Malaria, Measles and Knee Bone Soup

Another hectic week trying to make some big project decisions, read the hundreds of daily emails (I’m trying to stop the flow), and solve the problems of the world :)  My day typically starts about 6 am, cold shower, coffee and a bit of yogurt in my room (well, it’s labeled “yogurt” but is a bright bubblegum pink color and very sweet), then 10 feet to the attached office for a 12 hr workday.  I have my own office with AC, but interruptions are common and noise is amplified by concrete walls and tile floors.

The “malaria peak (or “pik” as they write here) is officially over – meaning instead of thousands of cases per month, we’re only seeing half that number.  From about August to December, our hospital in Agok was overwhelmed and pushed care out into the community with simple diagnosis and treatment for uncomplicated cases.  Most of the population lives along the Kiir River, and the mosquitoes carrying the disease are thick as bats at twilight.

Now we have an outbreak of measles all over South Sudan, but especially in the north.  Since the Ministry of Health has essentially collapsed along with most government services, there has been no funding or supply for routine vaccination provision, an essential part of public health anywhere.  So babies and children are not vaccinated against tetanus, measles, polio … We’ve been seeing 5-10 measles cases per site per week.  Additionally, there are many clashes between opposition groups as well as routine dry season cattle raiding and attacks.  Civilian populations flee and measles strikes moving populations.

Measles is a horrible killer.  Children tend to be undernourished at baseline, and get even sicker than the unvaccinated kids in the US. About 30% will have lasting neurological deficits – brain damage from meningitis, blindness, deafness; pneumonia; malnutrition…

Although we give antibiotics, Vitamin A, nutritional supplements and vaccine to the victims, the only way to stop the outbreak is with a mass vaccination campaign – this means a target population of 35,000 under 5 kids in one county alone.  Now, imagine those families spread out across areas that are only accessible on foot or by motorbike and only in the dry season.  A campaign needs to be done in 10 days and achieve a coverage of 95% in order to be effective.  Vaccines need to be kept cold, so MSF will be the Cold Chain (storage and ice pack production) and provide logistics – moving people and supplies to the vaccination sites.

Kinda silly that we Westerners heed nonsensical rumors and don’t vaccinate our kids, isn’t it?  Mothers in South Sudan will walk with their babies strapped on their backs for days in order to obtain these lifesaving vaccines.

We’re getting ready now for the campaign in our primary care project in Mayom and surrounding county.  Unfortunately, WPF (World Food Programme) has started a food registration and distribution – so for weeks, 40,000+ are moving from the county into Mayom, being exposed to measles, overwhelming our capacity to provide medical care.  The expat living conditions are basic, but comfortable enough once you get used to it.  A tent with bed and fan, common room for meals and social life, latrine (right) and bucket shower (left).  Pouring water from a plastic cup over your head at the end of a dusty hot day feels better than any hot shower at home!

I heard NPR is running stories about the conflicts in South Sudan. In two MSF projects (MSF Spain and Belgium) the teams had to be evacuated, under fire, as clashed between government forces, the UN peacekeepers and various tribes flare.  Although Juba is currently safe, South Sudan has long been dry tinder that explodes periodically.  Supposedly a coalition government is being formed, but people don’t think this will bring peace and more and more factions are forming.

On a brighter note …

A week or so ago, the guys at the workshop (there is an intersectional auto/truck repair compound – lots of work to keep all the vehicles in safe working order) invited me for lunch, under the tree, local food eaten with your hands.  It was absolutely delicious!  But the one dish I passed on was Knee Bone Soup – typically only served to honored guests.  While I swallowed my nausea, they all salivated over who would be next in line …

Bon Appetite!