Every morning the corridors of Lankien’s only hospital are filled with the sound of children crying and adults groaning in pain. It’s that time of the day when patients – small or tall - are given life saving injections against kala-azar. The injection hurts because the medicine is syrupy and has to be administered slowly.

By Ilona Eveleens

Doctors Without Borders (MSF) have been running the hospital in Lankien, to the northeast of South Sudan, since 1995. Preparations are underway for the peak of an epidemic of kala-azar that started last year. The parasites that cause the disease are transmitted by sand flies which become very active in the rainy season which just started in South Sudan.

The symptoms of kala-azar are skin sores that erupt weeks to months after the person affected is bitten by sand flies. Other consequences, which can manifest anywhere from a few months to years after infection, include fever, damage to the spleen and liver, and anemia.

120 doctors for 8 million people
“The patients are people who sleep in the open, like soldiers, traders, nomads and very poor people,” explains Dutch doctor Hanna Jellema. The patients need between one or two dozen injections to save their lives.

The majority of the medical care in South Sudan, which gains independence on the 9th of July, is given by foreign organizations like MSF. There are 120 doctors and some 80 qualified nurses for a population of around eight million southern Sudanese. Patients have to walk for days at times to reach a health facility. South Sudan has the highest rate of maternal and infant mortality in the world.

The 54th African nation-to-be is extremely underdeveloped after decades of war and an almost complete lack of progress. Building hospitals and clinics isn’t high on the government’s to do list in the capital of Juba. The authorities rely for the time being on foreign medical aid. “I’m afraid it will take a while before MSF can hand over this hospital to the government because of the shortage of trained medical staff,” says Hanna Jellema.

Illiteracy
Training and education is another major problem for the new country. The Ministry of Health expects that it will take around twenty years before a sufficient number of southern Sudanese will have received proper medical training.

Some 85 percent of the population is illiterate. Over one million people have attended primary school, but the attendance rate is still one of the lowest in the world. This caused by a lack of classrooms, teachers, school materials and the need for children to work to add to the meager income of their parents.

“Another big obstacle is the culture that prevents girls to go to school,” says teacher Nyang Tal of the biggest primary school in Leer, a town 200 kilometer west of Lankien. “Especially nomadic parents as they do not see the need to educate their daughters. They keep them at home until they are old enough to collect the dowry of dozens of cows.” Nyang Tal is not trained as a teacher. He only went to primary school for eight years, in a refugee camp in neighbouring Uganda. In his spare time he follows courses in education.

Blue collar jobs
Besides a lack of primary and secondary schools, South Sudan also battles with a shortage of training institutes for blue collar workers like mechanics, builders and electricians. Foreigners from countries in the region take up most of these jobs.

Nyang Tal speaks reasonable English, which has been adopted as the official language of South Sudan. Though not fluent, he is still better at speaking English than most people who stayed behind during the war and only speak their tribal language and Arabic.

“I worry about my mistakes in English because I will teach it to the pupils,” says the young teacher. “I’m afraid that the present generation of school children will not be perfectly educated. But it’s still better than being illiterate.”