Articles and Analysies
Health Care and Activism in Sudan by Noelle L’Etoile
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Nov 19, 2008 - 7:04:05 AM

Health Care and Activism in Sudan   by Noelle L’Etoile
Contributing Writer

They asked us for mattresses. Of all the things a 500-bed hospital in Southern Sudan might need, the top of the hospital director’s list was mattresses; theirs are over 50 years old. The hospital is Juba Teaching Hospital in the capitol of Southern Sudan. It serves the 6 million people that work the land in an area the size of France. It has a dual mission: to serve as the primary care facility for this population while training the next generation of nurses and physicians. This training is key to the success of Southern Sudan and the success of Southern Sudan may well be the key to peace and hope for Darfur.

By attending the conversation with the newly appointed ambassador to the United States from Sudan, on Friday, November 14 at 2 p.m. in N225, you will be able to hear first-hand about healthcare in Southern Sudan and find out what you can do to help train and equip healthcare workers.

The health challenges faced by Southern Sudan are myriad but they are all compounded by the lack of health care: only 25% of the population of Southern Sudan has access to health care, the inoculation rates of children is about 18% and maternal mortality in childbirth is the highest in the world at 3% which translates in to a life-long risk of 20% for the average woman who has 6-7 births.

The health-care budget for the 6 million Southern Sudanese totals 80 million USD/year or about $12 per person, as compared to the over $7,000 spent per person in the US. Indeed, tropical diseases such trypanosomiasis, onchocerciasis, schistosomiasis, malaria etc., which are gradually being controlled in other African countries are re emerging in the Southern Sudan (all facts are from the Saint Mary’s-Juba fact finding mission and can be found at: The state of health care is but a symptom of a more pernicious problem.

I was told by a Sudanese doctor in the UK that “In 50 years since Independence from Britain the Government of the Sudan which ruled the Southern Sudan with impunity never developed the Health infra structure, let alone organized training for Healthcare professionals.” Sudan is one of the poorest parts of the world. The infrastructure has been devastated by 23 years of civil war waged between the Northern, Islamic based government and the Sudan People’s Liberation Movement (SPLM) in Southern areas that are mainly Christian and Animistic.

During this war, as in most wars, children bore the brunt of the horror. As an illustration, one group of 40,000 boys between the ages of 5 and 14 were separated from their families. These boys fled the gunfire, without parents or food, by walking hundreds of miles to Ethiopia and finally to a refugee camp in Kenya. They swam a branch of the Nile, were attacked by hyenas and lions, and by the end they numbered 20,000. These “Lost Boys” made their way to the US where some attended college. They have told their stories in movies and books ( and they touched us. We now know their stories, we now share the burden of knowledge. In 2005, a comprehensive peace agreement (CPA) was signed between the North and the South that allowed the South semi-autonomous government based in Juba and for a referendum on possible secession in 2011. This new found stability and security allowed the “Lost Boys” to band together again and use their own meager private funds to build schools and clinics and rebuild their raped villages.

With the CPA, the people of Southern Sudan are on their path of reconstruction. Rebuilding Juba Teaching Hospital and health education is key to developing a peaceful and prosperous Southern Sudanese society. The factions of the government that want to rebuild are strong supporters both of this endeavor and for peace throughout Sudan. The success of the rebuilding is likely to gain them a stronger voice in Sudanese government and have the support of all the Sudanese people.

Southern Sudanese have made great strides and help from the international community could further accelerate this development trajectory. As Dr. Sibrino Forojalla, the Vice Chancellor of Juba University puts it, “We are in the 100 meters dash for development.” International help has come, for example, from St. Mary’s Hospital in the Isle of Wight, United Kingdom. Through a developing connection called St. Mary’s-Juba Link, this UK institution is working to send its staff to Juba to help develop curriculum and train healthcare professionals there. Likewise, students and faculty within the University of California have formed the group Health Alliance for Sudan. The mission of this alliance is to enhance the service and training capacity of Juba Teaching Hospital by providing them with donated medical supplies, equipment, and textbooks, as well as facilitating the development of academic exchange programs between the University of California and Juba University. As its first action, the Health Alliance for Sudan is working to send these 500 mattresses in two 40-foot containers to Juba. The newly appointed Ambassador from Sudan to the U.S. has agreed to come to give and talk to UCSF community and lends his support to this effort.

With this focus on healthcare development allowed by the CPA, there is hope for Southern Sudan and the greater Sudan. This hope lies in people like Dr. Akec Khoc, a former exiled physician who is working for peace and reconciliation between all Sudanese. He spent years treating refugees in camps in Ethiopia and has a long record in healthcare advocacy for the displaced and marginalized peoples of Southern Sudan. The coalition government just approved his appointment as ambassador to the US. He will be here to give a talk about healthcare in Southern Sudan after the talk, he will engage in a conversation with any of you who may be interested.

Noelle L’Etoile is an Assistant Professor in the Psychiatry department at UC Davis.

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