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Jon Waterhouse's Healing Journey: Sudan

In a war-ravaged world that is beyond remote lurks an unseen killer named Kala-azar. National Geographic Education Fellow Jon Waterhouse shares a story of Old Fangak.

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By Jon Waterhouse

In a very few days–on January 9, 2011–the people of southern Sudan will vote on a referendum for independence as part of the Comprehensive Peace Agreement (CPA) of 2005. The voting will decide whether there will be one country, Sudan, or two, with one becoming the newly created country of South Sudan.

Sudan is a place torn by many years of civil war between the north and south. The war began in 1955 and found a peace agreement/cease fire in 1972. Hostilities resumed in 1983 and ended in 2005 with the current CPA. During the war years, more than two million civilians were killed, one of the highest civilian death tolls of any conflict since World War II.

In the midst of that story, there is another story, one that is largely unreported. This story is at times desperate, at others hopeful, and it continues daily. Let me take you beyond the headlines to a remote corner of Africa’s South Sudan, a place that few of you have ever heard of and, in all likelihood, none of you will ever visit.

This place is Old Fangak. If you ask Google Maps to take you there, it won’t–not yet, at least. Located in the Sudd, or Al Sudd, Old Fangak has the distinction of being in one of the largest swamps in the world … that is, during the wet season. During the rest of the year, its temperatures soar to over 122 degrees Fahrenheit and, as you might imagine, it gets very dry. This is a village that has existed, it seems, since time began. Somehow, it has survived the ravages of war and unrest only to be challenged by disease and a glaring lack of world interest.

The people of Old Fangak are gentle and caring, the type you would love to have as next door neighbors. Their world would be considered by most–those who are unaware–to be simple. When life is going well in Old Fangak, the warm smiles you’ll receive are abundant and welcoming.

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Attending a celebration and dance that continues late into the night will leave you happy, if exhausted.

Traveling the river here by way of the White Nile, you experience a vast, wild land. Occasionally you may pass someone on a raft of reeds who is headed to market or someone in a traditional canoe making his or her way to another village. You may also pass someone who is fishing, backlit by a breathtaking sunset. The views as you approach a village are surreal and ancient-feeling: a thick haze of smoke to keep the mosquitoes away shrouds adults, children, and cows who are bathed in the reddish orange glow of the setting sun, which marks the spectacular end of another day.

Cows, other livestock, and some agriculture are the focus of life here. Cows play an especially crucial role: not only do they represent wealth and stature, but they are the currency used by any man who seeks a bride. My friend Goi paid an astounding 800 cows for his wife. However, a payment of 100 cows or less, usually much less, is the norm in these pre-arranged unions.

Sorghum is the primary grain source, a daily dietary item that is boiled and made into small cakes. This is the simple staple that keeps most people going.

If you had a chance to talk things over with the Elders of the community of Old Fangak, you would probably be surprised to discover that the issues that concern them and their aspirations are similar to your own. They dream of futures for their children that include a good education, medical care, abundant food, clean water and environment, and a long-overdue relief from war.

The hope for this future brings a continual increase in the population of Old Fangak, due to the influx of people who arrive in great anticipation of the January 9th referendum. Although this wave of humanity stresses all of the limited resources in the area, this is their chance to vote on creating their own country, all hoping that their dreams may be realized and that their lives will miraculously be deemed safe and of value, literally for the first time in their history.

But as we go deeper into this story, we find a dark shadow which looms beyond the threat of civil unrest, malaria, guinea worm, polio, and a host of other tropical diseases. Through a series of natural and man-made influences and events comes one especially wicked disease. It’s called Kala-azar, or Black Fever. The existence of this killer isn’t widely known (so far it has been spread in this corner of East Africa and in some areas of Brazil and India), but it is a killer which, like so many, shows no remorse as it attacks the smallest and most helpless of this society–the children.

Transmitted by the tiny sand fly of the Phlebotomus genus or Lutzomyia genus, the attack comes mostly at night while the victim is sleeping. The untreated survival rate is almost zero, and in a population already stressed by lack of nutrition and health care the odds of beating it are even less. Outbreaks in the ’80s and ’90s killed tens of thousands. In the words of Jill Seaman, the doctor who led the relief efforts during those years in the Upper Nile for the French organization Médecins Sans Frontières, “Where else in the world could 50 percent of a population die without anyone knowing?”

This is the hopeful part of the story, and where Dr. Seaman–one of the toughest, most compassionate people I know–comes in. She has continued her fight against this epidemic, surviving year after year in a world where most of us would simply give up and run away. She pushes tirelessly ahead, devoting herself to improving life in this most remote part of Africa. She sleeps in a mud hut, and her existence is not much different than that of any of her patients. In the few months each year that Jill is not administering care to the sick and dying in Africa, she is in Bethel, Alaska, working and saving enough money for medicine and airfare to return to Old Fangak with a replenished but minimal inventory.

Whether she is tending to malaria, any number of other children’s illnesses, injuries sustained in gunfire or blade attacks or more, Jill is there, unflinching as she fights in the face of this immense adversity. Many young girls in the region of South Sudan she serves now bear the name “Jill” in recognition of her efforts.

Always lurking is the devastating Kala-azar. It comes with the wet season, when a barrage of sand flies strike with a force that we who consider ‘pest control’ a minor nuisance cannot fathom. The ‘daily sick call’ due to the onslaught of these flies can swell the number of patients from less than 100 to more than 1,000 in a night.

Treatment is not pretty. It’s painful, 30 days of up to 17 daily injections which are placed directly in the muscle tissue, and still there is no guarantee of survival. On any given day a child, a brother or sister, a mother or father will seem to be recovering from Kala-azar. The next day they are dead. It is a situation which astounds and devestates.

There is hope with new drugs and treatments to up the survival rate and possibly eliminate this killer, but it requires time and money, and these are people of little means and even less attention from the outside world.

Fortunately, Dr. Jill is getting some help: A group from Alaska, the Alaska-Sudan Medical Project (ASMP) led by Dr. Jack Hickel, was established about three years ago with the idea of providing help where it is needed most. Somehow, “Jack and Jill” found each other, and from that connection hope has emerged. (Ya know, you just can’t make this stuff up.)

Starting with little funding, but a lot of drive, the effort has grown to a new clinic which is now in its final stages of completion, fresh water wells, medical training for community members, and appeals from other areas around the country for similar assistance. Jack and his dedicated team spend many days planning and coordinating the shipment of supplies and medical assistance to Jill and the people in Old Fangak.

The equipment to drill wells, build clinics, and make needed repairs, plus a wide array of medical supplies, come from around Sudan and the world over. All of this help must be routed through extremely difficult channels of government red tape, strike delays, border crossings and payoffs, then over physical terrain that at times is nearly impassable.

Part of the ASMP team has just returned from the village to wait out, for security reasons, the upcoming vote on the referendum, and will be returning to the village in February and March of 2011 to continue their work, so check back in a month or so for an update. This story isn’t finished. While waiting for the vote to happen and for our team to return to Old Fangak, here’s a story to ponder.

It will help you have a closer understanding of these wonderful people. The story was told to my friend, videographer and creator of the video above, Todd Hardesty–or as he’s affectionately known in the village, Gwan-Dit, which loosely translates to “Esteemed Father,” a term of respect for an old wise man (though Todd’s actually pretty young).

Villagers still talk about the “first” donkey in Old Fangak. It was many years ago. An Arab trader arrived in the village with his goods and a donkey. No one there had seen a donkey before. The children were afraid and other animals were curious. The donkey was tied to a tree. While it was tied there, a large bull with sharp horns came upon the donkey and gored it to death.

The trader asked that he be re-paid for his animal. After all, the bull gored his donkey. There was no denying it. The chief of Old Fangak, being a wise man, assembled a court to determine whether the trader’s request should be honored. After much discussion it was announced that the chief could not side in favor of the trader. “After all,” he said, “we do not know what the donkey said to the bull to cause this attack.”

However, he also ruled that since this visitor to the village arrived with a donkey he should not leave empty handed. So they gave the trader a calf. This calf grew to be a fine cow, and the trader was very happy. This is the story of the first donkey in Old Fangak.

This story, like all good ones, has a sequel–”The Donkey That Ate a Goat.” But that will have to wait for my next post. Jon Waterhouse is director of the Yukon River Inter-Tribal Watershed Council, a National Geographic Education Fellow, and an avid paddler. The views expressed in this article are those of our guest blogger and not necessarily those of the National Geographic Society. Mary Marshall contributed to this report. Photos courtesy Jon Waterhouse

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