Médecins Sans Frontières (MSF) is establishing a project in the town of Ulang, close to the Ethiopian border, in South Sudans northeastern Upper Nile region, to address the needs of people living in a remote and neglected area who have been affected by years of war and frequent bouts of intercommunal violence and who struggle to access medical care.
We have already set up a 30-bed hospital in town, providing the only secondary healthcare for the 100,000 or so people living in Ulang and in villages scattered along the Sobat river.
In July 2018, MSF launched a short-term emergency response, running mobile clinics in Ulang and the surrounding area. In October, we opened the new hospital, and in April we took the decision to run it as a stable project.
“Our aim is to provide secondary healthcare to very vulnerable people affected by recurrent outbreaks of different kinds of violence, living in a dire situation and with little access to basic services, meaning that sometimes people have to walk for hours and even days to reach much-needed healthcare,” says Hussein.
Between October 2018 and April 2019, MSFs team in Ulang provided 3,200 consultations, helped 81 women to give birth and admitted 719 inpatients, including 287 children in the pediatric ward.
“As well as dealing with complicated pregnancies, we treat people for severe malaria and for gunshot wounds because of the ongoing intercommunal violence.
We also very often treat quite complicated cases of patients co-infected with TB and HIV, who may have had symptoms for a year or more but have never been diagnosed or treated.”, says Madeleine Walder, MSFs field coordinator in Ulang.
MSF teams are engaging with local communities to explain the main diseases that people should be aware of and when to seek treatment.
We have put in place a referral system, with patients mainly transported by speedboat along the Sobat river from outlying health centres to Ulang hospital. Some victims of violence and patients with conditions that need surgery or other specialist care are transferred either to Malakal, which is about eight hours away by speedboat, or by plane to the capital, Juba.
“The Greater Ulang area presents logistical challenges, for us and for our patients,” says Walder. “During the rainy season, which lasts eight months a year, it is very swampy and the only means of transport is by boat, as most planes cant land. During the dry season, access is a bit easier and people can move around, but the distances to reach health services are still very long.”
Displaced by cyclical violence – Nyayuals story
Nyayual has nine children, aged one to 18. An outbreak of intercommunal violence drove her and her family from their home in Doma. They sought refuge in the village of Ying, where several hundred displaced people are staying.
“Our men go to the river and, if they catch some fish, the children will have something to eat. The children are not doing well – they suffer from vomiting and diarrhoea because of eating badly.
The violence in Doma left many people dead. The attackers arrived at night, at 4 am. They went through the village and started shooting at men, children, women, animals. We had been sleeping, so everyone ran away without being able to take many belongings. We lost most of our cattle.
Everyone fled in different directions. We walked for four hours until we arrived at Ying at sunrise. The locals welcomed us. They allowed us to stay in the school and under the trees. Some others who hid in the bush have gathered here too over recent days. All of my relatives are here. These attacks happen from time to time. Before they only took our cows, but now they also kill people.
Although we lack basic things these days, we are safe. We cant go back to Doma any time soon as there is a risk of more attacks.”
First and second – Yakongs story
Yakong is a 36-year-old mother of seven. Her twins Both and Duoth – first and second in Nuer – were born in late March at MSFs hospital in Ulang.
“I am from Wachjak, a small village on the Sobat river, two hours walk from Ulang. There are not many jobs there. People are often hungry. We grow some fruit and maize, but the main source of food is from fishing. My eldest child is 15 and bringing up my children has been a challenge.
Some of my relatives, including two of my brothers, died in the conflict, and my uncle lost three of his boys. It is very sad. I think peace will change things for the better.
“This is the first time Ive given birth in a hospital. My other children were all delivered at home. I had no idea I was going to have twins, but now I am very happy. I have named them Both and Duoth, which mean first and second in the Nuer language. The bigger twin has been a bit sick with very happy. I have named them Both and Duoth, which mean first and second in the Nuer language. The bigger twin has been a bit sick with diarrhoea, vomiting and fever.
When I was pregnant I was not comfortable. I felt dizzy, had abdominal pains and was losing fluids. I knew I wasnt ready to give birth, but it was causing me pain. I had heard in the community that MSF had opened a hospital in Ulang. If I hadnt come here, it could have been bad. In the end I had a normal delivery and it didnt last long. We feel safer with MSFs presence. I hope they dont leave.”
Daily struggle to meet basic needs – Nyamachs story
Nyamach is a 20-year-old mother of three from Ulang. Her youngest child, a five-year-old girl, was admitted to MSFs hospital in late March with convulsions and fever, and was diagnosed with cerebral malaria. The child also had a wound which had led to a tetanus infection. Vaccination coverage among the local population is low.
“… – like people injured in shootings or suffering severe diseases. To get medical treatment in the past, we sometimes had to go to Ethiopia.
We earn our living by fishing, and we raise cattle and grow maize, sorghum and green leaves. In the rainy season we put seeds in the ground and they grow, so we have more food. However, we lack basics like cooking utensils and proper sleeping materials. Because of the fighting, we have faced a lot of hardship. The war has left us without anything – not even seeds.
For three years I took refuge in Ethiopia and lived at Kule refugee camp. We decided to leave here because there were no schools or healthcare and the violence was affecting us. I was scared. I came back to South Sudan in January 2018 with nine relatives. Other people have decided to come back to Ulang after hearing that MSF is now here. We came back by car – it took three days. I hope the situation stays calm. At least in the rainy season [between May and December] people stay at home and dont run after each other.”
A high-level delegation visited Yei River State to intensify Ebola preparedness in Sudan
Juba, 16 July 2019 – On 15 July 2019, a high-level delegation led by Dr Makur Matur Kariom, Undersec..
Juba, 16 July 2019 – On 15 July 2019, a high-level delegation led by Dr Makur Matur Kariom, Undersecretary, Ministry of Health and Mr Alain Noudehou, UN Resident/Humanitarian Coordinator and comprising Ambassadors of donor countries, heads of United Nations (UN) agencies, , and Representatives of international non-governmental organizations visited Yei town.
The objective of the visit was to among others reassure local authorities of the continued support of the development partners and the one UN in South Sudan; secure sustained commitment of the local authorities to the EVD preparedness efforts and publicize in the national press key messages to the general public regarding Ebola preparedness.
South Sudan is one of the four priority one countries (Burundi, Rwanda, South Sudan, Uganda) prioritized by WHO to enhance preparedness and operational readiness based on the proximity to the outbreak area as well as the capacity to manage Ebola virus disease (EVD) outbreaks in the Democratic Republic of Congo (DRC).
The risk of transmission of EVD into countries that share borders with DRC, including South Sudan, has been classified as “very high” by WHO. Cases of EVD have recently been confirmed in Uganda, Goma and in Ariwara, a town in DRC located just 70km from the border with South Sudan.
“Diseases such as Ebola dont respect boundaries, race or religion so all must ensure that they work together to prevent its cross border transmission into South Sudan”, said Mr Noudehou. He also reiterated the commitment of the UN to continue to support EVD preparedness in the country under the leadership of WHO.
As a priority one country for EVD preparedness, the Ministry of Health, National Task Force, WHO and partners are implementing the National EVD Preparedness Plan, including vaccinating front-line health workers, educating people about prevention and response measures, conducting screening at multiple locations to help with early detection of cases, training personnel in infection prevention and control as well as being preparing for safe and dignified burial processes if needed.
“Although South Sudan has not confirmed any EVD case, implementation of effective public health measures is critical to manage the risk posed by South Sudans complex humanitarian context, the history of previous (EVD) outbreaks, increasing global travel and proximity to DRC”, said Dr Olushayo Olu, WHO Country Representative to South Sudan.
At the end of the visit, the Governor of the state, the state Health Ministry and partners on the ground reiterated their commitment to intensify key interventions and increase public awareness by providing adequate information through all communication channels, religious and community leaders.
In his closing remarks, the Undersecretary, Dr Makur appreciated WHO and other partners for the strong partnership and support rendered to enhance capacities to effectively implement the International Health Regulations (IHR, 2005) and address the threats of EVD and other infectious diseases.
Ebola Virus Disease (EVD) is one of the most fatal and highly infectious diseases known to the world. The on-going outbreak in the Democratic Republic of Congo (DRC) is the second largest outbreak reported globally. As of 13 July 2019, 2 489 confirmed cases and 1 665 deaths have been reported.
WHO is working in Jubek, Gbudue, Tambura, Maridi, Torit, Wau and Yei River states alongside their respective state health ministries and partners to provide strategic public health leadership and support required to ensure that all the high-risk counties are operationally ready and prepared to implement timely and effective EVD risk mitigation, detection, and response measures. (more…)
Winning the hearts of communities fearful of Ebola
Goma, Democratic Republic of the Congo, 24 June 2019 – “You cant take my son away because I know you..
Goma, Democratic Republic of the Congo, 24 June 2019 – “You cant take my son away because I know you will go kill him. You will inject him with Ebola. Thats what everybody here knows.”
This response from an angry father, faced with the possibility that his son would be moved from a local hospital to an Ebola Treatment Centre, reflects the reality of containing an epidemic in an area where folklore, rumour and suspicion of outsiders abound.
For Dr. Ramses Kalumbi, Surveillance Team Leader for the World Health Organization (WHO) in Goma, reassuring his patients and their families is all in a days work. Empathy, patience and compassion are a vital part of the treatment offered by his team of doctors, psychologists and health workers.
The Ebola-affected city of Butembo, where the 27-year-old man has been working as a driver, is 350km away – an eight-hour journey by road. He had returned home to visit his family when he started to feel unwell.
Initial symptoms indicated malaria but his high fever and diarrhoea have rung alarm bells, and now he is terrified. So far, the tiered system of surveillance set up by the government and WHO have kept the disease out of Goma, but nobody can afford to take any chances.
His case came to the attention of a surveillance team combing health facilities and neighbourhoods to identify patients with symptoms that might indicate Ebola infection.
Such cases are quickly sent to the alert centre which deploys investigators to assess the patient and decide whether to authorise a transfer to the nearest Ebola Treatment Centre for blood tests. If the test returns positive, the patient is isolated for treatment and if negative the patient is returned to the initial health facility or to their family to continue previous treatment.
Coupled with distrust of health workers is a belief among many people in Goma that Ebola does not exist.
“They do not have family members in the regions affected by the disease. They are people who have not travelled to see the devastation,” says Bahati Sabimana Faustin, a traditional healer who works in the Bujavu area of Goma.
Support from traditional healers like Faustin who have had training in how to recognise Ebola symptoms play an important role in containing the disease and in encouraging the community to take precautions. (more…)
As post-cyclone resettlement, 200 000 people lack access to health services in Mozambique
Maputo, 21 June 2019 – 94 health facilities damaged or destroyed by Cyclones Idai and Kenneth remain..
Maputo, 21 June 2019 – 94 health facilities damaged or destroyed by Cyclones Idai and Kenneth remain unsafe and 200 000 people who have been resettled live more than 5 km away from a functioning health facility, according to a recent Post-Disaster Needs Assessment and latest data.
“The ongoing relocation of families to new resettlement areas presents new challenges for access to heath,” said Dr Djamila Cabral, WHO Representative in Mozambique. “At the resettlement sites, there is limited access to essential health care, limited or no access to water and sanitary facilities. The fact that some health facilities remain damaged is a huge risk to health.”
Humanitarian partners continue supporting the population affected by Cyclone Idai in Mozambique shifting gradually from emergency to early recovery interventions. Urgent health priorities include delivery of basic health services for the affected population – especially at resettlement sites – building back better, strengthening surveillance and laboratory capacities.
Build back better with safe hospitals
With 14 per cent of the health infrastructure in the affected provinces damaged, there is an urgent need for construction of health facilities in districts that already had few health facilities and are now hosting resettled families.
Strengthen disease surveillance, response and laboratory capacity
Many communities in resettlement sites have no disease surveillance. There is need for health-facility based, event-based and community-based surveillance and to strengthen the national surveillance system to address acute vulnerability in the coming days and weeks.
There is also need to strengthen laboratory capacities at national and provincial levels and in health facilities to ensure timely processing of specimens.
Delivery of health services to affected population
Resumption of health service delivery is in progress with many challenges. Access to power is disrupting the immunization programmes cold chain; damaged infrastructure is a barrier to service delivery; and the settlement of population far from health facilities is overstretching the already weak health system. (more…)
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