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Dr. Geelhoed journal entry 23 Feb 2011 (part 1) – Response to MSF criticism

Series: 11-FEB-D-3

OUR TAKEOFF DAY AFTER A FULL DAY AND TWO NIGHTS IN WERKOK TO START UP OUR DELAYED MISSION TO CONGOLESE REFUGEES IN CAR

February 23, 2011

We are still at Werkok. The plan is to take off and get closer to CAR and gather up the calls and permits the closer we get to the border, but awaiting the contacts that have been made with multiple sources to clear the logjam on this ridiculously small glitch.

Two major events happened on our departure plans as we waited: one was the final tutorial and the wrap up session at Werkok led in all the important points by the Sudanese. The second was the vitriolic post to the TR Blog of a poison pen note accusing TR of being a crazy Paramilitary group of the Christian Right which was messing around in an area in which it had no business since a very well established and big NGO had already set up for many years in that area and had those problems exclusively under its control. It was written by an MSF sympathizer who was obviously stung by the small and agile group coming in and rendering services for which there was a great need while a large and well-funded and supplied agony had done little detectable services for the Murle people in the assessment of those most closely able to judge that—the Murle health officers and representatives of the people themselves.

As an organization to “bear witness” the MSF had obviously been stung by our arrival at the request of the Murle community since they had great needs which were not being addressed. In the opinion of the District Commissioners, two paramount chiefs, seventy eight sub prefecture chiefs and the County Health officer Juono and most of all the Murle SALT community leader Bishop Oruzu had called upon me to help address unmet health needs, and even pledged to forgo violence and abstain from retaliation if they could get some hope of health care where none was apparent to them. These direct quotes from those closest on the ground may have been the greatest stinging rebuke to the complacency of the MSF which has the Murle and the matter of their health care under control, especially since they were evacuating all emergency cases to Juba or to Bor for management. This might even fly if it were not for the fact that I have seen the Bor facilities, and know that they are less well equipped than any other to handle the kinds of emergency surgical aid that MSF alleges to deliver by transfer of patients to them. Just how apparent this is to those in the community was made even more appetent late when the report from Dr. Ajak, and the Director of the Bor Hospital and the Governor whom he reported are very grateful for the arrival of our container and are coming in a body on Thursday to MCH to claim a donation since Bor Hospital has no sutures! This is the referral center to which MSF transfers all patients needing operation! And this is the only service they can render since MSF leadership declines to allow any operations inside its rather commodious facilities and denies the opportunity of its very eager personnel to come to our group for such training. They have discharged their responsibilities with a claim that they have a limited mission and serve the people here within strictly narrow limits, which have been invisible to the leaders of the Murle which I have just cited. Rather than get angry at the Murle for blowing their cover, they have sent an inflammatory post to TR as the small and agile group who has actually come in to deliver services and also bear witness that this “emperor has no clothes.” This must have stung all the way through Juba to Brussels and the exclusive right to cover and care for the people within this mandate and they have been identified as not addressing the needs of the Murle—even those they claim to be doing. Public health as in TB and STD’s and antenatal care are all community needs we found that have no resources among those we have treated. The chief of the PiBor County Health Department Juonon quoted as saying the needed services for the pope within his official responsibilities are negligible addressed by the large presence of MSF here. I was not the one to discover that—Rev Oruzu and the indigenous authorities were. But is more politic to identify the small TR group as the party to attack rather than their alleged constituency.

A debate within our group was entered as to whether we should attempt to refute the arguments against us and our observations or to let the quoted testimony of the local authorities speak for themselves and have the MSF or UN show evidence other than the representations to the outside world that they are addressing the needs of the Murle and indigenizing the care of the community which will be taking over from them when they pull out through training and equipping them—when no Sudanese are willing to go there, there are no Murle staff, and not only were we not allowed to use the facilities and help them in it, but the MSF Country Director in Juba refused to allow any MSF personnel to participate in our tutorials or training even if it were done on our own and they were eager to do so from the MSF field personnel. No wonder the MSF directorship is upset. THEIR tightly controlled story about evacuating all emergencies for surgical care in Bor is a charade and we are in a better position than they to see through since no one so “transported” has a chance of any treatment. This is simple denial of services, and especially those most urgently needed.

DR. AJAK’S ANNOUNCEMENTS FROM BOR MEETINGS, THE AMAZING PROGRESS IN PIBOR MURLE COLLABORATION ALREADY AND THE ANNUAL REVIEW OF THE MCH PERFORMANCE

The final tutorial was led by Dr. Ajak and was an all Sudanese teaching Sudanese event except for a brief review by me of amblyopia in childhood to identify the “Squint” before the child is a toddler and using “occlusion” of the “dominant eye” to strengthen the extra-ocular muscles of the lazy eye in order that the cortical suppressions of all images from that eye does not lead to cortical blindness of a perfectly good eye which would occur by the age of ten and there would be no recovery of the blind eye.

Then Dr. Ajak took over for the final report. Amazingly, he had purchased and packaged for delivery to the Murle the requested microscope so that their lab man can make the diagnoses of malaria and other tropical parasitic diseases. Just like that. A year of requesting and waiting was concluded in today’s visit by answering this need, furnishing them the same kind of microscope and instructions as MCH has with its own lab man Simon. Second, they had requested a special vehicle with 4WD which was made available to them today. Third, the Jonglei MOH said it was not within his purview to furnish the transportation of the fifteen patients for operations we had aligned for MCH from PiBor but he would see that the Jonglei State ministry DID carry out the transport and carry down the fifteen patients and the three trainees as well as return with the patients after they have been operated in MCH and also carried back with the allocations of the resources for PiBor from the container.

That means that the collaboration is already underway and that the patients promised operations will really be done within the next weeks and the training will start then as well. The Minster of Health and Governor of Jonglei who apologized for missing our planned meeting when we went to the leprosy colony after he was detained, as well as the Medical Director of Bor Hospital, thanked us sincerely for the training but above all the container and said they would be coming by to collect what they wanted most from the container which they said was the suture since Bor Hospital had no suture! Recall that this is the evacuation site to which all surgical emergencies are allegedly transferred by MSF—a charade at best on each end. I was wary of this since other donations seem to have “gone missing” into Bor and about $135,000 in sutures is packed in the MCH store room and I do not wish to have very much of it sent to Bor as it seems much winds up in a black market as other materials have in the multiple arranged renovations of that facility which has never changed since the bombs that were dropped on it. So, an accounting will be kept of what they receive and what they use and how. No more will ever be given to them if they disappear without an accounting.

Dr. Ajak then gave the annual report of MCH which was an unusual year curtailed by the heavy rainy season that left the whole area flooded for five months. Ordinarily they would have seen 9,000 to 12,000 patients in a year, but it was down to 5.812 this year because no one could get to it during the rainy season. But among those patients were some highly unusual ones. First they made 31 deliveries, including triplets, diagnosed by the InterSon scan and one of them survived delivery. That is about a delivery every other week, and 110 operations, about two per week. One was a man in extremus with a retroperitoneal abscess which was drained under spinal anesthesia for a complete recovery.

Outpatient DIAGNOSES IN ORDER OF FREQUENCY WERE:

1 Malaria
2 Acute Respiratory diseases
3 Diarrheas
4 Parasites

13 patients were HIV + of those slightly more who were tested. 5,732 lab tests were done since Simon arrived in February: 125 typhoid, 370 brucellosis, 61 giardiasis, 1,385 of the lab tests were positive.

There is NO nurse and NO midwife.

The referendum occurred—peacefully—and 98.83 % of South Sudanese voted for separation and secession against the Unity government.

I congratulated Dr. Ajak for not only the clinical care but also for the training leadership in the future CME in which I will be successively less involved. And Jacob and Ajak are together the leaders of the new initiatives to incorporate the Murle of PiBor and the Akobo hospital in their plans for help.

MY ANTHROPOLOGIC NOTE ABOUT THE DIVISIONS AMONG THE SOUTH SUDANESE AND THE PEOPLE TO WHOM WE GO NEXT

Ethnicities in South Sudan:

1 Nilotic—Dinka, Nuer
2 Nilo-Hamitic—Murle
3 Sudanic–Azande