Southern Sudan's healthcare system creaking under malaria burden

Date : 24/04/2009 Publication : DPA News International Category : Feature

Juba, Sudan – Betty Pita, 20, sits on a rickety metal bed in the Children's Ward of Juba Teaching Hospital, watching her nine-month-old son Joshua finger the canula sticking out of his wrist.

Strewn around her are other mothers and their ailing children, the lucky ones lying on beds crammed into the narrow ward, the rest slumped on straw mats or blankets laid out on the stained floor.

Joshua is the liveliest kid in the ward – he can at least sit up. Some of the other children cry and reach weakly for their worried mothers. Most of them just lie there.

There are 44 patients in the overcrowded ward in the Southern Sudanese capital. Some 18 of them are suffering from the biggest killer of children under five in Africa: malaria.

Alice Manase, the duty nurse in the ward, says “fewer than ten” children have died in the last week. She seems to consider this a good result.

“We never have an empty bed,” says Manase.

The overcrowding in Juba Teaching Hospital is not an isolated case. Across the rest of Southern Sudan, where malaria is responsible for around a third of all attendance at hospitals and health clinics, facilities are struggling to cope.

According to Louis da Gama of Global Health Advocates, the scene in Juba hospital demonstrates the burden malaria puts on Africa's creaking healthcare systems.

“If a third of people in a ward have malaria, then cutting the (malaria) burden can strengthen the healthcare system and allow doctors to concentrate on other illnesses like HIV/AIDS,” he says.

The World Health Organization says malaria kills almost 1 million people annually, the majority of them African children. Yet the disease is both easily preventable and treatable.

Southern Sudan, which is still recovering from a 22-year civil war with the north, faces many problems in combating the illness.

The Health Ministry says only around 25 per cent of the estimated 8-12 million population has access to a health centre.

Warrap State illustrates perfectly the parlous state of the Southern Sudanese healthcare system. Its one million inhabitants are serviced by two hospitals, four doctors and forty nurses.

Patients often have to walk long distances to clinics in searing heat or through a quagmire in the rainy season. Even when they arrive, there is no guarantee there will be anti-malaria drugs or tests to diagnose the disease.

Da Gama and other health workers see prevention through mosquito nets as one of the key tools in the fight against the disease, and Southern Sudan is the target of a long-term net-distribution project.

US charity PSI and the Health Ministry gave away one million nets in 2008. In 2009, they are targeting handing out three million more – no mean feat in a country that is roughly the size of France yet has only around 40 kilometers of tarmac road.

Another 1.6 million nets are due to be handed out by other charities.

The goal is to meet a continent-wide target of 80 per cent of women and children under five sleeping under a net every night. According to PSI, in Southern Sudan this means handing out a total of around 7 million nets.

There are no firm figures on the success of the first phase of the campaign, but PSI says the political will to deal with the disease – something sorely lacking in some of Southern Sudan's more developed neighbours, where donor dollars are often swallowed by corruption – is clear to see in Southern Sudan.

According to Solomon Annguei Maynot, Director of Primary Health Care (PHC) in Warrap State, where nets were distributed in 2008, the campaign has made a difference.

“We have seen a reduction in mortality,” he says. “Fewer people are coming to hospital with malaria.”

A tour of some of the villages in Western Bahr-el-Ghazal, the other state that received PSI nets, reveals that most homes have a net.

“The small ones who sleep under the nets don't get sick,” Frank Rasoi Louis, 39, says as his wife rummages around in their straw-thatched hut on the outskirts of Wau, the capital of Western Bahr-el-Ghazal state, to produce one of the distributed nets.

With a bit of prodding however, Louis admits they only use the net during the rainy season, when mosquitoes are at their busiest. It is the same story in virtually every household.

Considering daytime temperatures often exceed 40 degrees Celsius in Southern Sudan and night is not much cooler, sleeping can be a chore. Add a mosquito net and you have a recipe for a sweat-filled restless night.

According to PSI, educating people about the dangers of only occasional net use is an essential part of any net-distribution programme.

“The goal is to get nets to people and teach them to value them,” says Marcie Cook, the PSI Country Representative for Southern Sudan.

Cook, however, acknowledges it is a struggle to build a net culture. She says that if 60 per cent of Southern Sudanese women and children are regularly sleeping under a net by 2010, it will be a good result.

At least one person is already convinced. Malaria took young Joshua to death's door, and Betty says she has learned her lesson.

“Sometimes we didn't sleep under the net,” Betty says. “Now I will use it whether it is hot or not.”

But outside pressures are threatening to derail Southern Sudan's efforts. Aid agencies say it is becoming increasingly difficult to raise funds due to the global economic crisis.

The Global Fund, a major provider of funding to PSI, is looking at a funding shortfall of around 4 billion dollars in 2009, meaning that many programmes will not get any money.

According to Maynot, this could prove disastrous, particularly as mosquito nets need to be replenished every few years.

“Child mortality has gone down due to nets,” he says. “If we get no replacements, we will be back to square one.”

But if the myriad challenges can be overcome in Southern Sudan, then da Gama says there is no reason why the same should not apply to the rest of Africa.

“If you can see success in southern Sudan, you can have hope of success in other countries,” he says.