“This is South Sudan”

“This is South Sudan”

One of many billboards erected in Juba, South Sudan, in anticipation of Independence day on July 9th, 2011 (Erin Polich/MSH)

MSH, leader of the the USAID-funded Sudan Health Transformation Project- II, is proud to congratulate South Sudan on their independence. The following blog post discusses the impact that independence will have on South Sudan’s health system and the challenges that still lie ahead.

Our Land Cruiser lurches unnaturally sideways for what must be the 200th time that morning. I grip the side of the seat, hope we don’t tip over, and send silent thanks that our driver is Ibrahim, who has twenty years of professional driving experience in Africa. Soon we approach a questionable-looking bridge over a dried stream, and the group decides to chance the rickety path down instead of taking the bridge. As we head down the embankment in a nosedive, looking at an equally arduous path up the opposite side, Dr. Omer Mohamed, head of our project in Mundri West notes, “This crossing here. This one is not so bad.”

On the other side, another lurch renders our vehicle nearly perpendicular to the ground, and Ibrahim painstakingly maneuvers us over another obstacle. Halfway through, Ibrahim turns to me, grinning, and says, “Erin. This is South Sudan.”

Despite the self-deprecating humor, Ibrahim says it with a sense of pride. Everywhere in South Sudan there are logistical nightmares that make working here difficult. But after decades of neglect and subjugation, on July 9th South Sudan will finally realize its status as the world’s newest nation. And optimism tied with the new national identity is formidable.

We all laugh, and the car levels out again.

MSH Land Cruiser navigating a perilous and steep section of the road in Mundri West (Erin Polich/MSH)

When we reach our first health facility, Dr. Omer reminds us to stay near the compound as the surrounded area is still riddled with land mines. As we look around, community members arrive in a search party, looking for a fisherman who went missing the night before. They fear he has likely been killed by an alligator or black mamba snake.

“It will be a long, long, long road”

Back on the road, the conversation turns to the topic of the impending independence for South Sudan. Dr. Omer states, “It will be a long, long, long road.”

As I look out before us at the ramshackle road and imagine the health facility housed in a tukul (mud hut) at the other end, I think the words could not be more appropriate.

Two hours after setting out, we arrive at the Bitti Primary Heath Care Unit and meet Edward, the community health worker in charge of the facility. He relays his challenges working as the only health worker for the community for the past ten years, tirelessly fighting diseases like onchoceriasis, malaria, and nodding disease.

Health care in Mundri West, like in most of South Sudan, faces innumerable challenges. Lack of functioning roads, water, and electricity are daily struggles. Disease outbreaks, preference for home births, and drug stock outs complicate care further.

A Community Health Worker’s Commitment

What is remarkable about this area though is not the challenges facing Edward, but his commitment to his community. Two hours away from the nearest town (assuming the rain has not rendered the roads completely impassable), Edward, who is supported by the USAID-funded, MSH-led Sudan Health Transformation Project (SHTP II), realizes he is the only thing battling disease and death of so many in the community. Thanks to the support of SHTP II, every day Edward works in his two room tukul in Bitti providing vaccinations for children, treating malaria, and providing health education to his community.

In Mundri West, one of fourteen counties supported by SHTP II, MSH provided DPT3 vaccines for nearly 900 children in the past six months alone. Providing DPT3 vaccines protects children from three major childhood killers: diphtheria, pertussis, and tetanus. Those 900 children account for 62% of all children under 1 year in the county. Providing those children with vaccination also restrains the three diseases further by providing increased “herd immunity,” where even children who are not vaccinated benefit from fewer overall germs.

Across South Sudan, SHTP II supports health workers like Edward who wake up every day and, in the face of vast challenges, make a difference in people’s lives.

The imminent independence of South Sudan will not magically erase the onerous challenges South Sudan faces. Independence will not provide Edward with an extra health worker to ease the burden. Independence will not fix roads or ensure pharmaceuticals are delivered on schedule. Independence will not even assure effective communication occurs between the state and county governments.

Moving Up from the Bottom Rung of Health Indicators

But independence brings a freedom, an excitement, to 10 million people who will for once have a sense of self-determination over their future. The anticipation for independence is palpable in the air, from Bitti to Juba to Malakal. Independence will not create a catch-all solution for South Sudan’s immense challenges, and without powerful allies and guidance, the country could falter and continue to suffer under the auspices of war, poverty, and famine.

But independence will provide 10 million Edwards their first opportunity to move their country slowly up from the bottom rung of health indicators. It provides a chance to begin anew, to grab hold of the opportunities on the global and domestic stages, and to write the next chapters of their history. It is a statement of confidence in their future.

SHTP II’s Chief of Party, Dr.John Rumunu, remarked of independence, “In the perspective of public health, independence means the capacity to organize this society’s organizations, both public and private, and individuals and inform their choices towards working for better public health.”

After saying goodbye to Edward and returning to Mundri that evening, I feel confident of two things. First, that Ibrahim could probably drive our Land Cruiser straight up the wall of a building. Second, that South Sudan does indeed have a long road ahead. However, the country has come far in just the past few years, and now millions like Edward are walking down that road, heads held high with a new sense of national pride and optimism, one step at a time.

Erin Polich is a communications consultant with the SHTP II project and is working in South Sudan. Erin is a graduate of Boston University’s School of Public Health.