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The Republic of Sudan, in northeast of Africa, is the largest country on the African continent. Southern Sudan is emerging from a 21-year civil war. But the health situation is dire, most health care facilities are destroyed during the war. Slowly, the country is re-building itself, but to provide all of the Sudanese people with the health care and facilities they need, a lot of work still needs to be done.


In November 2010, The United Nations released a report called ‘Scary Statistics – Southern Sudan’. The name is wisely chosen and the numbers back it up. This report confirms again how important and truly necessary it is for this country to improve better health care as soon as possible.


On the list of Failed States Index 2010, Sudan holds third place of the most unstable and fragile countries. The Failed States Index is a list of the United States think-tank Fund For Peace. Twelve factors are used to determine the rating for each nation. This includes security threats, economic implosion, human rights violations and refugee flows. Somalia has been the number one failed state for the last three years, followed by Chad. The countries in the top ten show little to no improvement since 2005. Worldwide organisations focused on Southern Sudan to develop stable and long term plans to build up the country’s health care facilities. The current situation has to change drastically.


Music and elation


Change cannot happen in the blink of an eye, of course, but there is always the potential for progress. If you visit Maridi in Southern Sudan at the end of November, music and elation fill the air. The dust rises from the hundreds of stomping feet, creating a hazy effect around the expansive green compound. The dancing crowds and the riot of colour combine to create an unmistakable atmosphere of celebration. Soon, the music crescendos and hits a frenetic pace as a 100 meter long queue of blue and black gowns emerges, snakes its way through the square and slowly approaches the dais. This is a graduation ceremony of the National Health Training Institute (NHTI) in Maridi, Southern Sudan.


The students of the NHTI in Maridi, their families and communities will always remember November 25 as a special day. For most of them, this is the culmination of a life-long journey to attain the right training and knowledge to serve their fledgling country. “This is the happiest day of my life,” says Akec Aleer, who is here to witness her niece, Regina Achel, take the final step to becoming a clinical officer. “I am so proud of her. Now she will take care of all our sick.”


Soldiers as health professionals


Each of the students at the Maridi NHTI is special in many ways. Most are former soldiers, who now offer themselves for selection by their communities and the Government of Southern Sudan (GoSS) to train as clinicians, offering scarce and vital medical services in this vast country. According to Dr Stanley Ambajaro, Director for Human Resource Development in the GoSS’s Ministry of Health, “clinical officers are now providing 75 per cent of required health services in our country. This school is training competent and committed mid-level health professionals.”


The Maridi School opened its doors in 1998, in the midst of the civil war in Southern Sudan, and has grown to be the leading health training institution in the country. In 2001, when the first class of 13 graduated, no one could have known that almost 10 years later, the Maridi NHTI would be celebrating the graduation of more than 150 students. “Southern Sudan is uplifting,” says the school principal, Mr Eluzai Lou, himself a former student and a former soldier of the Sudan People’s Liberation Army. “Today allows us to throw a light into the future of our country.” Lou’s words are spoken with a passion and commitment. Three-quarters of the school’s faculty are alumni of this same institution.


Midwives are needed urgently


Initially, the training offered at Maridi was only for clinical officers, but the class of 2009 comprises 93 clinical officers and 42 community midwives. The community midwives’ training is supported by the United Nations Population Fund (UNFPA) in a bid to quickly help reverse the grim dangers that women and children face from common conditions and diseases. Southern Sudan has the world’s worst health indicators, with 2,057 per 100,000 women dying during pregnancy or childbirth compared to 400 for 100,000 in Kenya and 3 in every 100,000 in Northern Europe. Only 10 per cent of births in Southern Sudan are attended by skilled birth attendants. The majority of maternal and newborn deaths and disabilities occur from preventable causes that can be averted through skilled attendance at birth, backed up with emergency care. Many of these are also the result of unsafe abortions among adolescent women, and could be prevented from access to family planning. But not only maternal deaths are costing lives in Southern Sudan. There are many preventable and treatable diseases, such as malaria, yellow fever and whooping cough that are claiming lives. Also leprosy, river blindness, polio, cholera and guinea worm are re-emerging. With only 1 doctor per 100,000 people, the Southern Sudanese citizens are left with little or no medical care. This makes the NHTI in Maridi even more essential. The NHTI in Maridi has the capacity to train 150 clinical officers every year. Because of funding constraints it is currently possible to train only 45 students.


“I am really excited to be graduating today,” says Alex Mawa, a graduating clinical officer. “It has been tough. Sometimes we even have to use donkeys to get to the hospitals where we do our practicals, but now after the long journey, I can go out and save many lives.”


300 graduates a year


A recent report produced by the WHO and AMREF Flying Doctors indicates that Southern Sudan needs 1,500 clinical officers in the next five years (a production of 300 per year). After 20 years of civil war, many professionals, including health workers, fled to neighbouring countries, Europe and North America. Currently, there are only 39 doctors working in the entire country, 20 of these in private clinics.


In her remarks to the graduates, the Chief Guest HE Grace Datiro said: “You will be joining many clinical officers from Maridi who have qualified before you and have gone on to become the backbone of Southern Sudan’s health services. A few years ago, many of you, young men and women, were fighting with guns but now you are properly armed to go and face our nation’s most daunting enemy - disease.”


On the 9th of January, 2011, Sudan will hold a referendum on whether or not Southern Sudan should remain as a part of Sudan. The opinions about the referendum differ. Some critics say it may be better for Southern Sudan to be independent from the North. On the other hand, some may think Southern Sudan is not ready to stand on its own. Also, increasing concern is there that consequences, such as violence will do more harm than good to the country. Let’s hope that whatever the outcome may be, eventually Sudan will become a better place to live.


*Jacqueline Lampe is director of AMREF Flying Doctors in the Netherlands.

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