I've been following South Sudan, and Water is Basic's work as a donor and now as a board member and feel pretty knowledgeable. The truth is, much of what we saw on the ground exceeded my expectations, then other days, it felt incredibly bleaker. For every smile from a child in a bustling marketplace, there was another child very ill from a very curable disease.
I recently spent four days in Yei, South Sudan. I was the technology-challenged sidekick to Steve Roese, President of Water is Basic, a man who is always on the fly, lives by “Whatever it Takes” and with Water is Basic has drilled over 600 borehole wells in his adopted land. He stops at nothing to bring life-saving clean water, build awareness and understanding, embolden others and bring hope to a land that has known little. He issued me a challenge, one I willingly accepted.
South Sudan gained independence from Sudan in July 2011, after a history of ethnic division, colonialism, famine, exploitation and more than 50 years of war. That much war creates quite a mess – both literally and figuratively. Among other challenges, South Sudan has essentially no heath care system and there are few trained health workers. To highlight what I mean by “few”: there is one doctor for every 65,000 people. Combine that with long distances, a widely dispersed and displaced population, poor roads and a lack of financial resources and it is estimated that only 1 in 4 has access to health services in a population of over 11 million.
What is the result? Some of the worst health indicators in the world. Health indicators are statistics that help us to compare the overall health of one nation relative to another. South Sudan is not faring well. For example, South Sudan has the highest maternal and child mortality rates in the world.
For every 100,000 women who give birth in the country, over 2000 die. Compare that to 18 per 100,000 in the U.S. Just 48% of pregnant women attend one or more antenatal care visits, which could reduce this number considerably. On average moms in South Sudan have 5 children. What happens when you lose a mom? Orphans.
For every 1000 live births, over 100 children die before age 5, with preventable infectious disease and malnutrition being the leading killers. Compare that to 7 per 1000 in the U.S. Simply, 1 in every 10 children in South Sudan don’t make it to kindergarten. What does this mean? Senseless broken hearts and a loss of human potential. No access to health services equals preventable and senseless suffering.
Of the services provided in South Sudan, 80% are provided by international and faith-based NGOs like UNICEF, Médicins Sans Frontières (MSF), Harvesters International and International Medical Corps, to name a few. Humanitarians and crisis warriors waging a battle to bring some level of care to the people, they are crucial. However, they proceed with caution so as to not create a systemic dependency and impede the natural, sustainable development of the local health care system. The future lies in the South Sudanese building their own models of care and capabilities to serve their own.
After gaining independence, things were starting to get better. People were learning to live in peace rather than war and some indicators were beginning to slowly improve. A nation was being built. Then in December 2013 just before Christmas, war broke out once again.
Two steps forward, one step back.
Despite this obvious setback, Steve told me about a primary clinic in Yei started by Bishop Elias Taban and the Evangelical Presbyterian Church (EPC) operating entirely with a local staff and without donor funds.
To which I said, “Whatever, not possible.“
When I spoke to health professionals here in the US about the existence of such a clinic, they told me plainly, “Primary care doesn’t exist in South Sudan; there is acute care only, all provided by outsiders.”
Steve insisted it was true and challenged me to come to Yei and see for myself. If I liked what I saw, he challenged me to help grow it. So I booked my ticket for the 30-hour journey to find a unicorn, a beast of legend, elusive and symbolizing hope and beauty.
As the trip grew closer, the security situation worsened. There were new reports of atrocities and violence growing closer and closer to Yei; food shortages, people fleeing and increased desperation. Things are always tough in South Sudan, but hope kept things moving forward. Hope was fading. I considered cancelling, but persisted because, if there was indeed a unicorn in South Sudan, the world needed to hear about it.
Turns out I found what I was looking for.
Along a small red-soil road and lined with tukuls and small cooking fires, not far off the main Juba-Lainya road, is the Evangelical Presbyterian Church of Yei. Adjacent to the church is a small cluster of buildings called the EPC Clinic.
Bishop Elias and Ann Grace Taban started the clinic because the people of their community were dying from simple, preventable illnesses. Their vision was to create a self-sustaining primary care resource for the urban areas of Yei that would reduce preventable deaths, improve the health of the community and eventually fund outreach efforts to the surrounding rural areas.
A local staff of 21 including two clinical officers and four nurses operates the clinic. It has 36 inpatient and outpatient beds, including a children’s ward and women’s ward, and serves a caseload of over 600 cases per month with people coming from as far away as Juba to receive services.
In addition to general medicine, the clinic performs minor surgeries and has a dedicated operating theater under construction, which will be fully functional by the end of the year.
In South Sudan, only 35% of health facilities provide immunizations. EPC Clinic provides an average of 400 free immunizations a month.
Less than 20% of health facilities provide laboratory services for common tests. EPC Clinic offers a full battery of laboratory services on site.
Over 50% of health facilities have regular drug stock-outs. EPC Clinic has a staffed pharmacy on site with a consistent supply of regularly prescribed pharmaceuticals.
The clinic has partnerships with other local health facilities, including the local Yei County Hospital, EPC Harvesters Bet Eman Hospital for Women and Children and The Martha Clinic.
Has it been easy? Absolutely not, but they are doing it day in and day out. Perhaps most importantly EPC Clinic does not rely on donor funds for operations and is funded by daily fee collections. It is locally staffed and managed, sustainable and provides culturally concordant care to community it serves. EPC Clinic of Yei is a scalable social innovation in some of the most difficult circumstances.
Water is basic, but I put forth that health is a universal human right. With health comes the ability to live up to our potential, look to the future and imagine progress. The EPC Clinic in Yei is a shining star, one that is leading the way to a healthier future for South Sudan. It is a beginning step towards sustainable primary care in a nascent nation whose people have known too much suffering.
What should one do when they see a unicorn? First, run and tell others about what they have seen. Then, use whatever resources are available to strengthen this beautiful creature and help it increase in number.
What if there were two EPC Clinics in Yei County? What if there were five clinics covering Yei and into the adjacent county? What if there were twenty across the region? You get the picture.
I am both an optimist and a pragmatist. I went to South Sudan to find a unicorn. I found what I was looking for and it has filled me with hope for a brighter future in the newest country on Earth.
Now it’s time to get to work.
I’m used to crying whenever my plane takes off from Yei South Sudan with emotions and thoughts whirling around my head and heart- I’m used to it now. I mean these are my people, my friends. They have suffered for years, most from the day they were born, through agonizing war, unspeakable atrocities, and middle of the night deaths of children, parents and friends. A good week is a week where a meal is eaten once daily. A good year, where enough funds were available for everyone to attend school, whether under a mango tree or a scorching hot corrugated roof.