December 2006 Newsletter
To all friends of the Sudan Tuberculosis Project,
Happy Holidays! May you find moments of peace and reflection in the midst of all the celebration.
We recently wrote you about Jill Seaman’s young friend Gatmai, whom she brought to the US in search of a cure for his prolonged, puzzling medical problems. He was doing well when last we wrote—and then went into kidney failure and died. What can we say? He was a corageous and charming kid. Jill was able to take back some presents that he had picked out for his family. Gatmai’s new baby sister,was born on Thanksgiving Day.
While Jill and others poured their skills and their love into Gatmai’s short time with us, we wish to emphasize that his care was not an official part of the TB project. The TB Project deals more with widespread health problems which, if you will, cost much less per life saved. But Gatmai’s situation was special. Much of his care, both personal and medical, was done for free. A designated contribution covered the rest. So no funds were taken from the TB Project budget.
2006 has been a rough year in South Sudan. The peace treaty of 2005 offered great hope for stability, and a government which could set up some infrastructure (like schools, immunization campaigns, communications, transportation - none of which are currently part of Sudanese reality). In the area around Old Fangak, where the TB Project mainly does its work, a civil government has not yet been established. Therefore the UN puts it on the higher-risk list, and many international organizations can not or will not enter. COSV, our Italian partner organization, left in March and is still absent. In the past few weeks there has been major fighting in Malakal, the regional center a day’s journey up the Nile.
Given the many uncertainties of this situation, a friend recently asked what makes our work sustainable. If Jill’s plane went down, what would be left? How much progress can one little project make, given the chronic conditions of war and unrest?
I told him about;
the research that Jill Seaman and others do on how to treat TB and kala azar in the field, in co-ordination with the World Health Organization and Centers for Disease Control
the daily English lesson, which enables Sudanese staff to enter formal health care training programs
Peter Sunduk, our former head nurse, who is finishing his third year of medical officer school. After next year’s internship, he will essentially be ready to serve as the first Sudanese doctor in the area.. And another devoted nurse is ready to start the same course. We pay $2500 yearly for Peter’s tuition.
the hope that comes with knowing that common illnesses are not a death sentence
But Jill said it much more eloquently. Here is her reply:
Oh my, Gretchen!
This would be a book in answering. Part of the answer lies in Mountains Beyond Mountains (a magnificent book by Tracey Kidder - recommended reading!). Part of the answer lies in the difference between developing and underdeveloped world programs. And part of the problem is my passion and how I have seen the issue of sustainablilty misused.
I was asked recently about the hygiene in Um Kurra, in northern Sudan. I told MSF (Doctors Without Borders) that the compound hygiene was unsustainably fantastic. They had guards at the latrines to enforce proper usage. Now where was a developing country like north Sudan going to find money for building high-class latrines - or for police to ensure usage of said latrines? They have money only for police to monitor women’s headscarves. . .
So I can not answer without getting to a calm place with no pulls on my time etc.
But, remember that when I came to Sudan in 1989, the people sustained life without one item of mass-produced goods - its just that 50% of them had already died. That says a lot about a lot of things. But one thing it says is that there is a complete lack of infrastructure - otherwise meds could have come in, a radio station would have announced the problem, some part of the world would have known. Now you see pieces of cloth, some beads, cooking pots. Somewhere there is a radio station that our nurses can listen to on the radios I bring in.
And this year the river opened. Until this year, and except for the parts of Sudan on the border, There was nothing sustainable in all of south sudan despite what everyone says. except for ngo planes, no meds came in, as there was simply no way for them to come. There was no infrastructure. All the latrines collapse after 6 months to 2 years because of black cotton soil. Who will fix the rare well? What is everyone talking about when they talk about sustainability???
Regarding the future, it is the education we give now that may have a lasting impact.
So here is something you can say about having a lasting impact:
Witnessing and solidarity are remembered for years beyond count and do give people some hope - as little as that may be.
Patient education may keep a few people alive - oral rehydration, boiling water for drinking (rarely done), mosquito nets to prevent malaria and kala azar etc.
Health worker education. Here is a nice story: MSF was asked to do a site visit. There was Frances Galeak, the man I used to say was my protege, in the clinic seeing patients with absolutely no equipment ormeds, just giving advice - and managing to call in MSF...
Now here is another story: COSV has been away from Fangak since the first of March. I left in May and returned in October. COSV did continue paying staff salaries and sending medicines, and I brought in thousands of dollars of meds as well. The Sudanese Peoples Liberation Army hired away some of our staff, as they have lots of money now. And guess what?! Our remaining staff kept the center open 24 hours a day, 7 days a week and managed a malaria outbreak. Patients were carried in hallucinating, unconscious or seizing all the time. No expats here at all (but without international support, where would the quinine have come from?)
And do you know why the health workers stayed? It is because they have hopes of getting more education. Peter Mut really organized it. He figured out how to make schedules, he taught everyone how to do IV;s and he requested supplies. In fact, I arranged meds for the area from Boston, as they had run out. We so hope for Peter Mut to begin clinical officer training soon.
And yes, Sunduk will soon be ready - for a 1 year internship – then back here - (and who knows maybe there will be a civil governtment then...)
Two subchiefs have asked to be in a TB class I am teaching about health education and case finding. Not bad! And they even forced me to change the timing - as it conflicted with the adult ed class run by a Christian evangelical group. Alas, still no regular school for children.
And then there is the fact that people are still alive to develop their country - and so many more would have died without our program.
Gretch, I hope you can write something polite, because I want to be polite and I can not be at present. What would happen to American hospitals if the staff got no pay?
Yesterday I stopped guards from beating a woman in prison. Two days earlier I could not stop them publicly torturing a man who had gotten drunk the day before and hit people. I did get him ibuprofen.
I am very far behind in everything. I so miss my little Gatmai. I am glad John Greenman is here and i am so glad all of you are helping from afar.
Never doubt that a small group of thoughtful, committed citizens can change the world.
Indeed, it is the only thing that ever has.