A Healthier Future for South Sudan's Families

by International Medical Corps
Vetted
Graduation at the Wau Health Sciences Institute
Graduation at the Wau Health Sciences Institute

With only one medical doctor for every 65,574 people and one midwife for every 39,088 people, South Sudan experiences one of the highest maternal mortality rates in the world: 789 deaths per 100,000 live births—as opposed to 21 deaths in the United States. The lack of personnel to provide lifesaving care impacts the availability of skilled attendance before, during and after childbirth.

International Medical Corps is contributing to the South Sudanese government’s goal of reducing maternal, newborn, and child mortality and morbidity rates in the country, and increasing the number of skilled birth attendants. Today, we operate three midwifery and nursing schools in South Sudan, at Kajo Keji Health Sciences Institute, Juba College of Nursing and Midwifery, and Wau Health Sciences Institute.

“Our midwifery school tutors use mixed training methods that focus on skills building so that newly graduated midwives have the confidence to perform services such as Basic Emergency Obstetric and Neonatal Care (known as BEmONC) in the health facilities where they work,” says Janet, our deputy director of health policy and practice. Our teams offer continuous training opportunities for school faculty to ensure that they are equipped with the latest tools and resources to graduate new midwives.

Every year, we increase the number of skilled birth attendants in the country, saving the lives of mothers and newborns. We enrolled our first students in Kajo Keji Health Sciences Institute in 2008, and our schools have graduated a total of 273 trained professionals: 230 midwives and 43 nurses.

Approximately 15% of women will suffer from complications during childbirth, usually due to obstructed labor, puerperal sepsis, hypertensive conditions such as eclampsia, and obstetric hemorrhage.

Regardless of where she lives or what medical services she has at her disposal, a woman’s chance of losing her life as a result of these complications decreases dramatically, by as much as two thirds, when she has an attendant present at delivery who is proficient in Basic Emergency Obstetric and Neonatal Care (BEmONC).

To address these complications, BEmONC is a set of seven signal functions or interventions that must be available to all women at the time of delivery. Parenteral treatment of infection with antibiotics, vacuum-assisted delivery, and manual removal of the placenta and newborn resuscitation are just a few examples of BEmONC interventions.

Our teams work directly with the Ministry of Health to improve our training in BEmONC at the three schools and ensure the long-term sustainability of our midwifery programs.

Janet adds that, “There is an urgent need to expand the number of midwifery training programs in order to meet the need for skilled birth attendants in South Sudan.”

We thank you and the GlobalGiving community for your support as we build the capacity of medical professionals in South Sudan, and work to address gaps in maternal and neonatal care—and save lives. 

Ceremony at Kajo Keji Health Sciences Institute
Ceremony at Kajo Keji Health Sciences Institute
Dr. Tek with a new mother and her newborn baby
Dr. Tek with a new mother and her newborn baby

Today, International Medical Corps is participating in GlobalGiving’s Pro-Rated Bonus Day. Give to our project any time between 9:00 AM EST and 11:59 PM EST, and GlobalGiving will add extra funds to make your donation go even further. Your donation and the extra funds will go towards reaching those in South Sudan and those affected by the recent eruption of fighting in the city of Malakal. Read our latest update below to learn more about the current situation.

 

It was amid the chaos of the carnage and destruction in Malakal, South Sudan that an Ethiopian OB/GYN named Tekeselassie—known simply as Dr. Tek—found himself doing something that can only be described as surreal, something that he is still trying to make sense of: bringing new life into the world at the very moment he was surrounded by death.

On February 17 and 18, fighting and violence erupted in the United Nations-controlled civilian protection site, where 47,000 internally displaced persons had come to seek shelter, health, and protection care. At least 18 displaced persons and three humanitarian aid workers were killed, and civilian shelters as well as humanitarian facilities, including health clinics and a rare and much-needed surgical operating theater staffed by International Medical Corps, were destroyed. An estimated 30,000 individuals lost their shelter, and many fled the civilian site.

As the fighting went on around him, with the operating theater reduced to shambles, Dr. Tek and his team from International Medical Corps delivered three new babies—all of them healthy—using the corner of an old shed as a makeshift delivery room and the floor as a table while relatives surrounded the mother, holding up a curtain to protect her privacy. He recalled that the first infant delivered was a girl who weighed 2.6 kilograms, just over 5 lb 11 oz, but much else remains fuzzy.

“We didn’t get the baby’s name,” he said. “It was chaos.”

The team delivered a fourth child several hours after the battle had ended in the relative comfort of a 20-foot-long shipping container hastily rigged as a delivery room. After giving birth, the new mothers were transferred with their infants to a recovery area, a 36 by 18 foot tent, where they shared their space with 15 others, all casualties of the battle.

Dr. Tek said the contradiction of bringing new life onto a de-facto battlefield didn’t hit him at the time but admits he has thought about it often in the days since.

“We were so engulfed in the moment, we were just physically overwhelmed,” he explained. “Now when I look back, it’s difficult…very hard to take in that people outside are dying and inside we’re helping people give birth. Hard to comprehend.”

He says he hopes to see the mothers with their newborns again in the days ahead when they are scheduled to return for a post-natal visit and vaccinations. In the meantime, Dr. Tek has other concerns, such as the fate of a new mother named Zeinab from the remote Nuba Mountains to the north who had recently taken shelter in the UN civilian protection zone along with her family. He had delivered Zeinab’s baby by Caesarian section just prior to the battle and she was recovering when the fighting broke out. By the time she was ready to return to her temporary home Zeinab’s entire family—her mother, husband and two children—had fled.

“She and her baby are both fine, but they have nowhere to go,” Dr. Tek said.

Then there’s the issue of rebuilding. The battle not only took many lives, but also destroyed life-saving medicines as well as healthcare clinics and medical equipment, including the lone operating theater and post-operative care rooms. These served the tens of thousands of South Sudanese who, like Zeinab, fled their homes for the relative safety of Malakal’s UN protection zone.

“It took months to complete the facility enabling us to carry out complicated deliveries,” he said. “I never dreamed this would happen.”

International Medical Corps is working to address the recent devastation and meet the emergency humanitarian needs in Malakal and throughout South Sudan. We thank you and GlobalGiving for your support as we continue to rebuild.

International Medical Corps
International Medical Corps' operating room before
International Medical Corps
International Medical Corps' operating room after
Lucia - Gender-Based Violence Case Worker
Lucia - Gender-Based Violence Case Worker

Lucia is a case worker with International Medical Corps who helps survivors of gender-based violence (GBV) overcome their trauma and move forward with their lives. Born and raised in Kodok, South Sudan, Lucia first worked as a midwife in Kodok Hospital. When fighting erupted and her town was caught in the middle, Lucia remembers everyone running into the bushes, fearing for their lives. She recalls, “Sometimes we had to stay in the bush the whole night. We were afraid of the shelling targeting Kodok Town.” 

Lucia knew she couldn’t just stand by and watch her people suffer. During breaks in the fighting, she set out to mobilize community members to help take the wounded to the hospital. Amongst the injured, there were also pregnant women in need of care. Using her skills as a trained midwife, Lucia helped women deliver despite the chaos going on all around them. During this time, she also came across GBV survivors. “The fighting caused a lot of confusion. People who didn’t know each other shared the same sleeping spaces, which put women at risk of sexual violence. Women were also at risk because there were no latrines and people had to go far into the bush to take care of basic needs. Many also had to walk long distances alone in search of water and food, usually in the forest, increasing their vulnerability.”

When women and adolescent girls find themselves in remote locations, their safety and security can be threatened. As a result of the training Lucia received from International Medical Corps to become a GBV case worker, she was able to provide psychological first aid - a non-intrusive way of providing psychosocial support in a crisis which teaches: doing no harm; recognizing normal reactions to stress and loss; listening in a supportive way; strengthening positive coping strategies; and using established referral systems to help those needing additional care - and link survivors to immediate medical help. Lucia is very committed to giving a hand to people in need. “I felt very sad to see my community suffering, especially the women and girls,” she says. “I am happy that I was able to provide some assistance. My passion is to help women and girls recover from what they have been through.”

International Medical Corps is providing life-saving health and psychosocial support to survivors of GBV. GBV is a life-threatening, global health and human rights issue, and in crises, the risk of violence is heightened, especially for women and adolescent girls [1]. In response to the ongoing conflict and scarce medical care within South Sudan, International Medical Corps is reaching those in need with primary and reproductive health care, mental health and psychosocial support, and nutrition services. Through our GBV services, we ensure appropriate medical care, including the prevention of HIV infection and case management. This support aims to reach 126,393 internally displaced persons and conflict-affected host community members in the Upper Nile and Jonglei states.

International Medical Corps is also engaging the local community through facilitating the development of community task forces, conducting community dialogues sessions and information campaigns, including the #IEmpowerWomen campaign, to further raise awareness and mobilize the community to not only respond to gender-based violence, but prevent it. In addition to confidential and compassionate care for GBV survivors, International Medical Corps staff provide skills-building sessions for women and girls with workshops in basketry, crocheting, and literacy classes to be together and build female empowerment and mutual support.

Lucia represents the critical support GloblalGiving and other donors can provide in times of crisis. International Medical Corps thanks you for helping make a difference in the lives of women and girls.

#IEmpower Women Campaign
#IEmpower Women Campaign

Tut was in his second year of training to become a midwife when the conflict in South Sudan began. In a country with one of the highest rates of maternal mortality anywhere in the world, the skills he was developing were vital. Yet his future and his life were thrown into chaos by the fighting that broke out in the capital, Juba.

“My teachers told us to leave the school early, because people from my tribe were being assaulted all across Juba. They could not keep me safe in the school.”

Tut left South Sudan for Kenya where he would be safe from the fighting, but after several months without any hope of continuing his studies, he resolved to return to his homeland. The journey back to South Sudan would be particularly dangerous, because Tut bears the distinctive facial markings of his tribe. As the ethnic divisions in South Sudan became ever more violent, these markings threatened to identify him to any fighters looking to attack people of his tribe.

The car he was traveling back in was ambushed by a group of fighters almost as soon as it crossed the border. Everyone in the car was pulled out and told to reveal which tribe they were from. It was only the bravery of his friends who convinced the fighters that they were all from the same tribe which saved Tut’s life.

Once back in Juba, Tut was able to complete his final year of studies and qualified as a midwife. Yet Juba still remained too dangerous for him to live freely in the city. On the day that he graduated he moved to the UN Protection of Civilians camp, joining 30,000 thousand internally displaced people seeking refuge from the violence.

“At first I thought I would never be able to use my skills as a midwife, but then I heard about the International Medical Corps health center where many babies are born every week.”

Tut joined International Medical Corps as a midwife and works every day in the maternal health clinic, supporting pregnant women and new mothers. Each month he helps to deliver as many as 80 babies in the camp’s small maternity ward.

“I am very proud to be a midwife because it is like saving two lives at once. I help save the mother and the baby.”

International Medical Corps is helping South Sudan progress toward the Millenium Development Goal of reducing child mortality and improving maternal health through direct service delivery at primary and secondary level health clinics, as well as capacity strengthening programs through the National Health Training Institute in Kajo Keji. The high impact services that International Medical Corps implements in primary health clinics in South Sudan focus on improving the health of women and their children. It is with the generous support of GlobalGiving and other donors that International Medical Corps is able to carry out such critical, life-saving work.

Children sign up to receive cholera vaccination
Children sign up to receive cholera vaccination

International Medical Corps has extensive experience in cholera outbreak response and prevention in a variety of countries including Haiti, Zimbabwe, Cameroon, Iraq and South Sudan. International Medical Corps began implementing programs in South Sudan more than a decade before the peace agreement was signed. Today, International Medical Corps works in rural and urban areas focusing on improving immediate and long-term health services. Our 87 primary and secondary health facilities provide a fully integrated package of public health services to more than 483,000 refugees, returnees, and other vulnerable populations.

International Medical Corps is currently managing the response to the cholera outbreak at a Juba Protection of Civilians (PoC) camp, which hosts a population of about 30,000. International Medical Corps’ enhanced surveillance system identified “patient zero” at this site, one of the “hotspots” of the current cholera outbreak in South Sudan. As of June 26, 2015, 313 cholera cases have been reported in the country, with 26 deaths.

In the PoC camp, International Medical Corps has three outpatient clinics and a field hospital that includes an emergency department, a 40-bed inpatient facility, a maternity ward with delivery rooms and an operating theater. Cholera cases are diagnosed using rapid diagnostic tests administered by the hospital laboratory. The inpatient department houses a 10-bed isolation ward that is currently operating as a cholera treatment unit for those who test positive. To mitigate the chances of spreading the disease, hygiene measures include hand washing and foot spraying with chlorine on entry and exit from the health facilities. We have trained a group of 35 community health promoters and they are actively sensitizing community members to good hygiene practices, and identifying and referring suspect cases. Our staff has also trained a contact-tracing and case investigation team to investigate every confirmed case.

Cholera, a highly infectious, but treatable diarrheal disease, is caused by the ingestion of food or water contaminated by the bacterium Vibrio cholerae. An estimated 3 to 5 million people contract cholera every year and between 100,000 to 120,000 of those people die as a result. As many as 80% of cases can be treated successfully using oral rehydration salts, but its short incubation period, which ranges from two hours to five days, contributes to the often rapid speed of cholera outbreaks in communities that are without proper water and sanitation systems.

In an effort to stop the outbreak from continuing, International Medical Corps chairs the multiagency cholera task force responsible for cholera response in the camp. With support from WHO and UNICEF, we vaccinated 27,340 people in a four-day oral cholera vaccination campaign in the camp, and followed up with a second round vaccination campaign shortly after. Overall we reached 85% of the registered population. International Medical Corps has treated a total of 69 cases since the beginning of the outbreak, all of whom have recovered. It is with the generous support of GlobalGiving and other donors that International Medical Corps is able to respond to this outbreak with such critically needed, lifesaving support.

Children show where vaccination was received
Children show where vaccination was received
Community health worker shares hygiene information
Community health worker shares hygiene information
Families line up to receive vaccination cards
Families line up to receive vaccination cards
 

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International Medical Corps

Location: Los Angeles, CA - USA
Website: https:/​/​internationalmedicalcorps.org/​
Project Leader:
Development
Los Angeles, CA United States

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