In a country wrought with so much pain and conflict, young Alkheer and Alfathi had now suffered yet another horrible tragedy.


By Karyn Ball

Chris walked through the door and I could immediately tell his day had been far from easy. It was evident as he dropped his bag, kicked off his shoes, and slumped into the closest chair at the kitchen table. But most clearly, you could see the struggle of the day in eyes. “What happened?” I wanted to know.

Chris shared the news. “There was a fire, a tukol fire in Kajo Keji. A man in the village set a family’s home on fire in the middle of the night. The two boys lost their mother in the blaze.” Tukols are commonplace in South Sudan, they are huts made of mud and straw and they serve as the traditional house for many here. I sat still for a moment, picturing the children’s home burning to the ground in a remote village of South Sudan.

The thoughts began to race in my head. Who would do such a thing? Are the children all right? Do they have someone to care for them? Before I could ask, Chris continued. “The two little kids are badly burned. They could hardly sit in the airplane, arms and legs extended straight out, they just stayed as still as could be. They didn’t even lean back on the seat, it would probably have hurt too much.” Chris grimaced.

It was a hard story to listen to, never mind actually experience. Charles, one of MAF South Sudan’s booking officers, told me that that the children’s mother was taken to hospital in Kajo Keji but she didn’t survive. The children were also admitted to this remote hospital, but needed to be medically evacuated to Juba for further treatment. Alkheer is 7 years old, Alfathi is only 5.

Chris said the children looked scared as they climbed the steps of the plane. Rightly so, their home had just burned down, they’d lost their mother, half their bodies were covered in severe burns and now they were about to fly in an airplane with a caregiver to Juba.

Once they got to Juba, a vehicle was supposed to be waiting to take them directly to the hospital. But there was no car in sight and when Chris realized the vehicle wouldn’t be coming, he asked David Juma, one of the guys on MAF’s dispatch team, to drive the children to the hospital in the MAF van.

After hearing all this, my heart was broken. In a country wrought with so much pain and conflict already, young Alkheer and Alfathi had now suffered yet another horrible tragedy. By the next Saturday I was still thinking about the kids, so Chris and I got a babysitter for our own two little ones, and headed out to the hospital, unsure if we would even be able to find them, let alone help.

We stopped in at the administration building, told the staff who we were looking for and one of the nurses kindly led us to the right ward. As we stepped into the simple hospital room, metal beds and saggy mosquito nets lined the walls, a handful of children who had been badly burned filled the small ward. But the first thing that caught my attention was an Abuba (Arabic for “grandma”) hovering over a small child. It was a beautiful sight, an elderly lady with eyes closed and hands raised, praying aloud in Arabic.

The nurse nodded at the same small child on the bed, fast asleep as the granny prayed. The nurse said “He’s the one.” The burns were horrible, the little boy’s entire head was burned and part of his face, as were his two arms and one of his legs. We waited for the prayers to be finished and then said hello. With tears in her eyes, the Abuba introduced herself as Jeselen, the maternal grandmother.

“The children’s mom was my…”, she could hardly utter the words as she mourned the loss of her own daughter.

Jeselen shared that the older brother Alkheer was healing well and had already been released from hospital. Alfathi, the young boy asleep in front of us, was also improving. He could talk and eat and even walk around some. Nabil, the children’s father was also there. There was a mix of sorrow and hardness on his face.

We were able to purchase some medicine and burn cream for Alfathi, as well as some juice and biscuits. A simple gift that I hope shows them that we care for them. We prayed for Alkheer and Alfathi before we left. Thanking God for saving their lives, praying for peace and comfort and healing for their little bodies and their precious souls.

I’m so thankful for MAF and for the life-saving flights they provide.

      

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There are many children named Irene or Mary in Kajo Keji. Traditionally in South Sudan, a child is named after someone special. In this case, it’s the midwives who delivered the children and often saved the baby’s or the mother’s life in the process.

Irene Ewuzie and Mary Akotimolla are part of the Deploying Midwives project established by the United Nations Population Fund. This is a group of 30 international midwives deployed around South Sudan to strengthen midwifery services and contribute to the goal of reducing maternal deaths.

Irene and Mary have spent two years in South Sudan training and mentoring students on a midwifery programme. They say it’s ‘enormously rewarding’ to be regularly saving lives. It’s the ultimate job satisfaction.

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Losing a baby

‘Helping a woman to deliver a baby and then checking that they are both alive and well is a joy, a passion!’ declares Nigerian-born Irene. ‘It’s not about the money. Not in South Sudan with all the dangers around us.’ She shakes her head.

But there’s another, very personal reason why this courageous midwife gets so much from her work. ‘I lost my first baby. It was traumatic. So each time I see a pregnant woman come to us, I try all I can to send her home with her baby, because I know the pain of losing a child.’

You can see the pain etched on Irene’s face as she continues, ‘If we lose a baby, I feel so bad. People sometimes say “Don’t worry” but I say “No! It is only that woman who knows just what she’s going through.” Nine months she carried that baby, and for nothing. It’s not okay!’

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‘I saved both lives’

Mary is from Uganda. ‘I’m always motivated by helping people at a time when they need it most. As a midwife, I feel fulfilled at the end of a day when I’ve supported a mum through her pregnancy and she’s had a normal, healthy delivery. It brings me the most joy to serve people who are less privileged than me.’

Since graduating from midwifery school in 2013, Alice Jaguru has been mentored by Irene and Mary. She works in the Kajo Keji Hospital next door to the school, and her eyes light up when she talks about her job.

‘Now I can manage emergencies in the maternity ward,’ she beams, ‘because Irene and Mary have added to my knowledge.’

She talks exuberantly about alerting doctors to dangerous conditions such as umbilical cord prolapse and placenta praevia. Both required an emergency caesarean section, which saved the lives of a mother and her baby.

‘I feel proud because I saved both lives. The second one happened on a Sunday morning. I was raising my hand up to God and saying, “You are taking care of me!”’

Every eight weeks, MAF flies Irene, Mary and a number of other international midwives back to the capital Juba, where they catch commercial flights to their home countries.

‘MAF is wonderful,’ says Mary. ‘When we first came to South Sudan, we didn’t have any flights to Kajo Keji, so we always travelled by road. When we were told that MAF had become available to us, we were so happy!

‘The staff are so kind and the pilots very good, but I’m touched most by the prayer. They always pray before the flight and, as a Christian, there’s nothing more beautiful to me than that. Whenever an MAF pilot says a prayer, I feel everything is fine.’

‘You know, our profession is a call from God,’ Alice concludes, ‘and I am very proud of that. My job is my passion!’

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When hundreds of thousands of South Sudanese are forced to flee their homes,
IMA meets their medical needs where they are.

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The town of Kodok sits on the western side of the Nile River in the far north of South Sudan. The “western side” is important. The eastern side, from the town of Malakal to the northern border has experienced endless explosions of violence since December 2013, causing a massive movement of people away from the area. Once South Sudan’s second largest city and a mix of various ethnicities, Malakal is now a shattered, burned, and mostly abandoned shell of a town. Its residents have scattered to safety among their own ethnic groups, and this western side of the river offers a small measure of security for upwards of a hundred thousand displaced people.

One of the greatest issues that arises when a massive movement of people occurs is access to health facilities; any services still available are now stretched far beyond their limits. With emergency funding from the Office of U.S. Foreign Disaster Assistance (OFDA), IMA World Health stepped into the aftermath of the crisis to set up and manage multiple mobile clinics for both the displaced and the host communities.

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300 Meters

The MAF Cessna Caravan, loaded to the max with medicine and medical supplies, takes a little over two hours to reach Kodok from Juba. The plane is filled with fuel for a round-trip as there are no locations anywhere in the north to re-fuel. Pilot Reinier Kwantes plans the final bit of his route to by-pass Malakal airspace as he descends. He can’t take the risk of getting shot.

Once he crosses the Nile River, he eases down to take a closer look at the 950-meter airstrip, making a low pass. IMA staff warned earlier that it had rained two days before, and this strip can’t handle much rain. It’s made from the dreaded black cotton soil, which turns into sticky glue when it becomes saturated. Reinier estimates that a strip of mud begins 400-meters in. The airstrip is wide, though, and there’s room to spare on the right of the mud patch if he needs more. It will be easy enough to take off as well with an empty load.

He lands in 300 meters, braking hard. It was a good call. The IMA clinics need this cargo.

South Sudan, IMA World Health, Kodok

Donkeys, Quads, Tractors, and Canoes

It’s crystal clear that getting around this area is difficult, especially in the rainy season. Four donkey carts arrive to pick up the cargo. IMA Medical Supervisor, Dr. Oleny Amum, and Field Operations Coordinator,

Serunkuma Luigi Adwok, arrive on a quad bike. The cargo includes malaria rapid tests and anti-malaria injectables, external and topical drugs, oral and injectable medicine, IVs, and syringes. Oleny and Luigi are responsible for making sure the cargo makes it to all the IMA medical clinics in the region.

This is the difficult part.

“These are not for Kodok alone,” Dr. Oleny explains. “It’s for all mobile clinics. We distribute the medicines equally. We divide them here in Kodok, and then transport them to the respective areas – in Luul, Ogot, Wau Shilluk, and Wau Primary Health Care Center. They are too far away. We take them by tractors, sometimes by the river, by canoes. Sometimes we go by quad bike, which takes three hours to the next clinic. By canoe it takes almost two days to Wau Shilluk. They have no other way to get the medicines.”

Just getting to the Kodok mobile clinic on the outskirts of town is tricky. Luigi drives while Oleny sits on the back. Once off the dirt road, it’s wet, slippery mud the rest of the way. Oleny points to possible less-muddy routes as they make their way to the small enclave of white tents and huts that make up the mobile clinic.

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Our Level Best

The number of displaced people is staggering. In this region alone, an estimated 150,000 people fled their homes and few have settled permanently. Through the mobile clinics, IMA provides emergency and primary health care services to approximately 128,000 Internally Displaced Persons (IDPs) from Upper Nile State, and emergency nutritional needs to approximately 202,500 IDPs and host community members. Between February and September 2015, the clinics in Upper Nile State saw a total of 52,534 patients and distributed approximately two to three tons of medical supplies each quarter.

“We are facing many difficulties to operate here,” Luigi says, “like the accessibility to the clinic sites after we receive the drugs, especially in the rainy season. After the crisis there was a shortage of many things for us to survive here, but we are struggling to do our level best to ensure that the health services reach the internally displaced and host community as well.”

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Serving to the End

In Kodok alone, there are an estimated 35,000 IDPs. Luigi and Oleny say they receive an average of 110 patients per day at the Kodok mobile clinic. The staff is part of the community of displaced people, having fled their homes and jobs in Malakal. By hiring and training staff who are themselves IDPs, IMA gives health workers a chance to serve their own communities.

“We depend on the medicine from Juba,” Oleny says. “Since we started the clinics, MAF has been transporting the drugs and all things we need in the facilities. It is a great job and great role MAF is playing. It is what we need, and we are still going ahead and giving the service to the community.”

IMA hopes to continue serving this population until the need no longer exists, and MAF will be in South Sudan, continuing to help.

Eye Surgeon, Santino Malang, a South Sudanese, examines a Jenity's eyes at Lui Hospital. Jenity is blind in both eyes. Her husband Stewart must help her with all movement. Jenity's cataract surgery was not successful. At the CMA Eye Clinic in Lui, South Sudan in August 2014

Eye Surgeon, Santino Malang, a South Sudanese, examines Jenity’s eyes at Lui Hospital. Jenity is blind in both eyes. Her husband Stewart must help her with all movement. 

The MAF plane touched down in the town of Rumbek, a fairly large centre by South Sudanese standards. Six Kenyans and one South Sudanese man walked across the red African dirt to the aircraft with their luggage, blue Christian Mission Aid (CMA) logos on their khaki jackets. These were extraordinary servants.

They travel from town to village to refugee camp across South Sudan. By day they see an endless stream of patients – performing as many as 30 cataract surgeries a day. By night they sleep in local mud huts, taking cold bucket baths and using squat toilets. They are far from ordinary. They give sight to the blind.

The team has just one surgeon, Santino Malang – the only South Sudanese in the group. When CMA paid for his training it was a dream come true. His father became blind and Santino saw the trauma it caused their family. He also saw the miracle of cataract surgery that gave his father his sight again.

Dr. Santino Malang operates on a patient at the CMA Eye Clinic in Lui, South Sudan in August 2014

Dr. Santino Malang operates on a patient at the CMA Eye Clinic.

River blindness

The team will tell you that the hardest part of their job is when they can’t help someone see again. A major cause can be a small worm known as OV – ‘River Blindness’. This condition mainly affects the elderly who don’t take medication early enough. The parasitic worm is spread by the bites of a black fly. Left untreated, a person will go blind. Medication must be taken for ten years – the life-cycle of a worm – to completely kill it. Many blind patients who come with OV are hoping for good news, but will rarely receive it.

One such patient, Joseph, sits on a wooden bench after his evaluation. He struggles to get his bare feet into a faded pair of boots, which are obviously too small. Joseph walked 15 miles to see the team today. He is going blind from OV, and although he looks much older, he thinks he’s about 55. He’s probably had OV most of his life. Santino sadly told him they couldn’t help. He responded, as many Africans do, with resignation. ‘It’s OK. There’s nothing I can do about it.’

Dr. Santino Malang checks the eye dilation of patients prior to surgery at the CMA Eye Clinic in Lui, South Sudan in August 2014

Dr. Santino Malang checks the eye dilation of patients prior to surgery.

A success

Santino has operated on thousands of patients over the last five years, but one of his favourite stories is from Bor.

‘We operated on this mother who was blind in both eyes. She had four children and had been blind for two years. She’d even not seen her last two children.

‘After removing the bandages, she looked around then saw her youngest daughter. “Is that my daughter?” she asked. We said yes. The lady started laughing, screaming and praising God. “I have seen my child!” she shouted. It was very touching and you really feel that you can do great things for people to restore their sight.’

Pilot Ryan Unger arrives in Rumbek to pick up the CMA Eye Team for transport to Mundri.

Pilot Ryan Unger arrives in Rumbek to pick up the CMA Eye Team for transport to Mundri.

MAF’s help

Joseph Njau deals with the logistics of making the eye clinics run smoothly, including travel. He expressed deep gratitude to MAF.

‘MAF has been a real help to the team. Since we started the programme, we’ve been travelling with MAF and they’ve been very faithful. The most important part is when the pilots pray for us. That brings a lot of joy. It would be very hard to travel without MAF – the roads are too bad. We have sensitive equipment that can’t withstand jerky movements. In other places, we don’t have roads at all.’

The CMA Eye Team in Lui, South Sudan in August 2014. From left to right: Santino Malang, catharact surgeon; Ann Njeru, anesthetist; Daniel Erus, Ophthalmic Officer; Joseph Njau, Project Coordinator and Ophthalmic Officer; Elvis Sempele, Ophthalmic Technician.

The CMA Eye Team in Lui, South Sudan in August 2014. From left to right: Santino Malang, cataract surgeon; Ann Njeru, anesthetist; Daniel Erus, Ophthalmic Officer; Joseph Njau, Project Coordinator and Ophthalmic Officer; Elvis Sempele, Ophthalmic Technician.

Prayer

This inspirational team works for 12 weeks, then takes 10 days off with their families – all year round. It’s draining, and Joseph asks that people remember them in prayer.

‘Please pray for us to persevere – at times it’s not easy, especially when you’re faced with problems you can’t help. We need God’s grace to continue.’

Pilot Ryan Unger arrives in Rumbek to pick up the CMA Eye Team for transport to Mundri.

Pilot Ryan Unger arrives to pick up the CMA Eye Team.