We arrived in Terekeka town Monday, met with a few leaders of the medical facilities and Terekeka county health department and planned out our attack plan for seeing as many medical facilities as possible. We plotted 9 out for the next 3 days (we would end up making 7).
The best way I can describe the journey we embarked on for the next 3 days is that it was like going on safari, except instead of searching for animals at the end of the jostle-y, potholed roads, we were searching for health facilities.
And find them we did. The first facility, Muni, is about a 2 hour ride up safari-roads, and is privileged enough to have had GoSS purchase an ambulance of sorts. It is supposed to be used to transport people to the facility, or to Terekeka when needed.
Unfortunately, this entire area and many surrounded villages were abandoned last summer for several months due to tribal violence. People returned in late fall, but retaining medical personnel has been difficult. Midwives are already scarce, and recruiting a woman to stay in a village where she has to rent a tukul or stay with villagers, and is a half day journey away from the nearest city is difficult. The village health committee, tired of midwives coming and leaving (or accepting the position but never showing up) decided to take action. They began collecting 1SDP from every patient, and have begun construction on several tukuls near the facility so that the health providers from the facility have a place to stay, rent free. It seems like a pretty neat combination of NGOs and communities working together to solve problems.
Most of the rest of the facilities we visited were run out of tukuls, and I have a story for each one (literally). In order to save space, I’ll just mention 2.
In Tukara, the CHW running the facility only spoke Arabic. Between a long day in the Rover, not enough water, and no food since a quarter cup of rice at breakfast, 2 of my colleagues and I decided that sitting inside the cramped tukul for an hour in the hottest part of the day when we weren’t needed sounded like a recipe for passing out. Instead, we camped under the tree outside the facility. The arrival of our Land Rovers attracted a crowd at each facility; add the fact that 2 white Americans and 1 Bangladeshi were hanging around with the village elders under the tree and to say we attracted a crowd is an understatement. At one point a girl about 15 years old came over, took off one of her rubber necklaces, and put motioned for me to put it on. I did, much to the merriment of the 30 people around me. When I tried to give it back , she refused. Things like this have happened to me before, and there’s no real way which I can adequately describe being gifted something by a community so impoverished, without coming off sounding naïve and voyeuristic. Let’s just say I was touched, and Mom, that African-style bracelet you gave me is now on the wrist of a girl in the middle of the South Sudan bush.
The last facility we visited had a similar story to Muni: A 2 hour drive up a windy, bumpy road (which was so bad that even after 3 days, we all felt a little ill, and my colleague described it as a “double helix” road) the VHC, realizing the 2 tiny tukuls they had were barely big enough to store their basic drug supply and a plastic chair, is gathering money from the village and slowly building a full building for their PHCU. The real story here however is that after our supervisory visit was done, the CHW for the PHCU mentioned that he’d heard there was a woman with a complicated labor in one of the nearby villages, and would we possibly be able to bring her with us to Terekeka? We sent a vehicle to get her, but little did we know she was another hour away in Borah, where there used to be a facility, but is no longer. My colleagues and I once more waited on log benches under the PHCU trees for their return, and then slowly began our windy version back, with the woman laid out on the floor in the back. I cringed for her on every bump we went over in that next 2 hours, but she barely made a sound. Once we made it back, she was surrounded by several midwives in addition to her TBA who traveled with her from Borah. Her chances of survival increased exponentially being at a facility with a Skilled Birth Attendant, but the facility still lacks the ability to do an emergency c-section if needed.
If you look at maps of South Sudan and where health facilities are, it’s almost painful. Only 25% of the country has access to medical services. The country has been ravished by decades of civil and tribal war. There’s a pathetic lack of skilled medical personnel. Each PHCU is run by a CHW who has undergone a nine month training and is qualified to administer vaccines, malaria and respiratory treatment, and various other health and family planning counseling. Most have at least one TBA whose training includes a 2-4 week course and a lifetime of learning (see CUA for more details on TBAs). A PHCC requires an ANC/maternal ward (which means midwife), and are generally larger. There are about 30 hospitals in the whole country, most of them in need of significant or complete refurbishment. And sadly, this is all better than it was 5 years ago.
It’s pretty easy to see why South Sudan has some of the worst health indicators in the world.