Jeg sidder foran den mudderhytte, der den seneste uge har fungeret som mit hjem. Overfor mig ligger den lokale radio-station. De sender ikke pop-musik, men det er hele landsbyens kommunikations station. Her er ikke noget telefon netværk, intet postvæsen, ingen veje der leder til byen. Jeg befinder mig midt i “the Swamp” -sumpen som i mange år var årsag til at man ikke kunne finde Nilens udspring. Og det er forståeligt. Her er et netværk af floder, store områder af langt græs der står under vand. Øer af græs river sig løs, og driver med strømmen. Tilsammen danner floderne et netværk som mest af alt minder om en labyrint. Floderne har forbindelse via få meter brede kanaler, der til tider helt lukkes til af en flydende græsø.
Jeg er her fordi der er en epidemi af Kala Azar (visceral leishmaniasis), en parasitsygdom der spredes af sandfluerne, og forårsager langvarig feber, stor milt og lever, blodmangel, og ubehandlet helt sikkert betyder døden. Det er hovedsagligt små børn der er syge, og der er ikke mange behandlings centre i landet. Men i Old Fangak driver en amerikansk ildsjæl og læge (Dr. Jill) et center. Hun arbejder halvdelen af året i Alaska for at tjene penge til at drive centeret, og tilbringer resten af året her. Der er fortiden 400 patienter der skal have daglige injektioner i 1 måned for at blive raske. Der er ingen andre der hjælper i området, ingen organisationer der driver sundhedscentre, og derfor kommer der i tilgift 3000 patienter hver måned som bruger centeret som praktiserende læge. Udover Kala Azar centeret betaler Dr. jill også lønninger til to Clinical health workers, der hver driver en lille klinik i to nabo Payamer. Mens Dr. Jill er i USA leder en Sudanesisk sygeplejerske centeret.
Min opgave her er at se hvordan vi i Medair kan hjælpe dette arbejde. Der er langt flere syge i år end vanligt. Centeret er overvældet, og de har påskyndet at der i denne uge har været 2 ekstra læger på stedet. En stor del af tiden har vi brugt på at have konsultationer med patienterne, revurdere de patienter som sygeplejersken var i tvivl om, give en hånd med ny-indlæggelserne. Det har været fantastisk at få lov at diagnostisere igen, og lære så meget om en sygdom jeg aldrig har set før.
Ugen har også budt på besøg i de to satellit sundheds centre. Rejsen dertil foregår med båd. Det ene center kunne dog ikke nås i speedbåd, da floden endnu er for lav. Vi måtte derfor stå af båden og vandre gennem bushen, på knap synlige stier, og endte i en kano lavet af en udhulet træstamme (præsis som dem de har på stenalder musset i Lejre). Vi fik straks serveret te ved ankomsten og mødte landsbyens ledere og ældste. Derefter blev vi vist til sundhedscenteret, der bestod af 4 runde hytter (tukuls). Kun Sundhedsarbejderen får løn, men 3 traditionelle fødselshjælpere, en assistent og en rengøringsdame arbejder fortsat frivilligt på stedet. De ser ca 20 patienter om dagen, og kan behandle de mest almindelige til (diarre, malaria, lungebetændelse, øjenbetændelse) og henviser resten til Old Fangak (en 8 timers gåtur gennem sumpen) Vi samler 3 kvinder med syge børn op på vejen tilbage til båden og tilbyder dem en lift til Old Fangak.
Det har også været ugen hvor jeg har bevist at jeg kan antænde og lave mad på et kul “brænder” og klare mig helt uden elektricitet i en hel uge (jeg er glad for mit 6 timer lange computer batteri, og en lygte med sol-panel )
Dette sted har en fantastisk unik natur, og jeg undres igen og igen over at det er muligt at leve her. Der fiskes, og der avles kvæg, og livet fortsætter her som det altid har gjort. Engang imellem forstyrres idyllen af en kommerciel båd der bringer varer til det lokale marked og fungere som bus.
English:I am sitting in front of the hut made of mud, that has been functioning as my home the last week. Opposite the hut, is the local radio station. They do not play pop-music, but it is a communication station for the whole village. There is no phone network here, no post-office, no roads are leading to this village. I am in the middle of the “Swamp”, the place where the explores lost track of the Nile, when trying to find it’s source. And i understand it. There is a network of rivers, big areas of long grass growing in the river, islands of grass is floating on the river with the current. Together it all creates a labyrinth. The rivers are connected by tiny channels, that occasionally is closed by a flooding island of grass.
I am here because there is an epidemic of Kala Azar. (also known as visceral leishmaniasis) a parasite carried disease, spread by the sand-flies, and causing longstanding fevers, huge spleen and liver, anaemia, and if untreated surely will cause death in the end.
It is mainly small children being sick, and the centres that treats this disease are few in the country. But in Old Fangak there is a such centre, lead and run by a fiery american doctor (Dr. Jill). She works half of the year in Alaska, raising money to run the centre, and spend the rest of year here in Old Fangak. At the moment there is more than 400 patients on treatment for Kala Azar, all needing daily injections for at least a month to recover. There is no other NGO’s helping in the area, no one running the health facilities, and there fore there is also 3000 general patients a month seeking help in the centre, and Dr Jill is also supporting 2 health workers in neighbouring payams with salaries. While Dr. Jill is in america, a sudanese nurse is running the centre.
My teams assignment is to see how we in Medair can support this centre. The case load this year exceeds expectations, and the centre is overwhelmed, and they are appreciating the hands of 2 extra doctors on ground. A big part of the time has been spend on doing consultations, in-patient rounds, and help with new admissions. For me as a Doctor it is fantastic to such clinical work again, and also to learn about this disease, that to be honest I had never seen before.
The week has also offered a visit to the 2 satellite health centres. To travel there you go by boat. One of the health facilities could not be reached in speed boat as the water was too low in the river. We had to get out of the boat, hike through the bush, and then climb into a hallowed tree-trunk, used as a canoe (like the once they have in the stone-age museum in Denmark) When reaching the village, we were immediately served a cup of tea, and met the local authorities and village elders. Then we were led to the health centre, consisting of 4 tukuls (clay-huts). Only the health worker is no a salary, but 3 traditional birth attendants, an assistant and a cleaner is volunteering in the centre. Everyday the treat around 20 patients for the most common diseases (diarrhoea, malaria, pneumonia, eye infection) and refer the rest to Old Fangak (which is an 8 hour walk through the swamp away) We collect 3 woman and their sick children on the way back, offering them a ride to the clinic.
It has also been the week where I have proved that I can light a charcoal-stove and cook on it, manage with out electricity at all for a whole week ( I appreciate my 6 hour battery on my laptop and my solar panel torch the more now)
This place has an unique nature, and I wonder again and again how it is possible to live here. There is fishing, and breading of cattle, and life continues as it has always been lived here. Once in a while the peace is disturbed by a commercial boat, bringing in supplies for the local market. The boat is at the same time the local bus service bringing people back and forth to the big city a days travel away.
