MAMMAN MUSTAPHA’S MSF ASSIGNMENT IN SOUTH SUDAN WAS ONLY MEANT TO LAST NINE MONTHS, BUT A SERIES OF UNEXPECTED EVENTS MEANT HE STAYED FOR ALMOST TWICE THAT.
I arrived at the hospital in Old Fangak in April 2019 to work as the project coordinator, responsible for all the non-medical aspects of the hospital: things like supplies, security and staffing.
My first impression was that it is a very isolated area, a huge swamp. There used to be about 5,000 people around there, but now there are more than 20,000 since many families came in to escape armed conflict in recent years.
THERE ARE NO ROADS OR CARS, ONLY BOATS
The water is often at chest level, so friends or family sometimes have to carry people with medical needs from the villages to the hospital. Or they send word and we send a boat as an ambulance. This happens almost every day, sometimes three times a day.
There is no phone network, so people usually send the strongest person available to walk fast and inform us that someone needs medical care, or they ask fishermen or commercial boats on the river to tell us.
People are very good about passing information — they are traumatized, they witnessed the war, and they were displaced many times. Now when something is happening, they share information very quickly.
A DIFFERENT KIND OF VIOLENCE
Since 2018, there is no active war around Old Fangak, but there are continuous conflicts among the various clans and families. We are now treating more people wounded by violence in the hospital than when I arrived.
People in Old Fangak are very friendly and are always offering a cup of tea. I often sat in the market on the weekends to talk and build relationships between MSF and the community.
FROM MALARIA TO MALNUTRITION
We see all kinds of medical needs in the hospital, since it is the only one in the area.
Malaria is very common. The time of year between when crops are planted and when they’re ready to harvest is known as the “hunger gap” and malnutrition is common then. We see obstetrical emergencies, respiratory tract infections, tuberculosis, HIV and other chronic diseases. During the rainy season, we see quite a few patients with snakebites, because there are many poisonous snakes and people are vulnerable, sleeping outside, working in the grass, going barefoot.
This year the rainfall has been less than in previous years, and we are worried about a food shortage, while on the other hand, there is a risk of flooding as everyone lives near the water.
COVID-19: ONE CONCERN OF MANY
I had been planning to stay for nine months as MSF’s project coordinator, but then I offered to stay another three months, to see every season of the year.
I kept working to understand the culture, to better understand the context and the needs of the community.
Then the COVID-19 pandemic was declared and I stayed for another five months. There was a lockdown in the country, and it was harder to get supplies and new staff. We focused on maintaining our essential activities at the hospital.
We have about 150 locally recruited staff and we worked with them to wear masks, maintain social distancing and increase handwashing. There is no testing available to confirm COVID-19 cases, but we saw our first two suspect cases in May and June. One person died.
We keep two beds to treat patients with suspected COVID-19 safely in isolation. But these days, COVID-19 is one of many medical needs we are concerned about.
THE REASONS WHY
The rainy season is my favourite time because it is the most challenging. There is mud everywhere, and sometimes our supply plane cannot land and you depend on the local food. You see all the beautiful insects and the sunset looks like fire in the sky.