfed in it too. If one resorts to the adage that it isn’t over until the fat lady sings, I would say the fat lady is no where in sight, certainly not in Old Fangak where skinny was the mode and large and extra large blood pressure cuffs were as useless as ice cube trays for the refrigerators we don’t have... We just can’t stop now, for now we have to move into the sustainability and development modes; together we can do it. Please, continue your financial support and help us as we envision a future that allows the people of Old Fangak to have just a small share, of what most of us take for granted. We truly are blessed, and have blessings to share. If you have thoughts, ideas, musings about sustaining this project, please forward them to me or to sudanmedicalrelief.org; the people of Old Fangak will be ever so grateful. Write that check out to Crosscurrents Institute, with the lower line designating the Sudan Medical Relief project and mail it to: I’m sure there will be stars in your crown, good karma will abound, and you will sleep with a smile on your face knowing that your small sacrifice makes a BIG difference in Old Fangak. Meanwhile, I’ll manage the 110+ temperatures and do what I can from here in Juba, without any ice cubes… Thank you, thank you, from the fullness of my heart…ann ann evans |
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