The clinic is getting busier all the time. Now we have fifty children in the inpatient centre and numbers in our ambulatory and mobile clinics continue to rise. It can sometimes feel like a bit of an anonymous process for me. A child comes in very sick with malnutrition and some combination of fever, diarrhoea, pneumonia or malaria. After a couple of days most of the children seem to get a little better so they can move from our ICU (not in the sense of an intensive care unit like back at home) to one of the other tukuls. From there the children move from phase one of our nutrition treatment through to phase two, weight gain and eventually discharge either ‘cured’ or back to our ambulatory programme to complete their treatment. Sometimes they seem to move through in a blur and it’s hard to remember the individual child and their caretakers.
I take time one afternoon to take a step back and have a look around. It allows me to see that the children and their caretakers are not just medication sheets, feeding sheets and weight progress sheets. The clinic is not all about medical care. It’s easy to forget that sensory stimulation is supposed to be part of our malnutrition treatment protocols. When I look around I see one of our nurses is playing a game of Ludo with some mothers with their children looking on. Other caretakers are playing cards, one of our health care assistants tells me they are playing a game called kuatene. Still more parents are sitting outside on mats with their children, enjoying the relative cool of the late afternoon sun, chatting and laughing.
Whilst the majority of children in the clinic are cared for by their mother during admission there are exceptions. At present we have two small infants whose mothers unfortunately died shortly after childbirth. These are being cared for by aunts. We also have a fair sprinkling of grandmothers acting as caretakers. One of the most frequent sights around the clinic in the past couple of days has been Nyachuol*. I see her frequently carrying out potties to the latrine or feeding therapeutic milk to her 1 year old niece. She is always smiling and often has a troupe of toddlers following after her smiling and giggling.
Nyachuol is nine years old. She has eight sisters and one brother. One of her sisters, Martha*, is eighteen years old and it is her daughter who is the patient here. Martha has TB and is currently receiving treatment. She struggles to manage to provide all the care her little daughter needs and relies on Nyachuol to come to the clinic every day to help. Nyachuol walks over thirty minutes to and from her mother’s home every day. Unfortunately she does not go to school one of the reasons Martha explains is the cost of the SSP25 (about €6) registration fee per month in addition to the cost of exercise books, pens and uniform.
I ask her if she would like to go to school and she says yes but she has to help care for people now. She got the opportunity to go to school for one year only and happily writes out the alphabet for me to demonstrate what she learned during that time. Nyachuol likes being here in the clinic to help care for her niece and to help her sister to wash the clothes. At home she says there is enough food the family buy kisero (a flattened bread similar to Ethiopian Injera) and soup from the market. She would like to go back to school and in the future she says ‘I want to be a doctor in the future, so I can help my country people’. She is obviously bright and if she lived in many other places she would have the opportunity to get an education and be able to become a doctor or a teacher or whatever her dream may be.
Unfortunately for Nyachuol and many children like here in South Sudan she is unlikely to realise her ambition. According to a 2009 UNICEF report a 15 year old girl in South Sudan has a higher chance of dying in childbirth than completing school. Improving access to education is one of the major challenges facing the world’s newest country. Children like Nyachuol deserve at least a chance.
*Names have been changed to preserve anonymity