Bearing Witness

The pain crawled through my neck, up into my face, and down into my chest. I briefly opened my eyes. Everything was white and bright. I tried to swallow but the pain was too intense. The sounds of beeping machines and respirators edged into my ears. It took me a few minutes to realise I was in High Care at Linksfield Hospital in Johannesburg and a few seconds more to remember I was waking up after neck surgery. I knew there had to be a morphine button close by and gingerly felt around with my hand in search of this miracle. I got tangled in the tubes and cords attached to my arm. A nurse noticed I was awake and came to assist me in accessing the pain relief. I enthusiastically pushed the morphine button and as the medication flowed through my sore body, I went back to sleep.

The neck surgery I had just undergone was ground breaking. My neurosurgeon, Dr Weinberg, had invented and developed the small ceramic and titanium disc he inserted between my C5 and C6 vertebra. It was a microscopic surgery utilising the most modern technology and equipment. Eleven years earlier, Dr Weinberg replaced a broken disc in my spine with a titanium disc and did a fusion at the base of my spine using three screws. His ingenuity and skill are inspiring and have significantly improved my quality of life.

My family visited me later that evening. They marvelled at the technology surrounding me; the dozen plug points, oxygen outlets, monitors, medications. Everything was tracked and monitored, and if anything went wrong, the nurses had all the equipment around me to fix the problem. It was an incredible setup showcasing progress and precision.

Three months later I landed in Juba, South Sudan. The Juba International Airport is a fitting welcome to the brokenness of the country. The airport is a series of dirty tents. The ground covered with splintering and broken ply wood. The space too small to hold the passengers and pesky baggage carriers. Next to the tent airport is the unfinished building of an established airport. The incomplete building next to the tents is a picture of what South Sudan could have been and what it actually is. The country had the potential for greatness, development, prosperity, but instead, it is battered and worn down, barely functional.

I have been living in South Sudan for almost eight months; the most fulfilling yet challenging eight months I have experienced. I am accustomed to the basic living conditions, familiarised with the limited movement allowed and extensive security restrictions, used to the simple diet, adjusted to living communally, and living in intense heat. These are not the challenging aspects of my new life. These are all manageable. The difficulty comes in my responsibility to bear witness to the suffering of South Sudan and the toll it takes on me as a result.

I have visited our field teams and projects in Renk, Aweil, Maban, and Pagil. Each site provides a variety of services to the surrounding communities; health, nutrition, water, sanitation, and hygiene (WASH), non-food items, and emergency shelter. The needs are great yet exceptionally simple; safe water, malaria treatment, wound care, supplementary food, cooking pots. More than seven million people are estimated to need humanitarian assistance. The population of South Sudan is 12 million, of which, 2.1 million are refugees in neighbouring countries and 1.9 million are internally displaced people. 4.8 million people are severely food insecure. It is difficult to comprehend the scale of the needs in this country.

My job as Communications Officer means the needs become individualised. I meet and photograph the people receiving our services. I interview mothers who have lost children to malnutrition and husbands to the civil war. I hear stories of pain, despair, torture, death, fear, and mere survival. I bear witness to their tragedy.

The people of South Sudan are often described as resilient; despite the incredible hardships, they keep going, keep raising their families, keep moving around, keep holding onto hope for a better future. But I don’t see resilience, I see survival. Resilience is defined as the capacity to recover quickly from difficulties. The word recover implies the return to a better place. I understand resilience to mean that when crisis strikes, the people work together to overcome the crisis and improve or at least return to a place of safety. Resilience is a choice, a privileged choice. South Sudanese do not have this choice, they do not have this privilege. They are forced to survive. They do not have the opportunity to recover and are given no tools or support from the country’s leadership to facilitate this recovery. Each new crisis, whether it be a cholera outbreak, increase in violence, or food security emergency, reduces their capacity to be resilient and pushes them further into just surviving.

I began this post with the recollection of surgery because it is something I often think about when I am walking through sparse villages where women are trekking hours to collect water and firewood, children are not afforded the gift of an education, men are jobless, food is scarce, there are few roads, little if any phone network, and no electricity. Given this environment, the healthcare our teams provide is exceptional. With limited resources and infrastructure, our doctors, nurses, and clinical assistants successfully treat thousands of people each year. Our team in Renk runs a Stabilisation Centre caring for malnourished children with medical complications. In Maban, our team runs a 24-hour delivery centre assisting mothers to safely give birth. Our team in Aweil uses bicycles to access the clinics during the rainy season to provide life-saving nutrition treatment. In Leer, our team crosses swamps with backpacks full of medicine to reach the most vulnerable. Our Emergency Response Team is active across the country running vaccination campaigns and treatment centres. The lack of state of the art facilities and equipment does not restrict the Medair health teams. They are as skilled and innovative as Dr Weinberg, perhaps more so. They save lives every day.

The work we are doing in South Sudan is easy to bear witness to. The work is good. The work is hopeful. The work indicates a potential for the choice of resilience. But the situation in the country and tangible trouble the people encounter daily make bearing witness impossible at times. It crushes my spirit and shatters my heart. I physically feel the pain of the place and the people.

There is a responsibility in bearing witness, but it is also a privilege. In my twenty minutes or so interview with a man, woman, or child, I get a window into their lives and their troubles. Opening this window, even a little, motivates and grounds me. It makes life simple. Life becomes about the tangible and the now. My perspectives are stripped, and I am left with an authenticity that can’t be attained in comfort. This life of mine is a gift. In its simplicity, rawness, and regular hopelessness, it’s a gift.

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Saving Saber

As I enter the Stabilisation Centre (SC) at the Medair Abayok Clinic in Renk, I head straight for a little boy I have heard much about. His name is Saber and he was admitted to the SC two weeks earlier. At one year of age, he weighs a meagre 3.83kg and his mid-upper arm circumference (MUAC) is just 8cm. According to the World Health Organisation (WHO), a normal weight for a one year old boy is 7.8kg to 11.8kg. Saber is severely malnourished. He is sitting on his mother’s lap. Her name is Martha David and she peacefully holds his tiny hand while resting on the bed. Saber’s eyes are intense as he stares up at me. This boy is just bones. Although he has been receiving treatment for two weeks, he is still exceptionally thin and weak. His body was so affected by the malnutrition that it is taking time to the treatment to enable him to fully recover.

SDS162-Albert Gonzalez-MECH-17-Health in Abayok, Renk-ABAYOK 07 (Medium)

Saber is the youngest of eight children. Although his family is from Malakal in South Sudan, he has spent his short life as a refugee in Sudan. His father is unwell and receiving treatment in Khartoum leaving his mother to care for him and his siblings. In July, Martha travelled to Renk with her 14 year old twins and Saber, relying on her oldest child to care for her brothers and sisters at the refugee camp in Sudan. Saber was not eating. He had developed a cough and a fever. Martha was worried about her son and travelled to Renk in search of treatment.

Medair is currently the main provider of primary health care in Renk and operates clinics and nutrition sites around the area. A crucial part of Medair’s strategy in Renk is the establishment of Care Groups. Care Groups are run by members of the community who are trained by Medair on key health, nutrition and hygiene messages to share with neighbours. Care Group ‘lead mothers’ are trained to recognise the signs of malnutrition in children and pregnant and lactating women (PLW) to then recommend treatment at a Medair clinic. It was one such woman that met Saber in Renk.

At the insistence of the Care Group volunteer, Martha brought Saber to the Saraya nutrition site on 21 July. Medair’s Health and Nutrition Manager, Astrid, was overseeing the clinic that day and was stunned to meet such a tiny one year old boy. Saber’s eyes were barely cracked open, his hair light and patchy, and his head looked absurdly large for such a frail body. His arms and legs were restricted to skin and bones and his joints protruded uncomfortably. Astrid assessed Saber and was concerned by his extremely low body temperature. It was clear that this boy needed urgent care if he was going to survive.

To assist in increasing Saber’s body temperature, Astrid carried him, with a blanket, skin-to-skin to the Medair stabilisation centre (SC) at Abayok clinic. He rested calmly against her chest as the vehicle carried them across the rough roads of Renk.  Saber was admitted to the SC to receive treatment for severe acute malnutrition. Initially he was fed special therapeutic milk and then progressed onto Plumpy’Nut, a peanut-based paste, for treatment of severe acute malnutrition. Saber’s progress was slow as his weak body attempted to heal and strengthen.Saber 1

The Medair team at the SC were relentless in their care for Saber. They monitored his weight, MUAC and other vital signs and were dedicated in their treatment to ensure this boy survived. Saber’s mother, Martha, said, “Saber was so severely sick when I brought him here, now he is better.” He did get better. After four weeks, Saber was strong enough to leave the SC. His weight had increased to 4.9kg. Although still small and underweight, his cheeks had filled out and his knees no longer protruded. He was stronger.

Saber continues to attend Medair’s Outpatient Therapeutic Programme (OTP) at Saraya Clinic where he is weighed, measured, and given a weekly supply of Plumpy’Nut. Martha explained, “Medair has been good! The children are getting treatment.” Although it will take some time for Saber to look and live like a normal one year old, he is no longer critical. Astrid recalls, “Saber is a real character. By carrying him skin-to-skin I feel like I made a bond with him. He recognises me when I come to the clinic.”

Saber 2

Saber is one of several hundred children suffering from severe and moderate malnutrition in our Renk project area. Medair’s recent SMART survey revealed that the Global Acute Malnutrition rate was 27.1% in the Internally Displaced Population sites and 32.2% in the host community, both above emergency thresholds. Medair is responding through the provision of emergency nutrition services, supported by the community activity of the Care Groups. Those most at risk of malnutrition are children under the age of five and pregnant and lactating women (PLW). Medair is proactively tackling this crisis.

Renk

I stepped off the plane and scrunched my eyes to adjust to the glaring sun. The men on the plane had pushed themselves passed the women to disembark first and now stood waiting at the bottom of the stairs for their bags. The wind was hot. Even in this season, the cool season, the temperature is regularly in the mid-thirties. Partnered with the warm wind, it certainly felt like at least 35`C. Several 4×4 vehicles were randomly parked around the airstrip; a dusty and bumpy landing zone. We spotted the Medair truck and made our way over to it with our backpacks hanging off our shoulders. Aida, the programme support manager (PSM) from Uganda, was there to welcome us to Renk. This was my first field visit.

Renk Market

I travelled to Renk, a county in the far north of South Sudan near the border with Sudan, with communications officer Diana, and two videographers, Andres and Ninja. We are filming and conducting interviews to create several videos for Medair’s internal and external use. This was Diana’s last field trip and my first and it was a privilege and a relief to travel with her.

Renk is a broken town displaying signs of a once busy and bustling centre and an extroverted market. Between the war with Sudan and the civil war in South Sudan, Renk has been battered and hosts both South Sudanese internally displaced people (IDPs) and Sudanese refugees. There are few government services available, including health care, and many military checkpoints. The community is visibly poor and yet striving for peace and stability.

Medair provides health and nutrition, and water, sanitation, and hygiene (WASH) services to the people of Renk county. We operate several clinics and manage mobile nutrition and health teams around the area who visit the remote villages sprinkled around the Nile River. A Medair clinic, located in the Abayok IDP camp, serves thousands of people. Abayok clinic has a 24-hour stabilization centre for children and a 24-hour reproductive facility for women. Other services include treatment for malaria, cholera, diarrhea, wounds, and respiratory and skin infections. The nurses and medical assistants are from South Sudan and graciously care for their own people.

A nurse weighing a new admission to Abayok clinic | Medair doctor, Jimmy

The stabilization centre at Abayok clinic hosts 14 beds in three different areas. There is no electricity and no running water. You would be forgiven for not identifying it as a medical facility. The walls are constructed of mud and straw and the roof tin. The beds are surrounded by essential mosquito nets. The stabilization centre is designed for children and for the mothers who bring them and stay with them. The days are long and the silence only punctuated by the cries of hurting babies. In these difficult circumstances, the Medair team provides genuine compassion and vital care.

The children in the stabilization centre are there for a variety of sad and preventable reasons. Most have some form of malnutrition and then illnesses associated with the condition. The children are weighed daily and are required to gain an additional 20g per day for several days to be released. Some of the children were looking stronger and preparing for departure but others looked dreadfully unwell.

One little boy captured my attention. He was maybe 18 months old and had a severe skin infection. Much of his skin had naturally peeled from his little body revealing excruciatingly raw skin below. He lay naked next to his mother and slept most of the time. His breathing was heavy as if he was trying to control the pain. I stared at this child and internally wept for his suffering and felt the anger rise within me as I mulled over the fact that his illness was entirely caused by powerful men playing games with their people. The food insecurity in South Sudan is a result of the conflict and not the weather. The men managing the violence are to blame for the state of these children.

Next week I travel to Aweil where Medair is responding to a severe nutrition crisis. My heart is sore and my disdain for injustice acute but I will endevour to connect with the people and share their stories.