South Sudan

Those too ill to walk or too poor to be carried, in time, simply die

Koch, southern Sudan - Five men are walking between the acacia trees. They are walking with long steps and straight backs. Four of them are each carrying a corner of a bed on their heads; the fifth is walking behind them with a spear in his hand. There is a woman in the bed - their sister. Her eyes are dull and sweat beads her face. They have carried her like this for two hours. A little further and they will havereached the health post of Medécins Sans Frontières (MSF).

Once the men have carefully set their siste's bed on the ground in the shadow of a tree, the health worker notes down her personal details - Nyatuay Riek Marial, 32 years old from the village of Let - and routinely inserts a thermometer under her arm.

It often happens that patients are carried into the post. How else would they get here? By car? In the south of Sudan there are almost no roads. By boat? The swamps bordering the Nile are overgrown with an impenetrable tangle of papyrus and other plants.

Sam Jones, a British doctor who has worked in Koch for some time, knows from experience how difficult it is to walk through the wilderness. When he visits his patients in the surrounding villages, he often has to wade through chest-high water with his clothes and medical equipment in a bundle on his head.

"Patients who are so ill that they can no longer walk, and who have no healthy men in the family and no money or cows to pay bearers, stay ill and, in time, simply die," he says.

Even if people can walk to a health post within a couple of hours, the fear of violence often stops them from going. It is not for nothing that Nyatua's brother carries a spear. Anyone who has to pass the villages of enemy clans is often risking his life.

Sam Jones regularly has to treat the victims of gunshot or spear wounds; most recently he saw to a young fellow with a wound from an iron spear-point that had missed an artery by a hair's breadth.

MSF has to supply its hospitals and health posts in the south of Sudan from the air. Near Kotsi is a landing strip of compacted earth where a small plane carrying food and medicines lands in a cloud of grey dust every ten days. In the rainy season, it is often too muddy to land the plane safely and the two nurses and the Sudanese health workers have to treat their patients using the supplies they still have.

While Nyatuay is drinking some water and being examined, two women walk into the health post. One of them carries a woven basket on her head. These are her mother and cousin. A couple of months old, Nyatua's baby lies sleeping in the basket under a sheet. They lay the baby down on the bed next to its critically ill mother.

The health worker looks at the thermometer. It reads 39.2 degrees Celsius - a high fever. Nyatuay may have kala azar, a tropical disease that is almost always fatal without treatment. Or it might be malaria, which, in combination with her recent pregnancy, can lead to severe complications. Or perhaps it is one of the many diseases that are actually easy to cure but which, in the south of Sudan, often remain untreated for so long that they can still be fatal.

The British and Dutch nurse working at the health post in Kotch have too few facilities for a thorough examination. Nyatuay will have to go to the small MSF hospital in Ler, which since recently can be reached from here by road. It is a rough, dirt road with large holes here and there, but at least it is a road. Her brothers carry her on the bed to the car and carefully help her into it; her mother and baby follow. In an hour or two, they will finally be at a place where she can receive treatment.