Sudan / 17.09.2009
Due to a desperate shortage of infrastructure in southern Sudan, reaching much of the region, especially in the rainy season, is particularly onerous and a few NGOs are present on the ground. Médecins Sans Frontières’ project in Nasir is only accessible by boat or air. © Sven Torfinn
Michael Rowell, a financial administrator from Melbourne, is on his second field placement with Médecins Sans Frontières in Juba, southern Sudan. In 2008-09, Michael was based in Islamabad, Pakistan for nine months on his first field placement. Here, Michael describes his experiences in his first five months of working in Juba and from the field projects he has visited in southern Sudan.
"Sudan has been a country at war for 39 of the past 50 years. Throughout the country the devastation of this continuous war is evident in the destruction of homes, livelihoods, means of production and infrastructure. As a result, health facilities are sparse and often inaccessible for most people. The availability of trained personnel also remains inadequate. Food security has been constantly threatened by large population displacements and raiding due to fighting and adverse weather conditions. These factors have also provided a setting where large-scale epidemics and famine can, and do, easily claim thousands of victims before any news reaches the rest of the world.
Médecins Sans Frontières was one of the first non-governmental organisations (NGO) to start working in southern Sudan. Since 1988, projects in Bahr el Ghazal, the Equatoria regions, in the Nuba Mountains and in the Upper Nile region projects have provided a range of medical services to the population. Working in such areas, Médecins Sans Frontières has had to adapt to the shifting needs of populations as well as volatile security situations. As a financial administrator in Sudan, my role is to help these projects run smoothly through the managing and planning of various budgets. In doing so, we can continue to provide vital primary and secondary healthcare services to populations who need it.
My first week has gone very quickly and it now seems ages ago since I left Melbourne. I arrived in Nairobi 30 hours after leaving Médecins Sans Frontières’ Sydney office, so I was glad to go straight to a guesthouse, have a meal at a nearby restaurant and then have an early night before my flight the next afternoon to Lokichoggio.
During the two-hour flight to Lokichoggio I could see the arid country, scattered with rugged mountain ranges and narrow rivers snaking their way across the land. Flying into Lokichoggio revealed a small town that had been purposely built to house all the NGOs that once operated from here. Now that most NGOs have moved to Juba in South Sudan (following the peace agreement four years ago) the expat population rarely gets above 50 people.
After much jolting in the back of the 4WD we finally came to the Médecins Sans Frontières compound. The gates opened into a wide area that was surrounded by various buildings, including a warehouse and cool store, workshops, generator room and staff offices. The living conditions in Loki were very basic but comfortable. My room was a modern version of a tukul, a small round dwelling with concrete walls and floor instead of the traditional mud. All the tukuls are linked by a series of cobbled paths and in between are shrubs and trees that make for a very nice setting. However, the comforts of Lokichoggio were only temporary, as I then moved onto Juba in southern Sudan to help plan the progressive move of the management team there from Lokichoggio.
Juba itself is situated on the Nile River, so as we came into land we got a good view of it as it snaked across the countryside. Juba has a population of 250,000 people, and the main road is so busy with traffic and erratic drivers that car and motorcycle accidents are common.
On a Friday and Saturday in the middle of April we had what is called a Field Associative Debate for the first time in southern Sudan. This is where a couple of staff from each project meets with the coordination team to discuss a selected topic and the results are then fed back to the Médecins Sans Frontières International Council. It was a fairly big gathering of around 60 people, and some very useful ideas were produced, especially from the Sudanese staff who were very keen to express their opinions. In the morning we saw a film about how Médecins Sans Frontières has changed over the last 35 years or so in response to the changing nature of conflicts around the world, especially in the 90s.
I am planning to visit all the projects as soon as possible. There is an advisor coming out in early May to do a performance audit of our Nasir and Leer projects and I will be accompanying him over a one-week period. It certainly makes a difference for me as a Financial Coordinator to see the medical work in action.
I returned back to ‘Loki’ to meet with the General Director of Médecins Sans Frontières Denmark who was visiting for a week to do an audit of two projects we were to visit. Our first stop was in Pieri where we picked up some surgery patients to be transferred to Nasir, our nearest project that had a surgeon. Two of the patients, a 13-year-old girl with a bullet wound to the leg and a man with a bullet wound to his forearm were casualties of the recent fighting which involved cattle stealing. After a short stop in Lankien, we arrived at Nasir, a large town with hundreds of tukuls surrounding the airstrip. The hospital in Nasir was also large, consisting of three inpatient wards, an antenatal clinic, a therapeutic feeding centre, and a tuberculosis village. There is also an operating theatre and a kala azar* clinic. All the inpatient wards were crammed with patients, supporting the monthly statistics that showed full occupancy at around 200.
During my two days in Nasir I continued to work on the four monthly budget reviews as well as spend some time with the logistician Lydia, reviewing the finance operations there. I also saw the water and sanitation infrastructure, as well as the construction of a hand dug, seven metre deep ash pit for the disposal of the incinerated hospital waste, and the new cholera treatment centre (emergency preparation, right now there is no cholera). We then flew to Leer, a region close to the major oil deposits. The hospital in Leer is the biggest out of the projects, with eight international staff, three regional staff** and 140 national staff. The services provided here were the same as those in Nasir, and once again the inpatient wards were crammed with patients, with a number of patients spread out under the verandas and under trees.
After two days in Leer, we returned to Nasir with a surgeon named Addy who was coming to assist with an influx of patients from the latest fighting that had left many dead and another 54, mostly women and children, wounded. On our arrival in Nasir we learnt that the surgeon, Sebastian, had been working non-stop overnight operating on the patients, as had all the other staff that had been on hand to treat the wounded. As we went around the ward it was shocking to see young babies, grandmothers, teenage girls and even a pregnant woman with severe gunshot wounds. Children had lost both parents and some women had lost husbands and children. There were some very serious cases, such as patients with head and abdominal wounds. Some patients with severe wounds to their arms and legs were to subsequently require amputations.
We only stayed in Nasir for around two hours. Once the plane had refuelled we got back on board for the trip back to Loki. Half way down the runway, the pilot aborted the take-off when the front-end of the plane started to vibrate very badly. Fortunately I was able to join another flight run by another organisation. After our aborted take-off I thought it was most appropriate when the pilot asked us to join him in a short prayer!"
*kala azar is Hindi for black fever, otherwise known as visceral leishmaniasis, is a tropical, parasitic disease caused by one of over 20 varieties of Leishmania and transmitted by bites from certain types of sandflies. Without treatment, this form of leishmaniasis is fatal in almost 100 per cent of cases.
**regional staff – we have to recruit field workers in positions normally filled by national staff from a regional pool of local health workers because in southern Sudan there is a huge lack of trained personnel. After three decades of war the South is almost completely devoid of any education or health training infrastructure, hence the need for the additional staff from the region, usually Kenya.
- A Médecins Sans Frontières nurse examines a dehydrated baby in Nasir. © Sven Torfinn