Letter from Old Fangak 2009-10-25

This was written by Ann Evans, clinical nurse volunteering her time helping Dr Jill Seaman in Old Fangak, South Sudan

Only one child has died since our charter reached Old Fangak 3 days ago with the much needed medicines and with this questionably useful 'helper', myself. The five year old had kala azar; his mother's wail spread mournfully over the village; everyone knew. Then the inpatient room, with its single light bulb, broken flooring, ancient metal bed frames with a few torn mattresses, a once-white plastic table, two rag tag metal cabinets, a few token supplies and occasional staff, emptied completely; no one remains around the dead. Only the bats and a variety of insects and lizards held their places.

The excitement of finally reaching Old Fangak began to fade soon after our plane landed--at the wrong end of the only place remotely available for landing, almost in the bushes, and too laden with cargo to turn around. Although planes land there, it doesn't deserve the term 'airstrip'; a couple of aged and broken-up planes testify to that. Children, women, Dr. Jill, and our internet technician load boxes on their heads, then carry them through the grasses and swampy water to load them into the waiting boat--the airstrip is on the opposite side and down river of the village. The men stand around and watch; they don't do this kind of work. Families of kala azar patients meet the boat in the village to unload the supplies. Our packages of oatmeal, a few other foods, and candles disappear; the canned corn reaches us; I guess we should be glad for that, although I would have preferred the oats.

We enter the building previously occupied by a European NGO that was funded to provide primary care. When the funds disappeared the NGO left too, dumping their responsibility and adding enormously to Jill's workload and costs of treating the deadly infectious diseases of TB, malaria and kala azar; one can't just ignore the other patients. The old NGO building--a large mud hut--is now our kitchen, dining, and food storage area. One area is said to be a 'great' place to rest; there are also two sleep spaces for guests. One area of floor space is being 'mudded'; part of the wall is missing. Jill says the rat problem in this hut was solved by a cat; but my attention is captured by the bats, some flying just inches from my head; their droppings obvious on tops of containers. I think the whole building is theirs-- far more than ours. Naphtali, our Kenyan internet technician, just here for a day or so, tells me that the bats eat mosquitos and are very good at not flying into people. His explanation and soft voice are meant to be reassuring. I keep my hand over my cup of coffee and wonder how I can adapt to this. I'm glad for the large breakfast I ate in Loki and that I still have 2 halves of almond butter and honey sandwiches that are only 8 days old and without visible mold. I'm also glad for my heat-diminished appetite as well as my desire to drop some weight while here.

Later, Sjoukje (a too-soon-to-depart for Holland NP), gives me a tour. She will provide my 1 1/2 day orientation to diseases I've never seen, on a continent never visited, under conditions that leave me all but speechless and with little time or energy for communicating it to anyone who might find the situation worthy of comment. We visit the rat infested storage area where spoiled bags of concrete, some mosquito nets, and the last six blankets are kept. The 'shower room'-- where two containers of water, a round basin for washing feet, and a bucket and cup complete the equipment for showering; forget about a pipe above one's head and other things that come to mind when one says 'shower'. Next we visit the hut where computer access is being set up. It is also home to a scrap-wood bookcase, a few shelves and two tables. The stains in a few old bed sheets covering areas of the straw grass roofing define some of the leaky places; Sjoukje hopes we can get more sheets so we can identify all the leaks. A small fluorescent light, not much bigger than found in a car, provides the only light for the hut. Jill says we should keep it off when our computers are being used because it uses extra energy and our computers provide enough light for what we are doing. What she says is true; and I know--in spite of what our mothers told us--reading in the dark does NOT cause blindness! Anyway, the 10 to 12 inch band of screening in some places below the straw roof also provides tiny bits of light. The hut is hot, although better when the door is kept open. This hut is the 'rat' hut; no need to explain that one. So...we eat in the 'bat' hut, work some out of the 'rat' hut, and sleep outside in individual REI tents--unless it is raining. The single latrine is kept locked so the village doesn't fill up the large buried barrel with the open rusting top.

As we walk around the village everyone says 'mali'--or some such spelling--meaning 'hello' or 'how are you?' Everyone shakes hands-- some are clean--without obvious dirt; but places to wash are few and far between. My hope of avoiding acute gastro disease shrinks with each outstretched hand that I take, all the while returning the smile and greeting. I remember not to touch my face.... We visit the TB station where medicines are being dispensed and 'directly observed therapy' occurs. Then into some mud huts where several elderly men lie on mats--old spinal TB, one with bad sores, another very frail, and one with no one to cook for him. Later we return and give the old men some soap and blankets; we are down to two blankets now.

We have a cup of soup in the evening, which is as much as I wanted anyway. I think we are settling in for the night, but it is only a break before we start clinic that goes until the last patient is seen-- well into the darkness and definitely past my usual bedtime. We work outside with headlamps and flashlights because there are only a couple of lights in the building that serves as the outpatient and OB, as well as the hospital, pharmacy, lab and central supply. People wait a long time, sitting or lying on the ground in the dark. I press the issue of lighting; Jill says someone is coming in February to properly wire the building; we go through a set of expensive AAA lithium batteries in 2 days.

Finally, the last patient is seen. Sjoukje had slipped away and has prepared a simple meal of canned corn and canned green beans with vinegar and herbs for a salad, and some potatoes that I brought from Nairobi. After dinner I'm too tired to deal with the new 'shower' in the darkness, so I climb into my tent still clothed, which is how one does it here. Letting go of all the other images of the day, I gaze at the stars, which are very beautiful and clearly seen in the near total darkness of Old Fangak. I'm happy for the good tent; sleep comes quickly and I awake refreshed in the morning, wonder how I can possibly learn all I need to know; then accept that I can not; and determine to do the best I can.

Lives are being saved here; what we do makes a difference, even though most of the world doesn't know and probably doesn't care. All donations to the Sudan Medical Project to date have been spent-- entirely. We who are here now--Jill and I--have both donated and loaned money to the project, as well as paid our way here and are volunteering our time. If you know people who want to save some lives, in one of the most efficient uses of donations possible, please have them go to crosscurrentsinstitute.org; to Current Programs; and make a contribution to the Sudan Medical Project. If you have connections to Foundations, to generous good hearted people, to church groups, community groups, to anyone who might care and might respond, please ask them to help. We are diagnosing more of the deadly kala azar every day. Without intervention it will kill, and it is the children who will die. The numbers of patients are increasing; we will need more medicines, blankets, food, and supplies. Even getting them here is very expensive because we generally have to charter a plane. Please do what you can do and feel free to forward this message to anyone you think might help. We who are so deeply involved in this project and the people of Old Fangak will be ever so grateful. Namaste and God bless you!


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