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Terekeka County: Bringing Clean Water to End Disease
Thanks to you
Sector Report: Health care
Report from the field Disease in the dirty water
Field staff interview
“I chose to volunteer to improve the health of others.”
Working for longer term health care
“Patients often travel for hundreds of miles to receive treatment”
Dr. David Sauter visits a Medair project in Madagascar.
Medair UK Unit 3, Taylors Yard 67 Alderbrook Road London SW12 8AD Tel: +44 (0)20 8772 0100 Fax: +44 (0)20 8772 0101 www.medair.org Photo credits: Images were taken by Medair staff with the exception of : Page 3 © Medair/Odile Meylan, Page 4 & 5 © Medair/Miguel Samper Sources: Medair, unless otherwise stated. Partners: Funding partners for Southern Sudan Humanitarian Aid department of the European Commission (ECHO), DFID BSF (British Government), UNDP (via Common Humanitarian Fund), WHO (World Health Organisation), MWRI (Ministry of Water Resources and Irrigation) (via Multi Donor Trust Fund (MDTF)), Swiss Solidarity, UNICEF Funding partners for Northern Sudan DFID (British Government), USAID, SIDA (Swedish Government), UNICEF, SDC (Swiss Government) Funding partners for D.R. Congo Humanitarian Aid department of the European Commission (ECHO), EuropeAid Cooperation Office, SDC/DDC (Swiss Government, OFDA/USAID, Swiss Solidarity, (USA Government), World Bank, UNICEF, OCHA, UNDP And wonderful private donors like you! Charity registered in England & Wales no. 1056731 Limited Company registered in England & Wales no. 3213889 © Medair 2010
Clean Water to Bring Relief from Disease from Dr. David Sauter, Medair Public Health Specialist Welcome to Medair News, with the latest reports of how your support is making a life-saving difference to the world’s most vulnerable people. In this edition we report from Sudan’s northern states as ‘Safe Motherhood Services’ save lives. We hear from a village midwife working to improve the terrible conditions many still endure throughout pregnancy and labour. And from a newly trained hygiene promoter teaching her community the benefits of good hygiene practises. There’s also important news from Terekeka County, Southern Sudan, about how your support can help provide safe, clean water and bring an end to the terrible suffering caused by Guinea worm disease. The complete eradication of the disease is now within sight. So the success of projects like those in Terekeka County are so important. To beat this disease for good and end the suffering of so many families, we will need your help. I am so encouraged to see what your support is achieving around the world, as Medair’s staff bring life-saving relief to the most remote and vulnerable communities. Your continued commitment makes this possible. Thank you once again,
Thanks to you “Since I attended the Medair training, I am able to help more women.” Since completing Medair’s training course, village midwife Asha Mohamed has grown in confidence and has noticed that the women who come to her for help have much greater trust in her advice. The training helped Asha to learn new skills such as measuring blood pressure and administering drugs, as well as developing a better understanding of the potentially life-threatening problems that commonly occur during pregnancy and how to treat them. Medair’s ongoing support means that Asha will regularly receive training to ensure she continues to offer women the very best advice. Working alongside Asha, we will keep her supplied with the essential equipment and drugs needed to provide quality care—such as antimalarial drugs, vitamins, iron and folic acid. We’ll also keep Asha well stocked with delivery kits—which contain sheets to wrap the babies, soap and clean razorblades for cutting the umbilical cord— and we were even able to replace her broken stethoscope. Thank you for bringing Safe Motherhood to the women of South Kordofan.
Asha Mohamed Ali, 30, a village midwife at Abu Likri.
“I chose to volunteer to improve the health of others.” Earlier this year we highlighted the shockingly high risk of death that pregnant women and newborn babies face in South Kordofan, Sudan (Northern States). Few mothers receive any professional help throughout their pregnancy, and where help is available, training is inadequate and equipment unsuitable. Thanks to you, the Medair team in Sudan has now trained 24 village midwives, and 166 hygiene promoters. They have all been supplied with the vital equipment needed to provide ‘Safe Motherhood Services’—and save lives. Here are the stories of Asha and Tamador, two of the women you helped train.
“What I learned, it’s worth all wages!” Tamador Abdallah told the Medair team, “I chose to volunteer to improve the health of others.” During the four day training programme all hygiene promoters attend, Tamador was taught basic hygiene practice such as washing hands, using latrines, and drinking safe, clean water. She was also taught the link between poor hygiene and disease and received teaching about AIDS. Tamador will now go out to teach her community everything she learnt and help them put it into practice. Although these may seem like small changes, they can make huge life-saving differences to a whole community. “The topics are very useful for us all,” Tamador told us. “Before I had some knowledge about hygiene, but little about AIDS. I’m really happy to have this certificate as recognition! I’m a volunteer, so I do not get salary, but what I learned, it’s worth all wages!”
Tamador Abdallah, 28, a secretary in Muglad and Medair Hygiene Promoter.
Medair’s work in South Kordofan continues today with more hygiene promoters being trained to take life-saving hygiene knowledge to other vulnerable communities. Thank you for making all of this possible.
Sector Report: Health care
A woman is treated at a Medair-supported health clinic in Soke, D.R. Congo. The clinic provides free treatment to all, including many internally displaced people.
Working for Longer-term Health Care Paediatrician and public health specialist Dr. Wendy Dyment, Medair’s Health Advisor, describes our approach to improving the health of communities in need. When we hear about a health problem in a community, we first conduct an assessment to determine the main health needs and priorities as well as the community’s ability to respond themselves with their own resources. If we decide to intervene, we prioritise how to make the biggest impact. Improving primary health care is often a top priority, and it is something that Medair does very well. At Medair, we provide relief with development in mind. Some agencies really do come in and say, “Here’s our package, this is what we deliver.” They don’t take the time to coordinate with the Ministry of Health, or to work with other charities, or leaders in the communities. Once they deliver their package and the emergency or funding is over, then there’s often an abrupt end and departure. But to make longer term health impacts, you need to involve the community from the start. You really have to
partner together and work alongside communities, and not just come in and deliver a set package of predetermined services without assessing the greatest needs. For instance, when we initiate a health intervention, instead of people seeing it as “Medair’s health clinic,” we want them to see it as their community’s health clinic. Medair is supporting them, but it’s their community, their health, and their clinic. So as an agency, even though we do relief work, we try to be mindful of the development context and the impacts over the longer term. Still, the short-term outbreak interventions are often the most immediately rewarding, because you can see rapid impact, and lives clearly saved. During one cholera outbreak, almost every time I left the clinic in the truck, someone would wave me down to help someone lying on the side of the road who was sick. It’s amazing to pick up someone who is unconscious from something as simple as dehydration and low
Sector Report: Health care
Dr. Wendy Dyment and Medair nationally recruited staff visit a camp for internally displaced people in D.R. Congo.
A child treated at the Medair supported hospital in Badiya, D.R. Congo.
glucose and then, within an hour or two after they receive fluids, to see them wake up and start talking. These people would have died had they not received care, then suddenly they are awake and talking to you—that’s quite a remarkable experience.
“These people would have died had they not received care, then suddenly they are awake and talking to you.”
But even though these changes at the individual level are amazing to participate in, when we take a step back, the bigger picture impacts on the health of communities are the more impressive ones. These changes come from Medair’s training of people about their health. Over time, you see beneficiaries take on the vision of being responsible for their own health. You begin to see people mobilising their communities, using the resources they have, and working together to make changes for health. Like many other Medair staff, I’ve made a conscious effort to leave a more lucrative life as a physician in the U.S. to make an impact on the health of mothers and children in difficult situations. So for me, it’s a passion, not just a job. It’s a lot of work, but it’s well worth the blood, sweat, and tears to dedicate your time and energy in life to trying to improve the health of people in crisis. October | 2010
Report from the field
Muni clinical officer Andrew Gall Michael shows us the main water source in Muni, Terekeka County.
Disease in the dirty water Guinea worm disease is a painful, incapacitating condition spread through contaminated water. For many villages in Southern Sudan, dirty stagnant ponds are the only source of drinking water. Our work in Terekeka County aims to bring safe, clean water—and an end to this dreadful disease. Guinea worm disease is contracted when people drink water containing the Guinea worm larvae. Once inside a human’s abdomen the worm will live for a year, growing up to a metre in length. After about a year, the worm emerges through agonisingly painful blisters on the skin that incapacitate and cripple. The cycle continues when victims, seeking relief from the burning sensation caused by the emerging Guinea worm, immerse their limbs into water used for drinking, which then stimulates the worm to release larvae, and so the cycle begins again.
Time to end the vicious cycle The only way to treat the disease is to wrap the worm around a stick as it emerges and carefully pull the worm out every day, inch by painful inch —often over weeks.
There is no vaccine or medicine to treat Guinea worm, but it can be successfully and simply eradicated from a community. Providing a source of safe, clean water for people to drink prevents the spread of the disease and breaks the vicious cycle forever. Medair is working in Terekeka County in Southern Sudan—one of the few remaining places in the world where Guinea worm is still prevalent—to help vulnerable communities construct new boreholes and train local people to maintain and repair the pumps. This means the communities themselves take responsibility for the long-term maintenance and operation of the new water source. We also train hygiene promoters to educate the community about Guinea worm disease—how it’s contracted and how it can be prevented. This helps to break the cycle through education and better hygiene practice.
Report from the field
“For four months I was lying down, unable to move.” Maria Kaku, Southern Sudan
Maria Kaku, with close-up of the scar on her leg where the Guinea worm eventually emerged.
Help us provide disease-free water to vulnerable communities Just £15 can help sink a borehole that will provide safe, clean water for 500 people. £20 will pay to train a member of the village water committee—to ensure the borehole is fairly managed for the whole community. £50 pays to train a pump mechanic to keep the water flowing for years to come. Please give a gift today.
Maria Kaku (pictured above) isn’t sure exactly where she got infected with the Guinea worm larvae, but thinks it was from the nearby stagnant ponds. The water there is contaminated with human faeces and is shared with cattle. Every day she made the journey to the ponds and collected water to drink, cook, and wash with. It was the only source of water for Maria and her family. The worm caused Maria’s skin to itch unbearably, first on her arm, then her leg, and later it felt like her whole body was on fire. Maria’s leg became swollen and so painful that for four months she was unable to walk. Maria told us, “My family missed a lot of things and often went hungry.” Eventually the worm caused blisters on her leg where it could be cut out and painfully extracted millimetres at a time. Medair installed a borehole in Maria’s village, so now she collects safe, clean water—free from Guinea worm larvae. And Medair’s hygiene promotion team visited Maria to teach her how to prevent further infections. “Now I collect water from the borehole,” Maria told us. “It is very nice at home as I keep it clean.”
Maria washes with clean water from the new borehole in Lojora, Terekeka County.
With your help we can put an end to Guinea worm disease —for good—so that families like Maria’s no longer suffer so needlessly.
Field staff interview
“Patients often travel for hundreds of miles to receive treatment” Simon and Lizzy Clausen are both newly qualified GPs working with Medair in Southern Sudan. We spoke to them about life in the field and the challenges they face in their work. Tell us about people’s health in Southern Sudan. Southern Sudan has some of the worst indicators for health in the world—particularly for children and mothers: one child in eight dies before five years of age and 39 percent of children under five years of age are underweight.
Can you tell us a bit about your work?
Simon: My role is managing the primary health care clinic in Melut town and the six primary health care centres spread throughout the surrounding county. These cover a population of approximately 50,000 people. I also spend a lot of my time managing the malnutrition feeding and immunisation programmes. Lizzy: One of my main roles is working with the County Health Department who, in the future, will be in charge of running the health services in Melut County. I am also leading the TB program which is very challenging. Patients often travel for hundreds of miles to receive treatment and then need to stay on treatment for six to eight months as in-patients.
Simon and Lizzy at work in Southern Sudan.
When patients start to feel better it can be very difficult to persuade them to stay to complete their treatment, as they often have families to care and provide for.
What are the living conditions like?
We live in a large compound next to the Nile with between four and 15 other Medair staff at any one time. We eat basic food (mostly beans, goat, and rice) but we do sometimes get treats like cheese and chocolate when visitors come, or when we receive parcels—always very exciting. The ‘bathrooms’ are pretty basic, the toilets are latrines (holes in the ground) and we shower with a bucket and cup.
What are some of the challenges?
The pace of work here is very different—we have learned to measure achievements in weeks and months rather than days. The language barrier can be difficult at times (Arabic is the main language but there are also many tribal dialects), especially when trying to work directly with communities.
If you would like to find out more about working for Medair, please visit www.medair.org/work-with-us or call the UK office on 020 8772 0100.
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