September 2009 Newsletter page 1

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It was truly an amazing year. Sjoukje and Jill arrived back in Old Fangak in September 2008 to find the airstrip full of people welcoming us “home”.  All the churches had organized singing and all the chiefs provided the stamp of officialdom. Kids ran through the swamps to wave at us.  Why this overwhelming greeting?  Well the last of the international aid organizations had departed during the rainy season.  The Fangak community was determined to let us know they wanted us back.

Trying to ensure primary health care while running a TB and kalaazar program was surely a stress.  We had more or less inherited the primary care staff, and were expected to find money to pay them and run their program while searching for another NGO to take over.

Little Yumlat has Jill’s blood.
Malaria is an equal opportunity
illness – deadly for the well off
as well as the destitute.

Luckily Peter Sunduk, the clinical officer with training similar to that of a nurse practitioner, was able to provide the necessary management skills for our mushrooming staff, as well as seeing the more complicated patients.  Sunduk grew up in this area, knows the political landscape, and is able to negotiate in ways that outsiders can’t do.  The $10,000 that we invested in his training has been repaid many times over.

September brings the end of the rainy season and the peak of malarial illness. New combination medicines using an artesunate derivative are fantastic. Artesunate comes from China and is the first drug springing from the developing world to be licensed in the developed world – for good reason; it works while the other antimalarials are failing. It only requires once a day dosing for 3 days! You poke the patient’s finger for a drop of blood, run a quick test, and hand them the prepackaged medicines and a few Tylenol. Ready for the next patient. It’s great!

But severe malaria can be quite a killer.  Just after we arrived the national staff called us to one of the inpatient children, who’d just become comatose.  Jill carried him outside to search for a vein in the remaining twilight while the unresponsive child gasped for breath.  Meanwhile national staff grabbed Shoukje’s arm to exploit one of her lovely veins -- our precious local reservoir of O negative blood.  Another health worker stuck in the large donation needle.  Within 15 minutes this infant -- strengthened by Sjoukje’s blood -- was breathing normally again.


Kala azar
This little patient has kala azar
and PKDL – a skin disease
that is frequently associated
with kala azar.


While malaria remains ever present but more manageable, kala azar is still a dreaded killer. Transmitted by a sandfly during the hot dry season, it causes fevers and a big spleen just like malaria. And just like malaria, it is deadly. The two are hard to distinguish. Unlike malaria, kala azar requires 30 daily injections of the heavy metal sodium stibogluconate for treatment.

We’re happy to report that the kala azar cases are decreasing. Mosquito nets for prevention, and rapid treatment of the disease may be working! We’ve noticed increased cases to the south and east of us. We’ll need to try to focus some outreach there this fall to prevent a possible deadly outbreak.

344 kala azar patients;
54% male
85% under15; more than half less than 5 years old.


TB remains one of the area’s biggest problems, and our largest program. One patient with TB of the lung can infect 10 to 12 people a year. In fact, just as we go to print our clinical officer sent a message that yet another sputum positive patient has been admitted in our absence.

Treatment is the only effective control method available – though we know better housing and nutrition make people less susceptible to TB germs. Treating TB has life-saving potential similar to that of vaccination campaigns.

Spinal TB, uncommon in the rest of the world, is huge here, and it is devastating.  The broken back never straightens,  but most of our patients can walk again at the end of treatment.  We advocate aggressive testing so we can diagnose all forms of TB early, before our people become handicapped.

TB PATIENTS 2008: 180 treated; 53% female.
53 adults were sputum positive, thus the most contagious.
22% of all TB patients had spinal TB.
45% of TB patients were under 16 years old.




Monitoring TB medicine
Sjoukje, monitoring the TB
medicines given by the
national staff for the
directly observed therapy.
Spinal TB
The river increases access for patients paralysed with
spinal TB. This woman's family brought her food as she
lost the ability to walk during her pregnancy. After she
delivered her lovely baby and still did not walk they put
her on a boat with her mom to come for treatment.
She’s walking now!


Since the peace accords of 2005, we have been able to live on the banks of the White Nile. Our branch is called the Po River, or on Arabic maps, “bahr el Zeraf” – the river of giraffes.
To the local people the meaning and value of a river is striking. It provides precious water, food, and transportation. It means people can wash, people can cook, people can drink. It means people can catch and eat fish. It means a market and fresh bread. It means boat loads of people can arrive all at once seeking health care. People are moving back to the riverbank. Since the peace agreement, there are no more gunships. There is health care in Old Fangak. People can finally return home.

The flies of Sudan can carry tracoma;
the leading preventable cause of
blindness in the world. They surely
keep our trachoma surgeon busy!
Here is Francis Gai, our locally
trained trachoma surgeon.
He operates by himself and then
for 3 weeks helps the visiting
eye surgeon with 300 additional
eye surgeries!
Francis Gai, our locally trained
trachoma surgeon

Fish Market in Old Fangak
These people arrived at night –
hoping for health care by

People of Old Fangak welcoming building supplies

All the people coming to Old Fangak love
going “window” shopping in our market!


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Website by Jeff van den Bosch