Feature story |

Southern Sudan: “Pal can go home today.” A letter from the field

Like his mother and elder sister, two-year-old Pal suffered from leishmaniasis, a very serious disease, before receiving treatment from us in Pagil, Southern Sudan. “Pal can go home today,” I said to his mother, who was beaming with joy. But this type of treatment didn’t become available overnight:

I’ve been working as a nurse for Médecins Sans Frontières in Southern Sudan since the beginning of the year. The security situation in the region remains precarious and the people there suffer from malnutrition, which has grown worse over the course of the year as a result of a late harvest. Leishmaniasis, a tropical disease transmitted by sand flies, is a common occurrence here. The main symptoms include fever, an enlarged spleen, loss of appetite, weight loss and anaemia. Without treatment, a majority of patients die. Because leishmaniasis is one of the diseases that mainly occur under the radar in poorer countries where patients largely can’t afford to pay for medicine, there are very few therapies available to us. The pharmaceutical industry doesn’t invest in treatment as there’s no profit to be had. We treat almost all our patients with a combination of drugs that are injected intramuscularly over 17 days and cause a great deal of pain. We also administer the drugs intravenously to pregnant women and those in the advanced stages of the disease.

In mid August, I joined a team and left for Pagil, a small village in northern Jonglei, where leishmaniasis is a particular problem. The closest health clinics that provide leishmaniasis treatment are about three days’ walk away and run by other organisations. The rainy season has made the region inaccessible to vehicles but at least there’s a makeshift runway here. We chose to set up camp in Pagil, as other facilities in the region had reported an alarmingly high number of new leishmaniasis infections. And that’s why we’re here – to deal with challenges like this.

Over the last eight months in Sudan, I’ve been able to gain a great deal of experience in treating leishmaniasis and managing projects. I also had the opportunity to provide some assistance for five days in March during an emergency situation. But getting a project up and running – which is what I’m here to do – is something completely new for me. To start with, we move into the small, local health clinic, in which medical staff employed by the ministry of health treat the most common diseases. It also happened to be the only permanent structure in the area. We hope the next aeroplane to arrive will be delivering some large tents so that we will be able to deal with the high number of patients we are expecting. We hire two translators, as there is no medical personnel there whatsoever and we have to provide the treatment ourselves.

Before clinically examining the patients, we have a conversation with them and record their medical history. If we suspect leishmaniasis, we carry out a quick leishmaniasis test and also test them for malaria. If the test comes out positive, we begin treatment immediately. The quick tests have turned out to prove a boon, as they enable reliable on-site diagnosis without the need for a lab or technician.

The rain has proven to be quite a challenge, as we sleep in dome tents and live out in the open. Our plan to dig latrines and build showers and fences was delayed for quite some time as the ground was too wet. The tents aren’t really waterproof, so we have to put our mattresses out in the sun to dry about once a week.

On the seventeenth day of running the clinic, the number of patients reached 104, three of which we were able to release with a clean bill of health. We eventually expanded the team by taking on people from Pagil and, thanks to the talented pilots who managed to land and take off on a muddy runway, the first tent finally arrived. And now that we’ve successfully treated 80 patients in the five weeks since the project launch, my time here is over and I’m returning to Lankien. But first I’m going to send Pal William home. Today he’s going to receive his last set of painful shots. We were able to release his sister a week ago and now it’s just their mother who has to finish her treatment.

After all the hardships and struggle, it’s really nice to see some positive results. The project is running amazingly well: we’ve been able to help lots of people, the Southern Sudanese employees that we hired are now well trained and motivated, and the camp is full for the time being. My job here is done and soon someone will be coming to relieve me.

Stefan Schöne, October 2010