On Jan. 9, the people of Southern Sudan will vote in a referendum to make the historical decision of whether they wish to remain united with the north, or form the world’s newest country. Residents in the border areas of Abyei and Agok will vote in a separate referendum, to decide whether they wish to join with the north or south. But amidst the political debate about the outcome of these referendums, and speculation from many about impending violence, the medical-humanitarian needs in the region remain enormous, with women and children among the most vulnerable.

© Kate Geraghty/Fairfax Media
Women and children are the first to suffer from the lack of healthcare. Mother and child mortality rates are extremely high Since 2006, Médecins Sans Frontières (MSF) has been providing much needed primary healthcare in the troubled Abyei region of Southern Sudan. Working in this tense area has become more and more difficult. But massive needs still exist. In Southern Sudan, maternal and child mortality rates are among the highest in the world. This is the story of one mother whose baby would have died without proper care. “I was only six months pregnant. I could feel myself go into labour; I had really bad back and stomach pain. I was worried, so I walked to the hospital. My baby, Litiong, was born very soon after. He only weighed 650 grams. I was sad, but whether he was going to survive or not was not a question for me to answer. It was always going to be in the hands of someone else.” Ines Hake, a nurse and leader of the medical team at the MSF hospital in Agok, remembers Litiong’s birth. “The baby was delivered in our hospital and he was not breathing,” says Hake. “His heart was really weak, so we performed resuscitation. Later on, he developed infections so he needed intravenous antibiotics for a long time. We had to feed him using a naso-gastric tube and we also had to use the oxygen generator so that the baby could recover. We were finally able to send him home after nearly nine weeks of intensive care.”

© Kate Geraghty/Fairfax Media
More than 2,580 children were treated for malnutrition by MSF in Abyei and Agok between January and November 2010. Litiong is one of the lucky ones. Torn apart by decades of civil war and with a resulting weak healthcare system with limited infrastructure and few trained medical staff, Southern Sudan is home to some of the world’s worst health indicators, including extremely high maternal and infant mortality rates. In this part of the world, where access to free, quality healthcare is so limited, giving birth cannot only be dangerous, it can be deadly for both mother and child. The statistics in the south of the country are alarming: one in seven women will die from pregnancy or a pregnancy-related complication and one out of every seven children will die before her fifth birthday. “Without the presence of this hospital, which was able to ensure a safe delivery for the mother, without the treatment the baby was able to receive afterwards including oxygen, resuscitation and medication, this would have been an entirely different story,” says Hake.  “If this baby had been delivered at home, which is normal here in Sudan, he would never have survived.” MSF is addressing this need, and more, in two projects located in what is known as the Abyei ‘transitional area’ of Sudan, an oil-rich area that has long been disputed between the north and the south. In May 2008, conflict almost destroyed Abyei town, where MSF was working at the time, and caused approximately 50,000 people to flee to nearby Agok, 40 kilometres away. In response, MSF set up a program in Agok and is now the only provider of hospital care in that town.  A smaller team continues to run an outpatient program in Abyei focusing on primary healthcare, treatment for malnourished children and care for pregnant women.
© Kate Geraghty/Fairfax Media
In Abyei and Agok, the MSF team provided more than 27,800 outpatient consultations and carried out prenatal consultations with 4,368 pregnant women between January and November 2010. MSF also ran mobile clinics into the northern area of Abyei, which is desperately lacking health services. But the situation has been so tense that teams have no longer been able to access this area. These mobile clinics were suspended in July 2010. A major component of MSF’s assistance in Abyei and Agok is the provision of a comprehensive prenatal and maternal care program.  Through community education in Agok and the surrounding areas, as well as the referral system that is offered to pregnant women from MSF’s nearby program in Abyei, more and more women are coming to the hospital to give birth. This ensures that they will have quality care for their newborn child and they will have access to the three essentials for a normal delivery: skilled birth attendants, drugs if necessary and equipment to facilitate the safe birth of the baby. In its hospital in Agok, MSF now carries out an average of 60 to 80 deliveries per month. Today, defying the odds, Litiong is six months old. But he has been admitted again, vomiting and with diarrhea, to the MSF hospital. He is malnourished and is receiving treatment. The nurses say he is doing well and will be able to go home soon. Sitting in MSF’s therapeutic feeding centre with his mother, his is a story that highlights the medical needs that are likely to exist in Southern Sudan for many years to come, regardless of the result of the impending referendum.   MSF activities in Agok and Abyei MSF’s hospital program in Agok provides a wide range of care including maternity, inpatient and outpatient care, a paediatric unit, a tuberculosis ward and a therapeutic feeding centre for malnourished children. Teams also run mobile clinics from Agok three times a week to the surrounding remote areas, focusing on children under five. Between January and December 2010, 31,199 outpatient consultations were carried out, more than 3,679 pregnant mothers were seen in the prenatal clinic and more than 2,389 children were treated for malnutrition. An outpatient program in Abyei, which provides prenatal care, primary healthcare and treatment for malnutrition, refers all deliveries and other serious cases to Agok. Between January and December 2010, the team provided 2,510 prenatal consultations and more than 334 children were treated for severe malnutrition.

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