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A letter from Nancy McGaughey in Sudan

October 24, 2009

Dear Friends,

It’s Saturday morning, and we are to make the 38-kilometer trip to Yirol, transporting eight community health worker students for their first “attachment” (practical assignment) in a primary health care unit. It started raining at 2:00 a.m. and continues to fall lightly. Before piling into the Land Cruiser, we must push start it (a common occurrence for us).  Pushing the vehicle in the mud is not easy, but finally it starts. The students, two staff, driver and two “extras” pile in and we are off.

The first part of the trip is relatively uneventful. It is crowded, but conversation (in both English and Dinka) flows. We cross into Yirol County and note that it has rained more in this area. Streams of water flow down both sides of the road. Soon we meet a vehicle off the road in the mud. We stop to offer our assistance. It took quite a bit of maneuvering, but our driver managed to pull the other vehicle on to the road without getting our own stuck in the mud. Of course the other vehicle also needed pushing to start, but there were several young men with us willing to help.

As we progress along the road, we start meeting groups of people (cattle keepers) moving their cows. They take up most of the road. Sometimes it seems as though we are moving in a sea of cattle! Progress is slow. We no sooner get through one group and start to pick up speed and another group appears. I am told they are moving to “higher ground,” fearing flooding from all of the rain. It takes several days to move the cattle to the next “camp.” The people carry all of their possessions as they move the cattle along. One man was carrying three small children—one on each shoulder and one with his legs around the man’s neck. “That’s just how life is here” one of the students told me.

Friday evening, Oct. 23, 2009

I have spent most of this week with students in the health center (PHCC – primary health care center). I have heard many people talk about how good this PHCC is and that people came from all around to get the good care offered here. I was shocked at how poor the service is, and it makes me wonder what is available at the other places. I spent more than half of my time in the maternal child health department (MCH), as that is where my interest lies. I was surprised to see that the women coming to the clinic are treated based on the history they give. I have stressed to students that history taking is very important, but I do not promote relying on it alone. None of the women coming to the clinic had their blood pressure or weight taken. The TBA (traditional birth attendant) who examined the women made no record of their examination. I discovered that there are good antenatal cards in the storeroom, but no one uses them.

Today the MCH worker in charge did not show up. Someone said she had visitors at home. That appears to be an acceptable excuse for being late or not showing up at all! It is very frustrating having to work through interpreters. I wanted to get the students started using the MCH cards, but had to get someone to translate what I wanted to do to the TBA. I don’t think she understood at first, and she didn’t cooperate very well, but by the end of the day we were getting along better. She even asked when I was going to come back.
           
One of the women who came today said she was four months pregnant, but had had some bleeding in September, so wasn’t sure if she was still pregnant or not.  She certainly wasn’t four months pregnant. The clinical officer said that sometimes there is tremendous pressure for the women to become pregnant and if they don’t, their husbands will take other wives. This woman already had seven children at home. A pregnancy test revealed she was pregnant, so we sent her home with iron tablets and some antibiotics. Except there seemed to be no antibiotic (for urinary tract infection) in the clinic, so they told her to buy it in the market. It isn’t even available in this market! I found out that the antibiotic was in the store, but they hadn’t requested it the day before, so the storekeeper was refusing to give it until after clinic hours. I said if he wouldn’t give us a bottle, I had some in my room and would go get it. Suddenly the bottle appeared. It is amazing what will be done when the kawaaja (white foreigner) makes the request. 

There is no proper exam table in the clinic. The women are told to lie on a very low, “springy” bed. The TBA must have a lot of backaches, to say nothing of the difficulty for pregnant women to get up from the bed. Next week I will look into having a table made. Despite the language barrier, there is a special camaraderie working with women in caring for women. When I return from Nairobi, I hope to arrange my schedule so I can spend two mornings a week working in the clinic.

Nancy

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