"Tell him that I think he has cancer," I say to the paramedic who is acting as my translator. He looks at me blankly. "It's when a cell.....ahh...is out of control," I fumble around for the words that will bridge the language and knowledge gap between us. The conversation eventually ends with confusion all around.
As far as I can tell, not only is there no Nuer word for cancer, there seems to be no conceptual understanding of it. Cancer, the great bogey man of aging millions in "the West", is off the radar in southern Sudan. It's not that cancer doesn't exist here, I'm sure it does, along with other chronic disease such as heart disease, osteoarthritis and chronic lung disease. Cancers of the cervix, breast, liver, nasopharynx, esophagus, and lymph nodes all occur in southern Sudan. But cancer, in the main, is an age related phenomena. It occurs more and more frequently as people move into their 50's, 60's and beyond. Since the average life span here is only about 50 years old, most southern Sudanese do not live long enough to develop cancer!
If I had been born in southern Sudan, I would already have reached my full life expectancy of 50 years, anything after this would be a bonus. Since I was born in Canada, I can reasonably expect to live for 30 more years. But Canada has already completed the so called "Epidemiologic Transition", and southern Sudan is only getting started. "Epidemiologic Transition" is a conceptual theory dear to the hearts of demographers, medical geographers, epidemiologists and those interested in international health. Simply put, it is the change in the pattern of disease from acute infectious disease to predominately chronic non-infectious disease. It occurs as countries climb the development ladder and life expectancy increases. With economic development, women have fewer children and more of those children live into adulthood. Consequently there are more old people and, with the benefits of improved living conditions, better nutrition and modern medicine, those old people start to live longer and longer. But development can be a double edged sword. In economically developed countries people are exposed to more risk factors for chronic disease, in particular smoking, obesity and sedentary life styles, ergo the increase in chronic disease.
Since the 2005 peace accord that saw the end to the civil war between north and south, places like Lankien have started to show slow signs development. There are more traders that come here and the market has more products. There is paper currency now, something that was not the case only a few years ago. But the transition is in its early stages and could easily be derailed by war, violent unrest or a large HIV epidemic.