Issues
> Overview
> Cholera
> Eye Diseases
> Guinea Worm
> HIV/AIDS
> Malaria
> Malnutrition
> Maternal Mortality
> Meningitis
> Sleeping Sickness
> Tuberculosis
Overview
South Sudan emerged from a 21-year civil war after the signing of the Comprehensive Peace Agreement (CPA) between North Sudan and South Sudan in January 2005. However four years later, the region is still not stable and medical needs remain critical. Diseases that have not been seen in the country for years now threaten to take the lives of men, women and children. In a country with a population of an estimated 11 million, there is only one trained doctor for every 100,000 people.
In addition to the ongoing violent attacks, malnutrition is prevalent; maternal mortality rates remain among the highest in the world; HIV/AIDs and guinea worm are ongoing problems; and large-scale outbreaks of meningitis, cholera, and malaria are relentless. In the midst of all of this, humanitarian aid is lacking, with some major donors having redirected their funds and the number of humanitarian agencies reducing due to a lack of resources.
Because of the Duk Lost Boys Clinic, John Dau’s home village of Duk Payuel is now a preferred location for the UN to repatriate thousands of displaced families. Over 19,000 Internal Displaced People (IDP) from Duk County are being transported back to their areas with the onset of peace. The situation of these returnees upon their arrival back home is of great concern to Duk County. The living and health standards are very poor. Failure of the Clinic will mean that the men, women and children of the region will no longer have access to even the most basic of healthcare services.
Cholera
Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium. Thin infection can often be mild without symptoms, but sometimes it can be severe. About one in 20 infected persons has the severe disease characterized by diarrhea, vomiting and leg cramps. In people with severe cholera, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.
A person can get cholera by drinking water or eating food contaminated with cholera bacterium. The disease can spread rapidly in areas where there in inadequate treatment of the sewage and drinking water.
Eye Diseases
Life is tough in South Sudan as the grossly impoverished region struggles to rebuild after 21 years of civil war. It's even harder for the tens of thousands who can't see, mostly because of preventable infections left untreated during the conflict, some of which have been wiped out in other parts of Africa. Blindness is a common problem in the region often and is often caused by river blindness, trachoma and cataracts.
River Blindness is caused by a worm that breeds in fast-flowing rivers. It is a major cause of blindness in west and central Africa. Around 18 million people worldwide are infected by river blindness, of whom roughly 300,000 are irreversibly blind. 99% of those live in Africa. River Blindness is preventable and treatable, if diagnosed early enough. Severe disease typically requires hundreds of bites to get infected. It generally takes its toll on the poorest of the poor.
A cataract is a clouding of the lens in the eye that affects vision. This prevents light from passing through and vision is blurred. Most cataracts are due to the normal aging process and develop at different rates. Certain medical conditions, like diabetes or heart problems, may also cause early development. The upward trend in cataract diseases cases in Sudan are ascribed to high temperature, malnutrition along with high blood pressure, diabetes and other infections. Around 50% of blindness in Sub-Saharan Africa is due to cataract.
Trachoma is an infectious disease of the eye caused by the bacterium, Chlamydia Trachomatis. The bacteria can be spread easily from an infected person's hands or clothing and can even be carried by flies that come in contact with fluids from the eyes or nose of an infected individual. This chronic eye infection results in scaring of the eyelids and damage to the eyeball, resulting in blindness if left untreated. There are 3.5 million people living with trachoma in Sudan, 75% of which are in South Sudan. Trachoma is a quiet disease that manifests gradually. Children that are infected may not have symptoms until adulthood.
Guinea Worm
85% of the world's reported cases of Guinea worm are from Sudan.
Guinea worm disease is a parasitic worm infection that occurs mainly in Africa. People are infected when they drink standing water that contains a tiny water flea that is infected with the even smaller larvae of the Guinea worm. Once inside the human body, the larvae mature, growing as long as 3 feet. After about a year, the worm emerges through a painful blister in the skin, causing long-term suffering and sometimes crippling after-effects.
The U.S. doctors who were recently at the Duk Lost Boys Clinic did not see any active cases of Guinea Worm as the season was not right. However, they did see people who had have been infected in the past. Guinea worm is particularly a problem in one of the feeder villages a couple hours hike away from the clinic.
HIV/AIDS
Sudan has the highest infection rate of HIV/AIDS in North Africa - 400,000 infected in 2005.
HIV is a retrovirus that can lead to AIDS. HIV can lead to a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. Infection with HIV occurs by the transfer of an infected individual's blood, semen, vaginal fluid or breast milk.
Because of its recent emergence from civil war, many fear that Southern Sudan could experience a major HIV epidemic because of low levels of HIV/AIDs awareness among the population, an influx of returning refugees from neighboring countries with higher HIV prevalence and an increase in cross-border trade. Many are also worried that as the country rebuilds, increased mobility among people could significantly intensify the spread of HIV.
Malaria
Malaria kills more than a million people worldwide a year. 90% of those who die are African children.
Malaria is a mosquito-borne disease caused by a parasite. People with this disease often experience fever, chills and flu-like symptoms. Left untreated, individuals with malaria can develop severe complications and die. This disease can be prevented and cured through the use of bed nets, insecticides and anti-malarial drugs are effective tools to fight malaria in areas where it is transmitted.
Malnutrition
45% of children in Sudan suffer from physical stunting as a result of malnutrition.
Malnutrition causes 60% of deaths in children under 5.
Malnutrition is the disparity between the amount of food and nutrients the body needs and the amount that it is actually receiving. This imbalance is usually caused by under-nutrition.
Southern Sudan has emerged from a 21-year civil war with a rural economy that was destroyed during the fighting. During the months of May and August, the months before the next harvest, when the previous year's food has already run out, malnutrition is chronic. To make things worse, lack of access to clean water and nearly total absence of primary healthcare makes children very vulnerable.
The Duk Lost Boys Clinic combats malnutrition by treating parasites that cause abdominal pain and bloating and stunt growth. Most photos of children with distended stomachs are due to parasites and malnutrition. Our American doctors have done mass campaigns while working at the clinic to eradicate parasites in whole villages by mass administration of medicine, which should be done every 3-6 months in areas with unpure water supply. The parasites come in part from unclean drinking water.
Another way the Duk Lost Boys Clinic supports nutrition is by providing vitamins and prenatal care to pregnant mothers so that they give birth to healthier babies. It also supports nutrition by re-hydrating people with rehydration salts after they become dehydrated due to infectious diarrhea (examples include: salmonella, shigella, cholera if there were an outbreak, amoebas).
Maternal Mortality
According to Doctors Without Borders and a MoS/GoS survey, maternal mortality in South Sudan is one of the highest in the world – with 2,053 maternal deaths for 100,000 live births. This rate is four times higher than for northern Sudan, where maternal mortality is estimated at 512/100,000 live births, twice as high as the Darfur region with 994/100,000 live births9, and 300 times higher than the Netherlands with 7/100,000.
Late presentation and lack of emergency obstetric care add to this high maternal mortality. Women tend to deliver at home and only seek medical help if a problem arises. Unfortunately, by the time most women arrive at a clinic, the delivery is often extremely complicated and this late presentation too often results in the loss of life for the mother and child.
Meningitis
Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord. There are several types of meningitis. The most common is viral meningitis, which is caused when the virus enters the body through the nose or mouth and then travels to the brain. Dust storms, which are common during the January to April dry season, for example, lead to an increase in respiratory infections and help spread meningitis because the bacteria attach to dust particles.
The meningitis belt, according to the World Health Organization, stretches from Senegal in the west to Ethiopia in the east, with an estimated population of 300 million people. Meningitis epidemics occur in cycles. Early treatment can help prevent serious problems, such as death. Vaccines can prevent some of the forms of bacterial infections that cause meningitis.
Sleeping Sickness
Human African Trypanosomiases, also known as "sleeping sickness," is a vector-borne parasitic disease. This disease is transmitted to humans by tsetse fly bites which have acquired their infection from human beings or from animals harboring the human pathogenic parasites. In time, the parasites cross the blood-brain barrier to infect the central nervous system. Without treatment, sleeping sickness is fatal.
Tuberculosis
According to Doctors Without Borders, Tuberculosis (TB) is one of the leading causes of death in southern Sudan, particularly among adults between 20-45 years of age. The current incidence of TB in southern Sudan is estimated at 325/100,000/year. The incidence and prevalence rates are likely to be much higher in the nomadic population of the Greater Upper Nile area. Approximately 75% of the cases are pulmonary TB, but the high rate of extra-pulmonary TB, such as spinal and lymph node TB is also a growing problem. With proper treatment, though, the majority of TB deaths can be prevented.
