One Brick at a Time

Building a medical facility in the middle of nowhere is difficult; watching people die is harder.

MALUAL BAI, South Sudan - Imagine this: one of your older children is looking after your two-year-old while you are outside working the garden.

The little boy is running around and knocks a pot off the table.

Scalding water splashes over his back. He screams. You come running inside. You wrap him in a blanket and head for the nearest medical facility.

In this case it's 12 hours away -- a day-and-a-half walk. This is the story of Angom Akot and her infant son, Deng, in south Sudan.

The boy likely would have died had she not been able to get him to a primary health care center being built by the International Rescue Committee.

"Along the route, I was so afraid," says 22-year-old Angom. "It was so far away, but I knew we had to get to this place."

At the center, Deng's back is cleaned by community nurses and coated with an antiseptic tincture. The boy is immediately put on antibiotics to combat the possible infections from the second- and third-degree burns covering 50 percent of his body.

Angom says if the center wasn't here, she would have had to resort to using local remedies like herbs.

Today, a week later, Deng is still in great pain. His mother sits on a blanket on the otherwise bare concrete floor while he lies on his stomach in her lap, drinking from a green plastic bowl. But while the dead tissue is beginning to crack, like a ceramic glaze, and fall away, healthy pink and white tissue is underneath. He is healing amazingly fast, says the center's main medical associate, Jamel Yel.

It is one of the small, but important victories in providing basic life-sustaining services to a south Sudanese community devastated by 21 years of civil war -- and just now beginning to rebuild itself in the aftermath of the new peace deal.

When completed, the new facility will have four buildings including inpatient and outpatient centers, emergency obstetrics care and an immunizations clinic -- but no doctor.

Yel, the most highly trained medical professional on-site, received three years of medical training at a specialized facility aimed at staffing centers like this in south Sudan. The workload at times can be overwhelming.

"On Monday I will have 150 to 200 patients all gathered in the courtyard waiting to see me," he says wearily.

The center won't be completed until November. Nearby, a half-dozen men are busy scooping mud and packing it into wooden blocks to make sun-dried bricks for the buildings, while others put in the wooden framework for a roof.

But even though the center is still a work in progress, that hasn't stopped the patients. Last month the center saw 1,000 people. Most of them suffered from malaria or upper respiratory infections -- byproducts of south Sudan's just ending rainy season.

In addition to Yel, the center has 15 other health care professionals, including nurses and midwives. They are supposed to serve an extended rural community of about 20,000 people. But since the region has only two other medical facilities -- one three hours away, the other six -- Yel says he and his staff will likely have to take care of not less than 50,000 to 60,000.

It is obviously exhausting work -- but sometimes also dangerous. When I try to shake Yel's hand he cautions me to go easy. It is swollen to almost twice its normal size.

"A drunken SPLA (Sudan People's Liberation Army) soldier came here yesterday," he explains. "He wanted to be treated immediately for something, and when I refused he started to fight me. I had to hit him with my fist. I knocked him down, but this is the result," he says, showing the hand.

We laugh at the notion that if the soldier didn't need treatment before, he probably did after the "consultation."

Inside Yel's dark thuckle (grass hut) is a wooden bed, a green metal table and half dozen bags of sorghum grain. He holds up a can and tells me that since most people can't afford to pay for treatment, they pay with a "malwa" of sorghum -- a measurement equaling half the can.

"During the war," he says, "our people got used to international aid agencies providing them food, water, everything. We want to break them of that mindset, get them used to paying for services, even if it's only something small."

Under a tree in the courtyard, while men saw and hammer and make bricks for the new center, a women holds her child, who is being treated for malaria. She shakes a homemade rattle -- a large gourd filled with pebbles -- and sings a wartime lullaby about a son who has to go off to fight and the sad family he leaves behind.

It is a beautiful song, but one many here hope can be left in the past, while the shadows of a healthier future begin to take shape around them.

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