Akech... and countless others who have not been so fortunate

I first met Akech in August last year when she was only about two weeks old. Her mother had died in childbirth and her grandmother brought her to the opening day of the Emmanuel Children’s Centre at Marialbai asking if Akech could be included in the program along with the other 240 children who had lost parents. These decisions are made by the Program Coordinator Paulino Malou in consultation with the Chief and the rest of the management committee. They decided that Akech could be brought regularly to the program and would be given some milk and biscuits.

When I returned to Marialbai with a team in July this year I recognised the grandmother as she joined the children and staff in greeting us. She was holding a baby and I asked through an interpreter “Is this Akech?”. Her answer was simply to take the child and hand her to me. Akech snuggled in close for a few moments… and then began to scream. I handed her back to the grandma, and was amazed to see her put Akech on her breast. It is common here for surrogate mothers to breast-feed their fostered children, but in other cases it is comfort, rather than milk, which is being provided.

Akech has given me a personal insight into an issue which is prevalent in South Sudan. Infant and maternal mortality rates in South Sudan are amongst the highest in the world[1]. It is estimated that one in ten women die in childbirth.

We deliver birthing kits (provided by Zonta and the Birthing Kit Foundation of Australia), medical equipment, and desperately needed training to maternal health care workers in the region surrounding Aweil in an attempt to address the horrific number of deaths through childbirth. In fact Akech’s mother was a recipient of one of our birthing kits. Sadly that couldn’t help with the complications she experienced in labour. Miraculously Akech survived and motivates us to do more to assist those who have so little when it comes to maternal health care.

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[1], The South Sudan head of UNFPA, Dragudi Buwa reported in 2007 that [maternal mortality] "Rates are actually at 2,030 per 100,000 births, the worst in the world."

When there is nothing we can do...

A few weeks ago we were being shown through a hospital at Marialbai where we met a woman who at first seemed to be paralysed. During a fit she had fallen backwards and hit the back of her head and had been brought to the hospital where she had laid motionless ever since. Ros asked various questions and was able to ascertain she still had feeling and movement in her feet, but couldnt determine why she was unable to move. She came over to me and quietly said there was nothing she could do to help.

Almost every day in the remote regions of Sudan we met people in desperate situations who would look to us with hope and expectation. It isnt easy to admit - to them or ourselves - that there is nothing we can do.

I said to Ros and Paulino Malou that at least we could pray with this woman. In prayer we recognise our weakness and God's greatness and express our belief that God's mercy is not dependant on physical realities. And, sometimes, it is all we can do...

Ros had more questions to ask, trying to find a medical reason for the "paralysis", and I left her to her work. Later she told me that she and Malou did pray before they left the woman. But that night Ros admitted her feeling of helplessness and frustration. It was one of the few times in the whole trip I saw her a bit shaken. We discussed the importance of knowing our own areas of weakness and accepting our limitations before we try to help others with theirs.

Before we went to bed one of the locals casually commented that the lady at the hospital that Ros and Malou had prayed for had got up out of bed, said she was fine, and walked home.

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Addition - Ros reminded me we were also told that the traditional healer (sometimes called witch-doctor) visited the woman at the hospital. Is that what you call having a bet each way?

What about the Hospital?

For those who have been following our partnership you might be wondering about our involvement in the Aweil Civic Hospital. Let me give a brief update.

A few weeks before leaving we learned that MSF have adopted a policy not to work with traditional midwives. They claim that in some instances there is a disincentive to bring mothers to the hospital. It was obvious that to supply birthing kits to Deborah at the hospital would be working against the operational practices of MSF and so we agreed that these would be best used in remote areas where home birthing is the only option. The previous article by Ros tells of how this has developed.

In addition to the supply of birthing kits, Deborah had asked us to provide some basic medical equipment and training. Now that MSF have taken over this role in the hospital this has become redundant. This of course is the best outcome as MSF are providing quality medical care. They report that the maternal mortality rate in the hospital has dropped from 22% to 1% since their takeover.

I have also had conversations with the Governor about supporting the development of one segment of the hospital. We haven’t been able to meet the Governor on this visit as he has been busy with pre-election campaigns, but after conversations with MSF we think it is unlikely this will proceed. The Ministry of Health has begun some refurbishments in conjunction with MSF and there are many other NGOs who have roles in the hospital. It seems we will be more effective if we concentrate in areas which have less resources and support. I will report more on this as it unfolds.

Provision of Birthing Kits…

We put Ros on a plane at lunch time and she is now on the slow journey home via Addis Ababa, Dubai, Kuala Lumpar and Perth. I told her I wouldnt let her leave until she had written a report on the birthing kits and medical equipment. She finished it this morning.


A report by Ros Stafford-Green
Following the 2008 trip by Steve and Joseph, there was interest expressed for birthing kits to be made available. 200 Zonta Birthing Kits were provided by Birthing Kit Foundation Australia (BKFA) for this trip. To ensure they would be used appropriately and that maternal and foetal outcomes would be known it was necessary to make contact with those who would use them. It soon became apparent that a new hospital at Malek Alel Church of Christ worked with some trained Traditional Birthing Attendants (TBAs) who could use these for home births. They had some experience using them some years back and realised their benefit. One bag of 100 kits along with a small amount of medical equipment was gratefully accepted for use in this community in Aweil South County.

Then travelling to the north west of Aweil we spent time in communities that have been decimated by the effects of war. However, with greater stability at the moment, Darfuri refugees and returnees from the north of Sudan are settling in the region. In a society where large families are expected, safe childbirth is a real issue. Here, complications at delivery can result in both maternal and foetal death. This is particularly pertinent in the Marialbai area where they are isolated and have no means of transportation when problems occur. As there are three trained TBAs there who had previous experience using the kits, the other bag of 100 birthing kits was offered to them. Cecilia, the head TBA, delivers three to four babies a week and was very keen to use the kits and receive further training.

At both these locations we were requested to provide further training for TBAs, as well as other medical, laboratory and nursing staff. We have begun to put in place the necessary administrative processes required by BKFA for an ongoing supply of birthing kits in these areas.


Whilst the optimal situation would be for all women to have access to a hospital and medical staff, the kits provide an immediate resource to help prevent infection, one of the major causes of death in Sudan.

Ros delivering birthing kits to Cecilia at Marialbai

Cecilia with one of the kits

Providing medical equipment to Philip Garang, the Clinical Officer at Malek Christian Hospital

A Spaceship to Sudan...

Spell-checkers on computer programmes are very handy - but they dont always get it quite right!

I have written to several airlines asking if they will provide assistance with freight of medical equipment on our next visit to Sudan. One airline executive wrote a very gracious letter of reply, commenting how inspired he was by our projects, but regrettfully couldnt assist with "spaceship". Obviously he meant to write "sponsorship", but with the aid of our innovative software it was changed into something quite different.

I resisted the temptation to reply that we werent going to Mars, and that a 747 would do the job just fine. (And I will continue to see what help we can get with transporting this vital equipment).

Correction...

Recently I wrote that MSF (Doctors Without Borders) will be leaving from the Aweil Civic Hospital. In fact I had been told they had already left. However I have now been told they are negotiating to stay. This is great news. Lets pray they will be able to continue their critical medical relief.

The Political Situation in Sudan...

Several people have asked me if our work will be affected by the Sudan Government’s expulsion of aid agencies. From reports I have been given the Government’s policy will not be implemented in the South. Even if it were, we have not established an organisation in Sudan, so effectively there is nothing to be evicted. In fact we are working in the manner the Government is advocating Ie resourcing local leaders to deliver the required services.

There are however some indirect consequences for our work. One is that MSF (Doctors Without Borders) are in the process of leaving Aweil. I am told this is in response to the abduction of three of their doctors in Darfur. They have been the only ones providing quality medical care in the region. The other obvious impact will be on the increase of Darfuri refugees fleeing south into Aweil as the situation in Darfur deteriorates.

Rather than being an obstacle to our partnership with Christian leaders in Aweil, the expulsion of Aid Agencies has brought a greater urgency in both areas where we have commenced work - our support for those ministering to Darfuri refugees, and the development of the Aweil Civic Hospital. However the situation is volatile and future developments are hard to predict.

A medical task group...

You've probably heard the news. The President of Sudan has been charged with war crimes, genocide and crimes against humanity and a warrant has been issued for his arrest. Rather than handing him over to the International Criminal Court the Sudan government has reacted by announcing the expulsion of aid agencies from the country. I thought this would only apply to Darfur and the northern regions but I have heard Medecins Sans Frontieres (Doctors Without Borders) are preparing to leave Aweil following the abduction of three of their doctors in Darfur.

Even though the MSF hospital looks more like a tent than a hospital, it is the only thing close to genuine medical care in the region. They provide excellent treatment to babies and children, including giving vaccinations. Soon it seems they will be gone.

This of course increases the sense of urgency in providing the medical assistance that Ang'er and Deborah, the midwife at Aweil Civic Hospital, have asked us for.
I have established a medical task group which is currently working towards sourcing the required medical equipment and supplies to resource the midwives and birthing assistants. When this is ready we plan to take a team to Aweil which will include an Australian midwife working with a Sudanese midwife to provide some basic training and establish a small maternity section in the defunct Aweil hospital. The task group includes Dr Victoria Anip, a Sudanese doctor based at Modbury Hospital, two Sudanese midwives - Asha Sulaman and Aderek Rieng - and Ros Stafford-Green who I introduced a few articles earlier.

It is hard to comprehend that a community that has so little appears to be losing the small amount of medical assistance it has received from the outside world. Please pray for our medical task group as we seek to respond to the ever-increasing need.

Trash and Treasure...

On Monday Joseph and I visited a warehouse used by Rotary to store equipment that has been donated for use in developing countries. We were accompanied by Ros Stafford-Green who is both an endorsed Church of Christ minister and has expertise in obstetrics – just what we needed considering we were looking for equipment to provide the midwives in Aweil with a basic medical kit they can carry as they move into the remote areas.

A few months ago I walked around Aweil Civic Hospital with Joseph. The hospital has almost no equipment, no nurses, no doctors, no medicine. I felt like Ezekial who in his vision of the valley of dry bones was asked “Can these bones live?” (Ezekial 37). I wondered to myself “Can this skeleton of a hospital be brought back to life?”

In stark contrast, Rotary’s Donations in Kind warehouse has more surplus medical equipment than I could imagine. And not only medical equipment! School desks, stationery, electrical equipment, wheel-chairs, library books, sewing machines, type-writers… Joseph said he would like to take it all and put it on a ship to Sudan. The fact is we throw away more equipment than most people in Sudan will ever lay eyes on.

The medical kits are a small start. Deborah and Ang’er (pictured) have asked us to provide fifty kits for the women Deborah has been training as midwives. They were the only people in the hospital that I saw providing any medical care at all. If we can also provide some other medical equipment to help them establish a small maternity ward I believe it could be a small step toward bringing the hospital back to life.

Obviously there is a lot to do. Let me know if you are interested in being involved. You will see I have added an email link on my profile section, so now if you don’t want to post a reply for the whole world to see you can send me an email instead.

The Hospital

On Friday 20th Joseph and I visited the Aweil hospital. The Hospital was built by the British in the 1950s and stands as a relic of a previous era. I expected we would report to the office to ask to look around – but there was no office, no reception. I didn’t see any nurses. There is a sign over one building “X-Ray, CT Scan, UltraSound” – but the room is empty. There were a few patients either in bed or sitting under the shade of trees outside, but I didn’t see any sign that people were being treated.

The following morning I meet Marko Mayol, the Executive Director of Local Government. He asks “What is the point of a hospital that has no medicine and no doctors?”. I have heard there are three doctors here, but Marko explains they are Arabs and two of them refuse to treat Africans. Then he tells me that a few days before we arrived the son of the Governor was involved in a car accident and taken to the hospital. He wasn’t provided any treatment and when he died his parents came to take his body away. I am shocked and outraged. Joseph comments “If the son of the Governor cant get treatment, what hope is there for the poor people outside of town?”

Two of the Governor’s daughters are in my Sunday School at Magill COC, and I am devastated to think their brother in Aweil has been denied medical care. When Joseph and I meet the Governor later that morning I tell him how sorry I am to hear of his son’s death, and that I will ask people in Australia to help make the hospital operational again. His Excellency Paul Malong is a strong and disciplined man, and very conscientious about providing for the needs of his community. But he is a quietly spoken man and his words are almost too faint for me to hear: “Too sweet for my ears to hear. We do not cry in public, but in our hearts we weep.”

We will have further discussion with my sister Anger, the local nurse who I met at Rev Angelo’s church on Sunday, and the Minister for Health to see what assistance we can give to provide at least basic medical care for the people of Aweil. Please pray as we see what can be done in this area of great need.