Damn the Rains

As our six-seater closes in on the small outpost of Walgak, South Sudan, the thing we feared most – short of a plane crash - happens.

It starts to rain.

A few drops quickly turn into a steady pounding against the pilot’s windshield. We are carrying desperately needed medicines and supplies – as well as a nutritionist and a mechanic to fix a long-broken generator - from Akobo, about 50 miles to the southeast. Walgak has been cut off from flights for weeks. Any moisture on its landing field means planes can’t land or take off. Often pilots, on approach, see a wet field, and are forced to pull back up and turn around.

“Will we be able to land?” I yell to the pilot. She flies in low, checks out the field, and turns her head around to me and my fellow passengers. “It’s too wet. I can’t risk it.”

This is incredibly disappointing. Walgak, about 300 miles north of the capital of Juba, will have to go without supplies for at least three more days, when the next charter flight is scheduled. Earlier this year, we tried unsuccessfully for six weeks to deploy a doctor to Walgak.

We are officially in the throes of the rainy season in South Sudan. This is a bit of a misnomer since the “season” is supposed to be April to October, but really it is more like nine months of the year.

The almost daily torrential downpours transform dirt roads (there are very few paved roads in South Sudan) into rivers of mud, unnavigable by vehicles. In Akobo, where International Medical Corps is helping run the county’s sole hospital, the only way to get around most of the time is by foot - or with one of the two tractor-trailers in town, used for carrying heavy equipment and supplies.

The rains also make it difficult for people to maintain proper sanitation and hygiene. Mud is everywhere, and most people walk through it barefoot.

At the hospital, I meet 18-year-old Buony. After suffering about a week with unbearable pain in his right leg, his brother and mother carried him for an hour, by foot, from their village of Mer to the hospital. Two of our volunteer doctors, Masashi Rotte and Shannon Langston, use a portable ultrasound machine to examine his leg, which has become swollen and rock hard, and determine that he has pyomyositis: an extensive infection that causes pus, blood and dead muscle tissue to build up inside his leg. If they don’t operate to drain the infected leg he could soon suffer sepsis and die.

The next morning, following a successful two-hour surgery, Buony tells me the pain is gone, and he is relieved to know that he will keep his leg. I comment to his brother that he may have saved Buony’s life. “I did something good for him, he would do the same for me. We’re brothers,” he replies.

I contemplate having to carry someone for an hour, in the mud, to get them medical attention. The rains make conditions in this already very remote area extraordinarily difficult.

But the rains bring another deadly problem: mosquitoes, and malaria, which is rampant here.

At the Akobo County Hospital, about 50 percent of our patients now have malaria. Many are also suffering from upper respiratory infections, like pneumonia. And tuberculosis is beginning to emerge.

I am doing rounds with Dr. Rotte. He is worried that three patients he treated for malaria and discharged have returned just a few days later with malaria again. Are they becoming drug-resistant to the IV-administered quinine used to treat them? This could be a disaster if the medications we give people are no longer effective. And having different malaria medications sent to Akobo could take weeks and weeks.

The needs here are staggering – but the impact we can have with the simplest of interventions is also huge. Dr. Langston tells me about a young girl who needs a blood transfusion or she is going to die within a day or two. “We don’t have a lab technician so we’re in the process of figuring it out, how we can possibly get someone to donate blood and maybe save her.” Within the day, he and Dr. Rotte do figure it out and are able to perform the transfusion. The next morning, she is up and about, laughing and running around, her old self. “She’s like a completely different child. She was literally on her death bed,” Dr. Langston says. “This makes me really happy.”