I just got back from Juba yesterday, so now I can blog in real time. This adventure is almost over and I'm really grateful for it. I am satisfied that we did the right thing by coming in with the Wharton team to do a careful assessment, asking some hard questions before jumping right in. Sure, you walk away wondering if this trip did any good, but you have to think long-term. It's not always just about feeling good.
And what feels better than practicing medicine? Seeing patients, prescribing medicine after a 15-minute interview, and doing surgeries is very rewarding, from what little experience I have. In Malek, another thing we did was set up a makeshift clinic with the small pharmacy of drugs we brought with us. People came in droves with health problems of every kind. It was uncontrolled madness and we definitely could have organized ourselves and our patients better. My mom and I interviewed and examined the patients with the help of translators, and Orin, Grace and John filled "prescriptions". Sush went to distribute vitamins to the women, and was apparently nearly accused of poisoning them (one of the women told him to swallow a pill himself so they'd know he wasn't trying to kill them all).
It wasn't that we didn't do any good that afternoon. I think we did. We de-parasitized, killed fungal infections, cleaned abscesses, and treated diarrhea. We tried to give clear instructions on how to take the meds, although communication is the most overlooked, most important factor in doctor-patient interactions (and is 100 times harder when you're being ambushed by mothers pushing their kiddos toward you). I can only pray that we did some good. But I am more convinced than ever now that medicine is NOT the answer for rural health, at least not in Malek.
Those kids need clean water to drink, and they need protein. Their bellies are obviously swollen with kwashiorkor. What good will pylotrip do for their ulcers without a proper diet? They need latrines, and they need sewage. They need vaccinations. They need to go to school. They need better housing to shield them from the elements, of which there are many in East Africa, home to a billion bugs and all those cool safari animals.
When we got back to Juba from Bor, we had a debriefing where the Warton team gave my mom and I their impressions of where Universal Unity should go next. They were all against building a clinic, as am I. Not because it's not needed, but because so much more, and so much more basic things, are needed more desperately. And because as a growing organization in its beginning stages, we don't have the know-how, the funds, the time commitment, or the managerial skills to make this happen. We're talking about a location where CRS, a behemoth of an aid organization with 10-year commitments to its subjects, is pulling out. What makes UU's chances better?
I'm not saying we should pull out too. Not at all. I think we should partner with Michael Lear from Real Medicine Foundation and send nurses to his nursing program at Juba Teaching Hospital. We can also help revise the curriculum and bring doctors and nurses in to help train for short periods of time (which is what we have to offer, since no one has stepped up to move to Africa permanently). I think we should refine our "Educate Refugees" project, which needs a lot of help before we take on something new (I knew this before we left for Sudan, and meeting former students in Nairobi only confirms it). In short, I think we should build capacity. In a few years, our students will be engineers and agriculturalists. We just met two high school graduates, Natalina and Mercy, who are hanging around Juba after sitting for the KCSE -- they would be perfect candidates for nursing school. In time, UU will be able to complete our promise to our students that we would help them find their way in life through education. It will be a more complete promise than simply paying their fees, and it would help us do what we've wanted to do all along: help Southern Sudan.
I'm mentioning this on the side, but the current peace agreement between the ever-warring North and South Sudan ends in 2011, at which time there will be a referendum. Kwai thinks the North will never agree to let the South be free for good, and I don't see why they would. He seems to think 2011 will bring war, at which time "you will see Kwai in uniform". With peace this fragile, building a clinic now makes even less sense. Better build capacity in a place where there is none, waiting for 2011 and its aftermath while continuing to educate students in Nairobi and hopefully soon in Juba.
Saturday, May 30, 2009
Tour of Bor and assessment in Malek
The next day was our only full day in Bor, so we had to make the most of it. We started by meeting IMA's team leader in Jonglei, Dr. Makina, and the state level minister of health, whose name I honestly don't recall. Dr. Makina is an MD/MPH, and the IMA (International Medical Agency) is the most important health care player in SS right now (the Government of SS, or GOSS as the cool kids call it, is broken and broke, and a multi-donor trust fund is the only money available for public services). It was a very informative meeting, and we got a lot of historical and
current information about Jonglei, Bor and Malek. The census data is shaky at best. But they were able to outline the biggest challenges they face, and where they think opportunities for aid might lie. It was a useful meeting.
Aware of our tight schedule, we first set out with Dr. Benjamin to tour Bor Town Hospital. The hospital is a converted barracks, staggering to meet the needs of its population. The buildings are dilapidated, and a few have been abandoned due to asbestos or massive bat invasions. There are makeshift buildings, such as the surgical ward, which is literally a tent donated by MSF. Inside, the heat and stuffiness are sweltering. I was shocked that either surgeon or patient could survive an operation under such conditions, but Dr. Benjamin said nothing. As in almost all other resource poor medical settings, they do almost all operations under spinal anesthesia.
Just as the conditions of Juba Hospital made me understand the dire need for health care in the capital city of SS, so did the conditions of Bor Town Hospital. But I was also struck by the distinct recognition that these people are doing the best they can with the resources available to them. There is no funding for salaries, yet they have four midwives. Their budget is hardly worth mentioning, yet they have an x-ray machine and an ultrasound. They do antenatal care. They have a lab where they run tests, and they treat patients based on the results. They do the best they can with what they've got.
After the hospital tour, we set off for Malek, a half hour drive from Bor Town. In Malek, we surveyed a couple of potential building sites. The team favorite was hands-down the site near the Nile with the open grass field, where Deng envisions planting crops to feed the patients of our proposed clinic. We then had to introduce ourselves to the village elders, which was a drawn-out affair of seeking to understand and to be understood. From our side, Orin did an excellent job of
being gracious and diplomatic. On their side, it was helpful (if not encouraging) to hear their reservations about our promises (and whether we would fulfill them, or disappear). It was also nice to know that they acknowledge our work educating their refugee relatives in Kenya.
current information about Jonglei, Bor and Malek. The census data is shaky at best. But they were able to outline the biggest challenges they face, and where they think opportunities for aid might lie. It was a useful meeting.
Aware of our tight schedule, we first set out with Dr. Benjamin to tour Bor Town Hospital. The hospital is a converted barracks, staggering to meet the needs of its population. The buildings are dilapidated, and a few have been abandoned due to asbestos or massive bat invasions. There are makeshift buildings, such as the surgical ward, which is literally a tent donated by MSF. Inside, the heat and stuffiness are sweltering. I was shocked that either surgeon or patient could survive an operation under such conditions, but Dr. Benjamin said nothing. As in almost all other resource poor medical settings, they do almost all operations under spinal anesthesia.
Just as the conditions of Juba Hospital made me understand the dire need for health care in the capital city of SS, so did the conditions of Bor Town Hospital. But I was also struck by the distinct recognition that these people are doing the best they can with the resources available to them. There is no funding for salaries, yet they have four midwives. Their budget is hardly worth mentioning, yet they have an x-ray machine and an ultrasound. They do antenatal care. They have a lab where they run tests, and they treat patients based on the results. They do the best they can with what they've got.
After the hospital tour, we set off for Malek, a half hour drive from Bor Town. In Malek, we surveyed a couple of potential building sites. The team favorite was hands-down the site near the Nile with the open grass field, where Deng envisions planting crops to feed the patients of our proposed clinic. We then had to introduce ourselves to the village elders, which was a drawn-out affair of seeking to understand and to be understood. From our side, Orin did an excellent job of
being gracious and diplomatic. On their side, it was helpful (if not encouraging) to hear their reservations about our promises (and whether we would fulfill them, or disappear). It was also nice to know that they acknowledge our work educating their refugee relatives in Kenya.
Finally on our way to Bor
After a few eventful days in Juba, we were ready to make the 200-km, 7 hour long trip to Bor Town on May 26. However, we were told that the police commissioner would not allow travel and that the roads would be blocked. Apparently, we had the good fortune of being in town for SPLA Day. While SPLA Day (SS Independence Day) actually falls on May 16, the celebrations are staggered across cities in SS to allow the president to be present for all the festivities. I thought it was strange that the capital of SS should have its SPLA Day ten days after the real thing, but whatever.
So on May 26, we pushed back our plans to travel and decided to celebrate the national holiday by going to the festivities. We saw some lively performances by men and women, singing and dancing in circles with colorful costumes and noisemakers of every kind. Older women sang about their days as female soldiers during the wars, and others marched and danced in rows, celebrating freedom. SPLA soldiers lined the field, their guns inexplicably pointed at the crowds. It was definitely a sight to see. Afterward, we got ourselves out of the blazing sun and ate lunch at a cute British sandwich shop (Juba is a place of utter social contradiction) where we saw some of the prime missionary/aid glitterati (Lebanese, American, Anglo, Japanese, Arab, you name it). Then, we drove home to Samaritan's Purse, rested until the sun let up, and went for a gorgeous hike in the mountains with Lori. Great way to spend a national holiday, Juba or not!
The next morning, we set out for Bor. We were traveling with police escort to ensure our safety, so we had to wait six extremely frustrating hours for our entire entourage to assemble itself. We had 21 armed soldiers with us. It was a bit ridiculous.
By nightfall, we were in Bor, which is more of a shanty than a town, despite being the capital of Jonglei State. We were taken to the Freedom Hotel, where Mach and many others had suggested we stay for our short trip (two days). My mom was horrified at the thought of sleeping in tents and found the communal bathrooms and showers equally horrendous, but with Sushant and I leaning heavily toward setting up camp as soon as possible, we decided to make Freedom our new base. It was a good decision, I think, and by the second night, we hardly noticed all the bugs in our tent!
So on May 26, we pushed back our plans to travel and decided to celebrate the national holiday by going to the festivities. We saw some lively performances by men and women, singing and dancing in circles with colorful costumes and noisemakers of every kind. Older women sang about their days as female soldiers during the wars, and others marched and danced in rows, celebrating freedom. SPLA soldiers lined the field, their guns inexplicably pointed at the crowds. It was definitely a sight to see. Afterward, we got ourselves out of the blazing sun and ate lunch at a cute British sandwich shop (Juba is a place of utter social contradiction) where we saw some of the prime missionary/aid glitterati (Lebanese, American, Anglo, Japanese, Arab, you name it). Then, we drove home to Samaritan's Purse, rested until the sun let up, and went for a gorgeous hike in the mountains with Lori. Great way to spend a national holiday, Juba or not!
The next morning, we set out for Bor. We were traveling with police escort to ensure our safety, so we had to wait six extremely frustrating hours for our entire entourage to assemble itself. We had 21 armed soldiers with us. It was a bit ridiculous.
By nightfall, we were in Bor, which is more of a shanty than a town, despite being the capital of Jonglei State. We were taken to the Freedom Hotel, where Mach and many others had suggested we stay for our short trip (two days). My mom was horrified at the thought of sleeping in tents and found the communal bathrooms and showers equally horrendous, but with Sushant and I leaning heavily toward setting up camp as soon as possible, we decided to make Freedom our new base. It was a good decision, I think, and by the second night, we hardly noticed all the bugs in our tent!
Juba
Our trip started out in Nairobi, after a nice layover in London (during which time Orin, John, my mom and I visited Sushant's family's home in Kensington Gardens!). We arrived to Nairobi the night of the 20th and stayed at the AIM Guesthouse, which houses humanitarian workers for $30 a night. It's a nice place with a lived-in feel. The only complaint I have is that the culture is distinctly missionary, and I am distinctly (vehemently) not. More on that later...this post is about our trip, not my soapbox!
We spent the next day in Nairobi (Friday) getting tickets to Sudan, which cost an arm and a leg ($550 roundtrip each). We also picked up more medicines to distribute in Malek, our proposed clinic site.
The next day, we finally arrived in Juba. Our flight was delayed four hours, and we were greeted by Dr. Benjamin Malek, known to us as the only doctor in Bor Town, the capital of Jonglei State, where the vast majority of our sponsored SS students are from. (Malek, and apparently all Dinka names, are words for cattle. Malek means brown and yellow spotted bull). We were also greeted by Kwai, who we worked with extensively last year, and who was instrumental in helping us implement the sponsorship program. It was good to see them again. We were also reunited with Mach, a strong-willed student who we interviewed last year but could not support. Mach ended up being extremely helpful to us throughout the trip, at every leg of our journey, whether it was car problems, police trouble, or the endless Jonglei cow herds blocking the roads. His left hand was burned at 6
months by a bomb during the war; he was rescued by his father and operated upon to salvage his thumb. Mach is one of the most determined people I've met, and he gets things done.
Once in Juba, we settled into our new accomodations at Samaritan's Purse, another hostel for missionaries. We spent a few days meeting with key contacts in the city who gave us invaluable information. My favorite meeting was with Michael Lear, who is launching a nationwide health care capacity-building project in partnership with the UN. I and the whole team envision a great fit between our interest in training nurses and doctors, and his desire to expand health care services. I quickly realized that Juba is a city whose presence is dominated by aid workers, whether they are NGOs or UN workers. SS relies heavily on this shaky support to get anything done.
We also visited Juba Teaching Hospital, which serves the estimated population of 300,000 with shockingly few resources. It has a program that trains nurses in basic care, but my mom and I flipped through their exams, and the curriculum is not at all up to par. Some of their textbooks date back to 1937! We were shown around by Magda, a fierce and stylish aid worker who clearly has a vision for the hospital and the people it serves.
As the clinic we are envisioning would most likely resemble what in SS would be called a PHCC (primary health care clinic), we went to visit one in a place called Kator to see what it looks like. The building itself was impressive; the structure was donated by an Italian NGO. However, what the place lacked was human resources; there were only two personnel there, and the rest of the place was totally empty. It was, of course, a Sunday. But in the capital city of SS, in a country where malaria is endemic and maternal and child mortality is the highest in the world, Sunday is no excuse for an empty clinic. The doctor who was there told us he sees about 1000 cases of malaria a month, and receives only 60 treatments from the government. They expect those 60 treatments to last three months. It's a joke.
Malaria nets are also a tricky business. In the cities, it is easier to implement net use. But in the villages, many people live in cattle camps. The tribal way of life is wholly centered around cattle. It is their wealth, their religion, their ideology. They sleep near their cattle in tents of their own making, and are suspicious of people who advise them to drape strange netting over their shelter. It's not impossible to implement change, but often here in SS it seems pretty
close.
We spent the next day in Nairobi (Friday) getting tickets to Sudan, which cost an arm and a leg ($550 roundtrip each). We also picked up more medicines to distribute in Malek, our proposed clinic site.
The next day, we finally arrived in Juba. Our flight was delayed four hours, and we were greeted by Dr. Benjamin Malek, known to us as the only doctor in Bor Town, the capital of Jonglei State, where the vast majority of our sponsored SS students are from. (Malek, and apparently all Dinka names, are words for cattle. Malek means brown and yellow spotted bull). We were also greeted by Kwai, who we worked with extensively last year, and who was instrumental in helping us implement the sponsorship program. It was good to see them again. We were also reunited with Mach, a strong-willed student who we interviewed last year but could not support. Mach ended up being extremely helpful to us throughout the trip, at every leg of our journey, whether it was car problems, police trouble, or the endless Jonglei cow herds blocking the roads. His left hand was burned at 6
months by a bomb during the war; he was rescued by his father and operated upon to salvage his thumb. Mach is one of the most determined people I've met, and he gets things done.
Once in Juba, we settled into our new accomodations at Samaritan's Purse, another hostel for missionaries. We spent a few days meeting with key contacts in the city who gave us invaluable information. My favorite meeting was with Michael Lear, who is launching a nationwide health care capacity-building project in partnership with the UN. I and the whole team envision a great fit between our interest in training nurses and doctors, and his desire to expand health care services. I quickly realized that Juba is a city whose presence is dominated by aid workers, whether they are NGOs or UN workers. SS relies heavily on this shaky support to get anything done.
We also visited Juba Teaching Hospital, which serves the estimated population of 300,000 with shockingly few resources. It has a program that trains nurses in basic care, but my mom and I flipped through their exams, and the curriculum is not at all up to par. Some of their textbooks date back to 1937! We were shown around by Magda, a fierce and stylish aid worker who clearly has a vision for the hospital and the people it serves.
As the clinic we are envisioning would most likely resemble what in SS would be called a PHCC (primary health care clinic), we went to visit one in a place called Kator to see what it looks like. The building itself was impressive; the structure was donated by an Italian NGO. However, what the place lacked was human resources; there were only two personnel there, and the rest of the place was totally empty. It was, of course, a Sunday. But in the capital city of SS, in a country where malaria is endemic and maternal and child mortality is the highest in the world, Sunday is no excuse for an empty clinic. The doctor who was there told us he sees about 1000 cases of malaria a month, and receives only 60 treatments from the government. They expect those 60 treatments to last three months. It's a joke.
Malaria nets are also a tricky business. In the cities, it is easier to implement net use. But in the villages, many people live in cattle camps. The tribal way of life is wholly centered around cattle. It is their wealth, their religion, their ideology. They sleep near their cattle in tents of their own making, and are suspicious of people who advise them to drape strange netting over their shelter. It's not impossible to implement change, but often here in SS it seems pretty
close.
Universal Unity in South Sudan!
I haven't blogged for awhile, but I'm on a trip to South Sudan right now so it's a good time to resume. I just finished my second year of med school, survived the boards (I think) and have two weeks before third year starts (the advent of a professional life...sort of). Since I'll be journalling our trip periodically, and we won't have much internet access for the greater part of the trip, I'm going to lump everything together :).
This year's Universal Unity trip to East Africa is very different from previous ones. Last year, we went to Kenya and interviewed Southern Sudanese (SS) refugees living in and around Kakuma camp. It was a very good project for an NGO in its incipient stages--it allowed us to come for brief periods, to manage the program remotely when we were not in country, and to feel satisfied that we were making a difference.
This year, the NGO's leader (and my mom) had the vision of taking UU's involvement with the SS cause a step or two or a million further: she wants to build a clinic in the village of Malek, where many of our SS refugee contacts are from. Enlivened by the Lost Boys' passion for helping their people, she wanted to bring quality health care to people who have no idea what that phrase even means. Naturally, since we've never even been to Sudan, we had to travel their first to do an assessment. That is what our two-week trip now is about.
Because of our desire to do a thorough assessment before investing in what's sure to be a large-scale project, we are partnering with business students who recently graduated from Wharton. Orin, Sushant, John and Grace are a vibrant, intelligent, seasoned bunch who are well-versed in international development, logistics and strategy...all of which we at UU are lacking. It's been great so far, and we are learning a lot from each other.
This year's Universal Unity trip to East Africa is very different from previous ones. Last year, we went to Kenya and interviewed Southern Sudanese (SS) refugees living in and around Kakuma camp. It was a very good project for an NGO in its incipient stages--it allowed us to come for brief periods, to manage the program remotely when we were not in country, and to feel satisfied that we were making a difference.
This year, the NGO's leader (and my mom) had the vision of taking UU's involvement with the SS cause a step or two or a million further: she wants to build a clinic in the village of Malek, where many of our SS refugee contacts are from. Enlivened by the Lost Boys' passion for helping their people, she wanted to bring quality health care to people who have no idea what that phrase even means. Naturally, since we've never even been to Sudan, we had to travel their first to do an assessment. That is what our two-week trip now is about.
Because of our desire to do a thorough assessment before investing in what's sure to be a large-scale project, we are partnering with business students who recently graduated from Wharton. Orin, Sushant, John and Grace are a vibrant, intelligent, seasoned bunch who are well-versed in international development, logistics and strategy...all of which we at UU are lacking. It's been great so far, and we are learning a lot from each other.
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