I've heard stories like the one I am going to tell four times already. I'm not sure I can stand to hear it again. It's terrible - doubly so because the tragedy could have been prevented. The problem has been exacerbated by the conflict in South Sudan, but its roots go back many decades.
A 28-year old woman was pregnant with her fourth child. When she went into labour, her husband realised that something was very wrong: the child's arm came out first. With the support of nine neighbours and friends, he carried his wife the eight hour walk to the CARE-supported health care centre in Yuai, Uror county, Jonglei state.
The Yuai clinic, though, is one of the most under-developed, neglected clinics I've seen in South Sudan, a country with a chronically under-resourced health care system. The staff there did everything they could to help the woman, but they soon realised that she had to have surgery. The nearest surgical facility is a ten hour walk through a swamp. Working with the county health department, organisations such as Médecins Sans Frontières (MSF) and the International Committee of the Red Cross (ICRC), CARE staff tried everything they could think of to get the woman to the surgical hospital.
They tried to get her evacuated - but the airstrip was too muddy for the plane to land. They tried to hire a tractor to take her - but the swamp water was too deep for the machine to pass through. They tried to hire porters - but none wanted to take on the long and exhausting march. The woman's husband had to return to the village to look after his cattle and the rest of the family. He left his wife in the care of his mother in Yuai. She decided to go to a local traditional healer. He severely damaged the woman, making her condition much worse and she very nearly died. After two weeks of being in labour, the airstrip was finally dry enough for an MSF plane to land to carry the woman to a surgical facility. She lived; her baby did not.
37 hospitals for 11 million people
South Sudan has one of the highest maternal mortality rates in the world. The health care system, while much improved in the past ten years, remains appalling. The numbers are staggering: one in seven mothers dies from pregnancy and birth-related complications . Utilisation of antenatal care (ANC) is only 4.8% and 80% of women give birth at home, often only visiting a facility if they are able to access one when complications arise. There are only about 37 hospitals for a population of about eleven million people. But until you see the biggest health facility in Yuai - in the most populous county in the largest state in South Sudan - it's hard to fully understand what that looks like. The health facility is a mud hut. It has three rooms. Over 7,000 people rely on this mud hut for health care.
The ANC centre is a separate facility for pregnant women for consultations, births and other maternal health services. It is made of concrete and much cleaner. Still, it's infested with bees and bats; the staff can't go in the medicine store during the day because of the bees and on hot days (which is almost every day), it smells of bat droppings. Neither the health facility nor the ANC centre has electricity or reliable running water. The vaccines, so crucial to keeping children alive, are kept in a solar-powered refrigerator 300 metres away in a different building.
Some of these issues seem simple to overcome and we can change things. With timely funding, we could build a concrete building, drill a borehole for water, install solar panels and electricity, get a refrigerator, hire some staff and ensure current staff get re-fresher training, and organise regular drug and vaccine shipments from UNICEF, World Health Organization (WHO) and the Ministry of Health.
The real problem, however, is much more complex. We would struggle to find qualified staff; there are no South Sudanese doctors in the entire county and very few midwives. We could hire international doctors, but that's not sustainable.
Long-term investment needed rather than short fixes
CARE is trying to find low-cost, low technology solutions to the problems that plague the communities we support. We install solar panels, we develop a pool of donkeys to transport patients, and are educating the local birth attendants to understand how to better ensure safe births. We are also supporting our staff to do more outreach to villages; this is crucial to prevent disease and sickness. The health care staff talk to people who do not understand the importance of visiting clinics when pregnant, who only want drugs to cure their ailments. The low level of education in the country means that most women and men do not understand the benefit of preventative health care. And the current conflict prevents even more women from visiting health centres because they are too scared to leave their villages. Together, this leads to some of the lowest health indicators globally.
Even with low-cost technology, we still need funds to invest in health care and education systems. Current funding focuses on international staff - quick fixes rather than long-lasting investment. We can do a lot more, if donors and others give funding with a longer-term view, combining emergency and development assistance.
The nurses who finally saw the woman say that they could have known that the woman would need trained medical help at least a month before she gave birth. Her baby may have been saved and she may have ended up less traumatised. With a view to sustainable solutions, we can help that sad stories like the one I just told do not happen in the future.