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The team dispatched is made up of drivers, a logistical coordinator, a doctor, a nurse and a community health advisor.
The MSF team dispatched is made up of drivers, a logistical coordinator, a doctor, a nurse and a community health advisor.
© Philippe Carr/MSF

Decentralised healthcare in Upper Nile State

The MSF team dispatched is made up of drivers, a logistical coordinator, a doctor, a nurse and a community health advisor.
© Philippe Carr/MSF
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In South Sudan’s northeastern Upper Nile State medical care for people living in remote areas is practically non-existent. Years of civil war and budget cuts have led to chronic underfunding and a near collapse of pre-existing medical structures.

MSF is providing decentralised medical outreach services to some of the most isolated places in the region, like Dethok or Oriny, from our main hospitals in the State.

Basic medical care is provided in the villages, with serious cases referred to either Malakal hospital - which lies roughly 70km up the White Nile river - or to Aburoc field hospital. Both are run by MSF teams. 

Isolated villages like Dethok have been spared from much of the violence associated with the war, but they have also been left with little access to medical care.

The outreach team to Dethok village sets off in a Land Cruiser at first light. Security is a major issue  as fighting is recurring in the area  so travelling at night is impossible. The town of Dethok is only 17km from the Aburoc hospital, but it can take more than three hours to cover this distance.
The outreach team to Dethok village sets off in a Land Cruiser at first light. Security is a major issue as fighting is recurring in the area so travelling at night is impossible. The town of Dethok is only 17km from Aburoc hospital, but it can take more than three hours to cover this distance.
Philippe Carr/MSF
The team dispatched is made up of drivers, a logistical coordinator, a doctor, a nurse and a community health advisor.
The MSF team dispatched is made up of drivers, a logistical coordinator, a doctor, a nurse and a community health advisor.
Philippe Carr/MSF

Passing through certain areas is only possible with the help of a tractor which tows the MSF Land Cruiser. Half way along the road the team comes across a wide swamp that can only be passed with the tractor.
Passing through certain areas is only possible with the help of a tractor which tows the Land Cruiser. Halfway along the road the team comes across a wide swamp that can only be passed with the tractor.
Philippe Carr/MSF

As the team follows its route, cattle camps can be seen on either side of the road. In the local culture livestock is highly prized  and typically it is the older men and  younger children who tend to the animals.
As the team follows its route, cattle camps can be seen on either side of the road. In the local culture, livestock is highly prized and typically it is the older men and younger children who tend to the animals.
Philippe Carr/MSF
Meeting the local community leaders is essential. Without their support  MSF will not have the permission to come to the village.  The council of Dethok is eager to hear from MSF as the medical humanitarian group is are providing much needed care. Often changes  need to be made at village level when it comes to things like water and sanitation.
Meeting the local community leaders is essential. Without their support MSF will not have permission to come to the village. The council of Dethok is eager to hear from MSF as we provide much-needed care.
Philippe Carr/MSF
Once the team arrives at Dethok, the health post is prepared.  Local community leaders have  been given advanced notice to spread the word to the whole village and surrounding areas.
Within a few minutes there are more than forty people awaiting  a consultation.
Once the team arrives in Dethok, the health post is prepared. Local community leaders have been given advance notice of our arrival to spread the word to the whole village and surrounding areas. Within a few minutes there are more than forty people awaiting a consultation.
Philippe Carr/MSF