At the beginning, two years ago, it was just the coughing. Then Njasama Thijen’s legs grew weaker and weaker and eventually her grandmother took the girl to a clinic run by Médecins Sans Frontières. There a team arranged for her to be flown to Pieri, a remote location in the southern Sudanese state of Jonglei and the only place for miles where she could be treated for tuberculosis.
When she arrived half a year ago, she could no longer walk - spinal tuberculosis (Spondylitis tuberculosa) had rendered her legs useless.
What is unusual is that her case is not very unusual in southern Sudan. Tuberculosis is widespread and is still one of the leading causes of death.
Tuberculosis is one of many conditions
Children are also undernourished. Because they are not treated, countless southern Sudanese die from malaria, respiratory disease and diarrhoea. Sleeping sickness and leishmaniasis are also widespread. There are far too few hospitals, with a ratio of one doctor to 400,000 people; the child mortality rate is high; and the mortality rate amongst mothers is one of the highest in the world.
And the lack of medical supplies is only one of the problems the people face in this part of a country, which has long been forgotten and only makes the evening news in conjunction with the "other" conflict, the struggle to gain control of Darfur in the northwest.
Displaced or killed are in the millions
A fragile peace agreement has been in effect between southern and northern Sudan for three years now, but the good news stops there. The civil war has been waging for two decades and has officially displaced over four million people and killed two million.
There is also tension due to religion, clan feuds, unsettled boundaries and distribution of oil deposits. Southern Sudan is still listed at the bottom of the international development and corruption indices. In addition, 90 percent of the population live below the absolute poverty level of less than one US dollar a day. Only a quarter of them have access to sanitary facilities.
When asked what they need most urgently, almost all of the people have the same answers: lasting peace, medical supplies, schools for children and a better infrastructure.
There are hardly any streets in this enormous region in the south of the largest country in Africa, which is seven times the size of Germany. The water is still drawn from wells and electricity is only available in cities, usually produced by diesel generators. There are very few schools, and 48 percent of women are illiterate.
A visit to this region is like travelling far back in time, to the point when civilisation first began.
With the peace agreement, tens of thousands of refugees are returning from Kenya, Uganda, Ethiopia and other neighbouring countries and, in addition to existing diseases, they are also bringing AIDS into the country, which until now has hardly been an issue, but could soon turn into an immense problem.
At the same time, most of the humanitarian organisations have withdrawn or reduced activities because of the peace agreement, while development aid drags along and a functional government health system is almost non-existent. The new government is in no way capable of dealing with the approaching responsibility of providing the population with the medical attention it needs and, following the war, has literally had to start from scratch.
MSF pushed to its limits
That is why Médecins Sans Frontières is the only organisation to provide medical attention in many regions of Southern Sudan. It is increasingly pushed to its limits in providing patients with basic care. Because of the lacking infrastructure, qualified employees, medicines and materials have to be flown in from abroa -, an enormous and cost-intensive logistical challenge.
The medical program in southern Sudan alone cost nearly ââ?š¬20 million in 2007; around 1,600 staff members are now active. And there is no relief in sight. In many clinics, the number of patients has increased by 40 percent compared to last year: In 2007 Médecins Sans Frontières did around 290,000 outpatient consultations and treated more than 5,400 inpatients.
As the organisation was designed to provide short-term emergency services, the high percentage of long-term inpatients is threatening its flexibility in reacting quickly to cholera and other epidemics. And still, 2,100 patients were treated and 630,000 vaccinated last year during a meningitis outbreak. And more than 47,500 children were provided with the life-saving measles vaccine.
And what of little Njasama
Now when you see little Njasama playing and jumping around with the other children in the isolated tuberculosis complex, it is hard to imagine that she was paralysed just a short time ago. The therapy worked. More than anything, Njasama would like to go back to school when she is healthy again. And if the peace agreement really holds, she will be able to.