By Aimee Ansari, Country Director, CARE South Sudan
“I’ve heard stories like the one I am going to tell four times already. I’m not sure I can stand to hear it again. It’s terrible – doubly so because the tragedy could have been prevented. The problem is exacerbated by the conflict in South Sudan, but has its roots going many decades.
A 28-year old woman was pregnant with her 4th child. When she went into labor, her husband realized that something was very wrong. The child’s arm came out first. With the support of nine neighbors and friends, he carried his wife the eight hour walk to the CARE-supported health care center in Yuai, Uror county, Jonglei state. The Yuai clinic, though, is one of the most under-developed, neglected clinics I’ve seen in South Sudan, a country with a chronically under-resourced health care system. The staff there did everything they could to help the woman, but they soon realized that she had to have surgery. The nearest surgical facility is a ten hour walk through a swamp. Working with the county health department, organizations such as Médecins Sans Frontières (MSF) and the International Committee of the Red Cross (ICRC), CARE staff tried everything they could think of to get the woman to the surgical hospital.
They tried to get her evacuated – but the airstrip was too muddy for the plane to land. They tried to hire a tractor to take her – but the swamp water was too deep for the machine to pass through. They tried to hire porters – but none wanted to take on the long and exhausting march. The woman’s husband had to return to the village to look after his cattle and the rest of the family. He left his wife in the care of his mother in Yuai. She decided to go to a local traditional healer. He severely damaged the woman, making her condition much worse, leaving her near death. Two weeks after her labor started, the airstrip was finally dry enough for an MSF plane to land to carry the woman to a surgical facility. She lived; her baby did not.
37 hospitals for 11 million people
South Sudan has the highest maternal mortality rate in the world. The health care system, while much improved in the past ten years, remains appalling. The numbers are staggering: One in seven mothers dies from pregnancy and birth-related complications[i]. Utilization of antenatal care (ANC) is only 4.8 percent and 80 percent of women give birth at home[ii], often only visiting a facility if they are able to access one when complications arise. There are only about 37 hospitals for a population of about eleven million people. But until you see the biggest health facility in Yuai – in the most populous county in the largest state in South Sudan - it’s hard to really understand what that looks like. The health facility is a mud hut. It has three rooms. Over 7,000 people rely on this mud hut for health care.
The ANC center is a separate facility for pregnant women for consultations, births and other maternal health services. It is made of concrete and much cleaner. Still, it’s infested with bees and bats; the staff can’t go in the medicine store during the day because of the bees and on hot days (which is almost every day), it smells of bat droppings. Neither the health facility nor the ANC center has electricity or reliable running water. The vaccines, so crucial to keeping children alive, are kept in a solar-powered refrigerator 300 meters away in a different building.
Some of these issues seem simple to overcome and we can change things. Together with the Ministry of Health and reliable, timely donors, CARE could build a concrete building, drill a borehole for water, install solar panels and electricity, get a refrigerator, hire some staff and ensure current staff get re-fresher training, and organize regular drug and vaccine shipments from UNICEF, World Health Organization (WHO) and the Ministry of Health. It would probably cost about USD 500,000 to do most of this. The initial outlay is high because the market in Yuai isn’t working and there is not much one can buy here. There are no reliable roads; we have to fly almost everything to Yuai.
The real problem, however, is much more complex. We would struggle to find qualified staff; there are no South Sudanese doctors in the entire county and very few midwives. We could hire international doctors, but that’s not sustainable.
Long-term investment needed rather than short fixes
CARE is trying to find low-cost, low technology solutions to the problems that plague the communities we support. We install solar panels, we develop a pool of donkeys to transport patients, and are educating the local birth attendants to understand how to better ensure safe births. We are also supporting our staff to do more outreach to villages; this is crucial to prevent disease and sickness. The health care staff talk to people who do not understand the importance of visiting clinics when pregnant, who only want drugs to cure their ailments. The low level of education in the country means that most women and men do not understand the benefit of preventative health care. And the current conflict prevents even more women from visiting health centers because they are too scared to leave their villages. Together, this leads to some of the lowest health indicators globally.
Even with low-cost technology, we still need funds to invest in health care and education systems. Current funding focuses on international staff – quick fixes rather than long-lasting investment. We can do a lot more, if donors and others give funding with a longer-term view, combining emergency and development assistance.
The nurses who finally saw the woman say that they could have known that the woman would need trained medical help at least a month before she gave birth. Her baby may have been saved and she may have ended up less traumatized. With a view to sustainable solutions, we can help that sad stories like the one I just told do not happen in the future.
[i] UNDP, “South Sudan: Millennium Development Goals.”
[ii] Health Sector Development Plan 2011-2015. 2011, March.Government of South Sudan Ministry of Health.
Read more about CARE's response to South Sudan