In South Sudan malnutrition and disease are the killers not bullets
Darfur and the DRC are two of the most dangerous places on earth, with armed factions fighting for control of territory and regular violent clashes. But far more dangerous than bullets is the silent killer of disease and malnutrition that has claimed many thousands of children’s lives. Emily Cooper, a nutrition expert for the international children’s charity World Vision, recently visited South Sudan and heard people’s stories.
My work as a nurse and nutritionist has taken me to many war torn countries over the last 10 years. While I’m away, my friends and family worry that I might be injured or worse, having seen reports of heavy fighting on the news.
Though I sometimes find misguided scorpions in my room or mice nesting in my medical bag, I can’t remember hearing a single gunshot fired in aggression or a bomb blast nearby. Nor have I treated any wounds that came from violent conflict.
Most of what I see is children and families suffering from the more silent impact of war, disease and hunger, which continues well after the fighting has stopped. We know that more than 80 per cent of deaths in Darfur between 2003-2008 were caused by disease, not violence. Likewise, in DRC only four percent of 5.4 million deaths due to the recent conflict occurred as a result of violence.
My work for World Vision recently took me to Warrap state in South Sudan. Our team in the newest country in the world is working with the government and UN agencies to help address issues that stem from a conflict with North Sudan that lasted for more than two decades. Here paved roads are a luxury as are bridges. With large areas of the state flooding every rainy season it means transporting supplies and medicines to health centres is very difficult and often impossible.
Indeed during my visit several health units were completely cut off after flooding made roads and bridges, where they exist, impassable. At one of the sites we were able to access, I had a chance to talk to Rebecca. A couple of months ago she had to walk for two days to a neighbouring state hospital to get medical care for her son, Athiei who has been sickly since he was a baby. With no milk from her cows this year to give the hungry two-year-old, it was hard to get him the nutritious food he needed.
Athiei received help at the hospital but became ill again shortly afterwards. Fortunately, one of the outpatient nutrition points that World Vision supports is now operating regularly, only two hours from Rebecca’s home, meaning she can more easily access the care she needs for her son. When I meet Athiei he is thin, but eagerly eating the high energy peanut paste he’s given. Rebecca is confident he will improve quickly because the nutrition point is close enough to home for weekly follow-up visits.
Staff working with World Vision in South Sudan have witnessed the benefits of this sort of nutrition programme time after time. During my trip I spent time with my colleague Dr Severin Kabakama. He told me about children who come to our centres close to death but after receiving support like that Athiei had “within two weeks they are walking and running”. It’s good to hear.
Another major challenge in South Sudan is the lack of trained healthcare professionals. Though things are improving, during the conflict educational opportunities were very limited. Boys’ schooling was often prioritised while girls stayed home to help with the housework. This makes finding and training people – especially women – who can work as trained medical staff difficult. There is currently no nursing or medical school within Warrap state and bringing skilled staff in from other areas can be expensive and unsustainable.
World Vision believes it is crucial to train health workers within the community and is working with the ministry of health to facilitate this. I had a chance to visit one of the county refresher training sessions for the health staff working in nutrition and was pleased to see how engaged and interested they were.
At a local hospital I meet Angong, with her small two-year-old daughter Nyibol and her seven-year-old sister, also called Angong. The family lives over two days away by foot but fortunately received a ride to the centre from a passing car. Nyibol was very ill and malnourished when she arrived but is improving quickly and will be discharged soon.
I am happy about this but concerned for her sister who will have missed weeks of school to make this trip. She will go back to class when Nyibol is well enough for her not to be needed to help. I hope so. For South Sudan to have a successful health system, young girls like Angong must get a good education and know they have the chance to become nurses and doctors.
During my trip I saw a general optimism that things are improving. For instance, the first nursing and midwifery college in South Sudan’s history was recently started in a nearby city and has more than 70 students enrolled from across the country. Hopefully new graduates will be able to start working in the health system in the next few years. But there are still many challenges ahead and continued support is vital as the country’s fledgling government and communities look to provide these services independently.
World Vision has just released a report looking at how conflict affects people’s access to health care: ‘No Short Cuts: The Difficult Path the Maternal, Newborn and Child Health in Fragile States’.
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