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.


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.

First Rotation

“Woe to the land of whirring wings along the rivers of Cush, which sends envoys by sea in papyrus boats over the water. Go, swift messengers to a people tall and smooth-skinned, to a people feared far and wide, an aggressive nation of strange speech, whose land is divided by rivers.” Isaiah 18:1-2

It is believed that the Kingdom of Kush / Cush is ancient Sudan at the confluences of the Blue Nile, White Nile, and River Atbara and Isaiah 18:1-2 is a prophecy of that land. Kush was the eldest son of Ham who was a son of Noah. Many hold the perception that this verse refers to South Sudan’s secession from Sudan in 2011 and God’s blessing on the land. After two and a half months in South Sudan, I can attest to the fact that South Sudan is “an aggressive nation of strange speech, whose land is divided by rivers.”

After a week of briefings at the Medair headquarters in Switzerland, I arrived in Juba, South Sudan on Sunday, 18 June. I had been warned about the chaos of Juba International Airport prior to departure but was not fully prepared for it. The airport is housed in a series of white tents, stained with dirty mud, and open to the elements. The floor consists of broken pieces of plywood balancing precariously on cinder blocks. There are regular holes in the floor where unsuspecting travellers’ feet have fallen through into the sludge below. There is not enough room for the multitude of people and the locals vying for the opportunity to carry a bag for a fee. The experience was surreal and an adequate introduction into the mess that is South Sudan.

After decades of war, South Sudan succeeded in gaining independence from Sudan in 2011. It was a joyous and hopeful event marking what many believed to be a new chapter in the lives of the people of this broken country. President Salva Kirr and vice-president Reik Machar vowed to usher in a period of peace and prosperity focusing on unity and democracy. However, after years of fighting, the government positions were filled primarily with soldiers with little or no experience in nation building. It did not take long for the cracks to appear and corruption to take root. In mid-2013, Machar indicated his intention to challenge Salva Kirr in the next presidential election. Threatened by this prospect, Salva Kirr fired Machar and other members of his cabinet. In December 2013, a civil war flared up enveloping the country, killing thousands, and displacing thousands more. Over three and a half years later, the war continues and those suffering the most are the women and children scattered across a beautiful, fertile, and oil-rich land.

Despite the harsh reality of life in South Sudan, I have loved my time here so far. It is difficult, it is tiring, it is frustrating, but it has become my home and I am pleased to be here. My first rotation was ten weeks. I am currently in Nairobi, Kenya on rest and relaxation leave which is a requirement of Medair and most other NGOs. It is a welcomed break.

I was fortunate to have an extended handover period with the previous Communications Officer Diana. It was an invaluable few weeks of learning about Medair, South Sudan, and the requirements of my role. My tasks are varied and involve updating social media, compiling press releases, hosting media guests, drafting private funding proposals, managing photographs and videos, writing stories, editing the monthly prayer report, and overseeing branding and visibility among other things. I am enjoying the work and the people I interact with. The process of getting my work approved has been an adjustment; on most occasions, at least six people review and edit my story or proposal before it is used.

I had the opportunity to have four field trips in my first rotation; two to Renk in the north of the country and two to Aweil in the north-west. Both were excellent chances to see the work being done on the ground, meet the teams in these locations, and witness the life-saving work taking place.

My first field trip was to Renk to which I travelled with Diana and two videographers who were collecting material for Medair. My second trip to Renk was with a professional photographer. Renk county is on the border with Sudan and Medair is a provider of primary health care including a 24-hour reproductive clinic and 24-hour stabilisation centre for children with malnutrition experiencing complications, nutrition treatment, and water, sanitation, and hygiene (WASH) services. The team is dedicated and diligent, working exceptionally hard under difficult circumstances. Often mothers giving birth have complications and as there are no facilities for caesarean sections in Renk, the team arranges for the mother to be referred to a hospital in Sudan. A Medair vehicle transports the patient to the border where she is then transferred to a donkey cart to traverse the no-man’s-land between the borders, and finally taken by taxi to the hospital. On my most recent trip to Renk, two babies and one mother died. It is a desperate situation but for every life lost, several are saved by the Medair team.

I visited Aweil with the same videographers and again with a journalist and photographer representing one of our donors. Aweil is an exceptionally fertile region suffering from a severe food crisis. Medair initially intervened in Aweil as an emergency response to the nutrition catastrophe but the immensity of the problems resulted in the establishment of a static project. Currently Medair is operating eight nutrition sites and will begin supporting local primary health care units next month. Over 5,500 people are being assisted by Medair in Aweil each month. Aweil should not be enduring a food disaster; the land is intensely green and crops should grow with little assistance. Amartya Sen, a Harvard economist, argued that there has never been a serious famine in a country, even an impoverished one, with a democratic government and a free press. The press acts as a warning system and the pressures of democracy dissuade rulers from famine producing policies. Although South Sudan is no longer considered to be in a state of famine, 6 million people are in need of urgent food assistance. In Northern Bahr el Ghazal where Aweil is located, almost 500,000 people are classified as living in a state of a nutrition emergency. The Medair team in Aweil is providing assistance to children under the age of five and pregnant and lactating women.

I spend the majority of my time in the capital city, Juba. Juba is a broken metropolis characterised by potholed roads, few services, tight security, and a fearful population. The Medair compound consists of our residence and offices and is under 24-hour guard. There are usually approximately 24 people living and working in the base and there are frequent team members travelling through Juba to and from leave. Two dozen national staff also work on the compound. Due to the security risks, Medair imposes a 7pm curfew on all staff staying on base. We cannot be out after 7pm or before 6:30am. We are not allowed to walk anywhere and are therefore reliant on Medair drivers. Electricity is provided by a generator which is switched off for three hour-long intervals each day. We are fortunate to have air conditioners in our rooms and offices which makes the intense heat tolerable. We have running water but it is exceptionally salty and only cold. I am accustomed to cold, salty showers. Lunch and dinner is provided each day except Sunday. The food primarily consists of rice, beans, and ugali. As a team, we make the most of our restricted life. We play games, watch movies, have “room parties”, and go out to eat on Sundays. Some play ultimate frisbee with other NGOs on Saturday mornings. Life is simple in Juba. Besides the security threats surrounding us, we work hard, make the most of our times off-base, and build relationships with each other. We have team devotions every week-day morning and often have prayer and worship evenings. Without our faith, life in South Sudan would be that much more difficult.

I feel deeply privileged to be working with Medair. Our work is truly saving lives. I also feel a huge responsibility to adequately tell the story of South Sudan, her people, the struggles, the hope, and the team members of Medair sacrificing so much to do this vital work.

I am excited for my second rotation which begins on Monday with a visit from a French documentary maker whom I will host for three weeks. I will again have the opportunity to visit several field locations. I value the relationships I have established so far and am expectant for what they promise to develop into. My time of rest in Kenya has been much needed and valuable. I plan to go back to South Africa in November after my second rotation.

Thank you for your prayers and support. I continue to feel God’s hand of guidance, protection, and providence over me and my work.