A Healthier Future for South Sudan's Families

by International Medical Corps
Vetted
Cholera prevention training
Cholera prevention training

Every year, South Sudan’s rainy season intensifies what is already a dire humanitarian crisis. Stretching from May to October, the rains turn entire areas into swamps, making road access to many communities impossible. They also create fertile ground for disease—including cholera. This year was no different. As of October 20, there have been 2,539 reported cholera cases in South Sudan, with 39 resulting in death. Cholera is a bacterial infection caused by ingesting contaminated food or water. The infection causes acute diarrhea, which can lead to severe dehydration and, if untreated, death. Dr. Meroni Abraham, International Medical Corps’ Medical Coordinator in Juba, South Sudan, explained, "Cholera is treatable, but timely treatment is critical."

The majority of these cases have been in the capital, Juba, where International Medical Corps has been fighting cholera in the city’s largest displacement camps. These camps, or “protection of civilian” (POC) sites, host more than 37,000 people. Many of them have sought refuge there since South Sudan’s civil war first erupted in late 2013, but others poured into the UN Houses this July, after deadly fighting broke out in the capital between government and opposition forces. It was on the heels of this violence that the first cholera case was confirmed in the camp.

While this was not the first time International Medical Corps had responded to cholera in the camp, the aftermath of the July violence made the disease more difficult to prevent. "Sanitation in the camp deteriorated significantly and water supply was disrupted for a number of days, as the fighting prevented road traffic in and out of the camp," said Dr. Abraham. "This, combined with the onset of heavy rains, created a perfect storm for a cholera outbreak."

Dr. Abraham and his team were prepared. All clinical staff were trained on cholera case management and disease surveillance. Cholera bed, medicines, supplies, and testing kits were all prepositioned in the camp so that response could start immediately if it was needed. "It was because of this preparation that we were able to begin testing and treating people immediately," said Dr. Abraham.

In addition to being curable, cholera is also preventable, if people follow strict hygiene practices and have access to safe drinking water and sanitation services. It is because of this that Dr. Abraham and his team trained 70 community health workers to equip families with the knowledge they need to keep themselves safe from the disease and know the signs and symptoms and where to seek treatment. Dr. Abraham said, "The community health workers have gone house-to-house, talking with families about how cholera is spread. Stopping a cholera outbreak is as much about education as it is about timely treatment." In total, International Medical Corps treated 88 cholera patients in the Juba POCs since the first case on July 21. All of them survived. "Every case that we have treated in the cholera treatment unit or the cholera treatment center is a success story," Dr. Abraham said.

We thank the GlobalGiving community for your continued support as we work to treat and prevent cholera in South Sudan.

Cholera Treatment Center in Juba
Cholera Treatment Center in Juba
Preparing Cholera disinfectant
Preparing Cholera disinfectant
Amelia and Mujwock after a healthy check-up
Amelia and Mujwock after a healthy check-up

It was an early February morning when Amelia started to feel labor pains. “I just kept thinking about having a normal delivery,” she said later. “My real worry was that people would continue fighting.” The night before, violence had broken out at the UN refugee camp in Malakal, South Sudan where Amelia and her family have lived for two and a half years. Amelia, along with her husband and children, rushed out of the camp, spending the night outside as gunfire crackled nearby. A few days before, Amelia would have delivered her baby in International Medical Corps’ clinic, but now, even the doctors that worked there couldn’t access the clinic. Dr. Jean Paul Umuringi, our Medical Coordinator in Malakal, explained, “We had to relocate to a safer place, but when we found one, all that was there was a container. We did the only thing we could do: we improvised and put a delivery bed in the container.”

During the two days of extreme violence, Dr. Umuringi and his colleague, Dr. Tekeselassie Gebreyohanne, safely delivered four babies in the container outside of the Malakal Camp. Dr. Gebreyohanne recalled, “It’s difficult…very hard to take in that people outside were dying and inside we were helping people give birth.” After the violence subsided and our team returned to the camp, they found the clinic had been demolished in the violence. But they already knew that life goes on, even in the midst of destruction, and we set to work rebuilding and restocking the clinic. Today, the facility offers a variety of health services to the 33,000 people still living in the Malakal camp, including maternal and child care, primary health care, mental health support, and surgical procedures.

In the face of fear and uncertainty, all mothers hope for the best for their babies. Amelia delivered a healthy baby girl and name her Mujwock, which means “Gift from God” in their local Shilluk language, a nod to the miracle of her birth in the midst of violence. Mujwock is now a six month-old baby with bright, round eyes and chubby cheeks. Amelia brings her to our clinic in Malakal regularly for immunizations and check-ups to make sure she gets a healthy start to life. When asked what she wants for her children’s loves, she replies: “I want them to grown in peace.”

We want to thank the GlobalGiving community and other donors for supporting our work and making a difference in the lives of South Sudan’s mothers, children, and their families.

A clinical health worker helps a mother and child
A clinical health worker helps a mother and child
A mother and child visit the clinic in Malakal
A mother and child visit the clinic in Malakal
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
 

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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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