May 8, 2013— Walgak, South Sudan (Akobo County West) is one of the most remote places on earth—surrounded by swamps and virtually inaccessible eight months out of the year due to rain. The region is largely dependent on rations from the World Food Program and life expectancy there is just 42 years; the nearest secondary school is a 3-day walk; and a woman is more likely to die in childbirth than to learn how to read. Most of the people who were educated before the war (1983-2005) have since died, while many of those remaining spent their early years fleeing violence.
Violent cattle raids are frequent among the mostly pastoralist inhabitants of Akobo, during which animal caretakers—often young children—can be injured or killed. To address mass casualties resulting from ethnic violence in Akobo, International Medical Corps designed a program focused on trauma training. But as Dr. Melissa Clark, an International Medical Corps Emergency and Disaster Care Fellow, recently learned, humanitarian relief often looks very different in the field than on paper. Melissa spent two months in Walgak with the goal of providing trauma training—but her time there ended up being much more than that.
In Walgak, Melissa encountered extremely low health literacy, as South Sudan faces a severe shortage of health facilities and health care workers—with only about 120 medical doctors and 100 registered nurses for a population of nearly nine million people (International Committee of the Red Cross). The Walgak Primary Health Care Center, which receives hundreds of patients every week, has no South Sudanese doctors, and the closest hospital is a four-day walk. Those who function as doctors are actually Community Health Workers (CHWs) who receive nine months of training after high school and have “very variable levels of practice.” South Sudanese nursing assistants only receive on-the-job training and, as Melissa discovered, frequently do not know how to do things that we expect nurses in the U.S. to do —like take vital signs or administer proper medicine dosages.
Thus identifying multiple issues in patient care, Melissa had to branch out from trauma training and try to upgrade from there. Melissa trained “everybody she possibly could”—on everything from latrine use, to treating life-threatening infections, the importance of prenatal care and much more. She also trained village health committees on how to get the word out about health services and overcome community resistance to accessing them. Says Melissa, “A lot of it is having them come up with what will work for their communities—asking them what will work for them and what won’t—and then brainstorming together.” Melissa trained about 35 health staff and 100 community members in Walgak.
Originally from Marin County in northern California, Melissa went to UCLA as an undergraduate and then onto medical school at Georgetown. Her dad and grandpa were doctors, so she pictured doing something different—but eventually settled on medicine because it combined her love of science and helping others. It was while completing her residency at Highland Hospital in northern California that Melissa learned about International Medical Corps, with which she volunteered in Haiti in 2011. Melissa loves International Medical Corps’ mission of training because “it really creates a longer-lasting impact.”
Despite no running water, eating virtually the same thing every day, contracting malaria and living in a mud hut, Melissa loved her time in Walgak. She felt embraced by the community and says that people there remain optimistic even in the face of so much death. She recalls the 14-year-old boy she stabilized after he and his family were shot in a cattle raid. International Medical Corps got the boy evacuated by helicopter for a blood transfusion and seven hours of surgery, without which “he absolutely would have died.” Melissa got to see him fully recover and play soccer again. She also got to see the community really bind together when, after the shooting, “all of these people came out of the woodwork” and stayed all through the night helping.
When she works abroad, Melissa relies more heavily on her clinical skills, which she says makes her a better doctor overall. As an emergency physician, Melissa is “used to seeing awful things”—but in the developing world, working with so little, it is “that much more amazing when people recover.” She feels that working with International Medical Corps has broadened her experience and made her more compassionate and conscientious of the resources that she uses. Melissa currently divides her time between Harbor UCLA Medical Center in southern California teaching residents and researching global health issues for International Medical Corps. She’s looking forward to her next assignment in the field, where she’ll no doubt make a tangible impact by embracing the unexpected challenges—and rewarding experiences—that arise.
International Medical Corps’ two Reproductive Health Complexes in the Eastern Democratic Republic of Congo are equipped to provide the highest level of gynecological and obstetric surgical care. Located in Chambucha and Kalonge, this project has helped to improve the health and well-being of 70,000 women of child-bearing age.
A strong stigma surrounds gender-based violence (GBV), which prevents many women from going to a health facility to avoid drawing attention to their situation. Less than 1% of rape victims arrive at a health facility within 72 hours of the attack, making it difficult to prevent sexually transmitted infections and HIV/AIDS with post-exposure prophylaxis, and reducing chances of preventing pregnancy with emergency contraception.
International Medical Corps’ project helped address these needs by establishing a well-equipped facility in accessible locations that are staffed by trained, qualified medical personnel who can now provide a wide range of maternal and reproductive health services, including prenatal and postnatal care, emergency obstetric care, fistula and other gynecological surgeries, clinical care for sexual assault survivors, and education and counseling on family planning and other reproductive and maternal health issues. In coordination with the provincial government, International Medical Corps has successfully trained 171 health workers in primary health care, pregnancy risk, family planning and reproductive health, and emergency obstetrical care. With these skills, they will not only provide treatment but also prevent the development of complex reproductive health problems.
International Medical Corps also strengthened 65 health facilities in order to provide quality healthcare to GBV survivors, while 460 medical and paramedical service providers were trained in evidence-based clinical care for sexual assault survivors.
To promote women’s rights and protection at the community level, International Medical Corps supported the creation of four Gender Task Forces in accessible health areas in the project area. The task forces carried out monthly meetings with International Medical Corps’ guidance to find solutions to identified practices that increase vulnerabilities to GBV, and improve awareness and suggest actions to reduce maternal morbidity and mortality. The traditional birth attendants in these communities supported by International Medical Corps took a strong lead in the task force activities.
International Medical Corps continues to be committed to improving the lives of women and children in the Democratic Republic of Congo. We thank you for your continued commitment, as well.
Hannah is 22 years old and finds meaning in her life from family, friends and her faith. She grew up in the Libyan city of Misurata and visits the International Medical Corps-supported physiotherapy center each week to help her enjoy those important parts of her life, despite her disability. Hannah has spastic paraparesi, a condition that causes weakness in her legs and makes walking difficult.
At age 14, Hannah left school because of the way her teachers treated her, keeping her inside at lunchtime and assuming she could not do anything for herself. She also felt excluded by the other students and thought they were always staring at her.
When International Medical Corps first began working in the Tadamon Centre in Misurata, Hannah was very shy and would just come in for physiotherapy and then leave without speaking to anyone. She would often miss appointments and was not making much progress.
Our team of physiotherapists and psychosocial experts spoke to Hannah, her doctors and her family. It soon became clear that Hannah had been told that her condition would quickly get worse and worse, with no chance of preventing it. It is hardly surprising that Hannah had responded to this advice by giving up hope.
According to Leticia Pokorny, an International Medical Corps Physiotherapist in Misurata:
“I explained to Hannah that we could not cure her condition, but Hannah had the power to control if and when it would get worse through hard work at her physiotherapy. Simply introducing the idea that she has control over her own destiny made a huge difference to Hannah and her whole approach to treatment.”
At the same time, our team of psychosocial specialists began introducing Hannah to group activities that had never been available at the Center before our involvement. Very quickly, Hannah began to open up and make friends. Hannah explained,
“...this was the first time I have ever met other people with disabilities and it makes me feel less alone and ‘different’.”
Hannah joined several others from the Tadamon Centre in preparing a photo exhibition that showed their plans and dreams for the future. As she discussed her photos, the group helped Hannah realize that no matter what happens to her in the future, the things that are most important to her – family, friends and faith – will always be there to support her.
In March 2013, International Medical Corps supported a group of persons with disabilities to produce a short play about living with a disability in Libya. Hannah was very keen to participate, but her family was reluctant to let her take part. Our team met with Hannah’s family to explain the benefit of the activity and Hannah’s sister came along to one group session. It was immediately obvious how the interaction with other people and the challenge of standing in front of an audience was helping Hannah’s self confidence and her family became happy for her to carry on. Today, Hannah is planning with the rest of the group to perform the play in schools around Misurata and even considering taking it on tour to Tripoli.
Julie Currie, International Medical Corps Rehabilitation Coordinator, observes:
“Hannah faces more challenges and uncertainty than most 22-year-olds anywhere else in the world. But, with the support of those around her, she hopefully now has the confidence and the strength to face whatever comes her way. I doubt that would have been the case if International Medical Corps had never come to Misurata.”