Lauralee in Lankien

Southern Sudan has one of the highest concentrations of Neglected Tropical Diseases (NTD’s) in the world. The NTD’s are a group of infectious diseases that traditionally receive little attention from governments and donors. Their victims are some of the poorest most marginalized people on earth, people who have no economic or political voice, people who live under the conditions where NTD’s thrive: unsafe water, poor sanitation and little or no health care. In contrast to the Big Three (TB, malaria and HIV/AIDS), the NTD’s suffer from a lack of international awareness and funding for research and development.

To my knowledge, with the exception of Chagas disease (American sleeping sickness or American trypanosomiasis), which occurs exclusively in Latin America, all of the NTD’s are present in southern Sudan. The list of diseases covered by WHO’s Neglected Tropical Diseases department is long: Buruli ulcer, Chagas disease, cholera and other epidemic diarrhoeal diseases, dengue, guinea-worm, yaws, African sleeping sickness, leishmaniasis (including kala azar), leprosy, lymphatic filariasis (elephantiasis), onchocerciais, schistosomiasis, soil-transmitted helminthes (worms), and trachoma (a blinding eye infection).

Neglected tropical diseases suffer from the 10/90 Gap, a term first coined to describe a statistical finding of the Global Forum on Health Research. In 1990, it estimated that only 10% of all the money spent globally on health research and development was devoted to the problems of the poorest 90% of the world. Conversely, the other 90% was spent on the richest 10% of the world. Although these estimates are old, the term 10/90 Gap still persists to describe the mismatch between resources and need.

The World Health Organisation’s Neglected Tropical Diseases:
http://www.who.int/neglected_diseases/

Global Forum for Health Research:
http://www.globalforumhealth.org

Drugs for Neglected Diseases Initiative:
http://www.dndi.org

The team I joined will not be the team I leave. The composition of the expat team is constantly changing as the contracts of volunteers begin and end in a staggered fashion. This is good and bad. It allows for continuity in the project, transfer of knowledge between team members and variety. But it also means that we often find ourselves saying good-bye, sometimes to people we have come to cherish. The expat team lives and works together and the interaction can be very intense. We become more or less like a family, sometimes a happy, efficient family and sometimes a miserable, dysfunctional family. This is one of the great challenges of working for MSF, how the team works can ‘make or break’ your mission and how it works is both within and outside your control.

I have already said good-bye to more than half of the original ex-pat team. The Good-byes can be tough, the conversation populated with Maybe I will see you on another mission, Let’s get together in Toronto, I will see you in Amsterdam, etc. And perhaps you will, but it will never be the same.

Good-bye again friends, Jodi, Jackson, Fiona, Lindsay and Uriah

Jodi Pipes, Outreach Nurse. Photo Credit: Lindsay Farnsworth

Jackson Lochokon,Technical Logistician. 

 Fiona Gillett, Nurse Midwife. 

 Lindsay Farnsworth, Logistician Administrator. Photo Credit: Trish

Uriah Morgan, Outreach nurse.

Some medical problems can be notoriously difficult to diagnose early in their clinical course: ectopic pregnancy, meningitis, pulmonary embolus, pancreatic and ovarian cancer. The clinicians among you will undoubtedly want to suggest others. Even with the benefits of advanced diagnostic tools, these problems can be difficult to diagnose. Often as the disease progresses in its natural history, the diagnosis declares itself. Inevitably, the last doctor to see the patient looks like a genius. “It’s easy to diagnose a pumpkin in October, try doing it in May,” I like to remind my specialist colleagues.

In Canada, patients tend to seek medical care early, a blessing of our universal health care system. Not so in southern Sudan. Here, patients often present only in advanced stages of disease. But late presentation does not always make diagnosis easier, particularly for ‘Western’ trained physicians more familiar with seeing early disease.

In the end, the patient had a “chronic” ectopic (tubal) pregnancy. She had been sick for weeks with pain, vaginal bleeding, and a large midline mass in her lower abdomen. I had trouble making the right diagnosis, not because she presented so early but because she presented so late. In my defense, we have no ultrasound, no blood tests for pregnancy and certainly no laparoscopy. I was thrown off by the large pelvic mass, which turned out to be the ectopic pregnancy itself, made huge by repeated internal bleeding. Ultimately, the patient was transferred to Nasir for surgery, where the diagnostic mystery was solved and the patient received a successful operation. As for me, I chalked it up to experience and another lesson in humility.

“The neck looks fuzzy,” says Leanna, training her binoculars on a large marsh bird in the distance. I am flipping back and forth through The Birds of East Africa trying to find the section on storks and ibises.

“There’s something here called a Wooly-necked Stork?” I offer. We switch roles. Leanna takes the bird book and I look through the binoculars.

Sunday is the closest thing to a day off in Lankien, and Leanna and I are on a bird walk. We are hoping to make it a tradition, an effort to unwind, see the world outside the compound and indulge our mutual interest in birds. Leanna Hutchins is our talented logistician administrator and like myself, this is her first mission with MSF. I have watched Leanna apply her considerable skill to master the tough, steep learning curve presented to every first missioner. Leanna is also the only other Canadian currently in the project and as such, we happily share the bonds of culture and language. I am very lucky to have her here.

“Yes, it’s the Wooly-necked stork!” says Leanna enthusiastically, snapping some photos. She is surrounded by a group of children; they hang off her arm and demand to see the camera. She laughs, shows them the pictures and asks them their names in Nuer. They are thrilled.

Below: Leanna and Friends, Birding at the Airstrip

 Below: Lauralee and Children at the airstrip

Below: The Wooley-necked Stork. Photo Credit: Leanna Hutchins.

Gunshot #1: The bullet ripped through his mother’s forearm, shattered the bones and left bits of cloth from her sleeve peppered throughout the wound. It then entered the cheek of his infant sister as she slept in the crook of her mother’s cradled arm. It was a mistake of course. He’s only six years old and didn’t intend to hurt anyone. He got hold of a loaded gun; that is the way it happened. Underneath all the blood, his baby sister had only a superficial wound; it will heal with a scar. His mother however, will always have trouble with her right arm.

Gunshot #2: It happened during a cattle raid. Someone tried to steal his cows and shot him in the process. A single bullet went through his left ankle, touched the inside of his left thigh, brushed the skin a centimeter below his scrotum on the right side, then entered and exited his right hip. I spent a few minutes trying to figure out the path of the bullet. He said he was sitting on the ground with his left leg outstretched; his right leg, bent sharply at the knee, was tucked tightly into his body.

Gunshot #3: Another cattle raid and another young man barely out of his teens. The bullet entered his back, just to the right of his spinal column. It narrowly missed his spinal cord, traversed his right lung and exited his right shoulder.

When I first got to Lankien, I marveled at the luck of many of the gunshot victims, although they had serious injuries, they did not die from their wounds. Of course this was all a mirage. It takes a long time to get to the clinic; the victims of lethal wounds never get here.

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