Experiences in South Sudan

“Unfortunately only one of my students was left”

Von Myriam Brunelli / Medicus Mundi International MMI

Myriam Brunelli was in the South Sudanese Marial Lou Mission from October to December 1996. At that time, South Sudan had been devastated by the second civil war. Not even the United Nations had managed to create humanitarian corridors to reach the various villages and take them the essentials for survival. Villages were destroyed, children were sold as slaves, and women were raped. In this setting, missionary action became more and more difficult and opposed by the government in Khartoum. Missionaries were expelled in wave after wave.

I met a Colombian missionary in Uganda in 1965: Father Mattia Bizzarro. He had been expelled from Sudan and was trying to help the Sudanese refugees gathered in Ugandan camps along the border with Sudan.

When he went back to Sudan in 1981 after years spent in the various missions in the south of the country, he left Juba and followed the advances of the Sudan People's Liberation Army (SPLA) towards the North. In 1995, he opened the Marial Lou mission. It was then that he realized how serious the healthcare situation was in there, especially several cases of malaria and tuberculosis. He wrote and invited me to come to this mission. My primary task was to train local human resources at least to diagnose tuberculosis, definitively; this disease was reaping victims, not just among people, but even among the cows, a precious asset for those people who live mainly from rearing cattle.

War affects every sector of people’s life

Although I have been in many African countries where I had seen poverty, hunger, and disease, in Sudan I actually experienced firsthand how wars can stop any progress in every sector of people’s life, forcing them to live in unimaginable conditions for us. The mission had only been open for a year at that point, and in addition to the huts where the three nuns and three priests lived, there was a church (a tamarind tree with a small hut for the tabernacle), a dispensary (a hut), and two straw classrooms for two primary school classes, while the third class was in the shade of a tree. We shared the blackboard with the children in this class/tree: they used it in the morning and they brought it to me in the afternoon. Despite all that poverty, you could see the joy of people whose hunger for knowledge and for food was being sated.

I had to start to train prepare the human resources. My students had been chosen by the Colombian priest as the most suitable ones for this kind of work; the five of them had a third grade education. They were 20 to 25 years old and had been born and had lived though guerilla wars. They had frequented the first grades in zones that they had had to flee: Ethiopia, Uganda and Kenya. This experience was especially hard compared to the ones I had had in other countries.

The population here is the Denka: a dignified, proud race, quite tradition bound. In addition, their whole life is lived day to day and no one instructs them about order, discipline, or the sense of duty and responsibility. This makes them wary of accepting these principles and adapting to a precise work schedule. For example, it is hard for them to accept that a nun controls them and manage what they are doing. In their tradition, women must be at their service. Women cannot give advice, much less express judgments.

I was accepted by these young men; they even gladly spent time with me because I taught them how to use the microscope. As with everything else they learned from me, this helped raise them in everyone else’s opinion. People walked past the tent where we were working and stopped, amazed at the microscope. I cannot describe the joy of some little boys and their laughter when I asked them to remove a louse from their head (lice are always ready to pick in places like this) and then they saw it magnified in the microscope.

A bomber or help?

The guerilla warfare continued here as well. Nothing but destruction reigned in various missions in the diocese of Rumbek: schools and even the church of Rumbek were destroyed, children were sold as slaves, and young men were taken by the guerillas when they needed reinforcements. Every once in a while you heard an airplane; you did not know whether it was a bomber or someone bringing help with drops of medicine and victuals. Add to this that they were not able to build anything in this climate, given the precariousness of the situation and the difficulty of transporting the materials needed; the few roads were neither connected nor safe. At that time there was only a small airplane once a month that could carry five to six people, food, and medicines for the various missions. It had been hired by Monsignor Cesare Mazzolari, the apostolic administrator of the diocese of Rumbek at the time (where Marial Lou was located). He became the bishop in 1999.

Right after my arrival, the priest started building the laboratory. It was so hot that it was actually impossible to do our work under a tent as we were supposed to. We worked in front of the tent and kept our materials inside the tent. Like the dispensary, the laboratory was a rectangular hut. What astounded everyone, was that not only did it have an entrance but two openings like windows as well: one in the East and one in he West. I actually hoped I could employ the microscope whose mirror uses sunlight, in both the morning and the afternoon. Instead, I was disappointed when I realized that there were only a few hours a day when the sunlight struck the right way: from about 10 am to 1 pm. Having electricity was not even imaginable and so that laboratory had to be organized by relying only on equipment that was so simple, it was primitive. On the other hand, I was especially interested in teaching people how to find the Koch bacillus in expectorate, and I did have what I needed. When I left Marial Lou, my young men knew how prepare the basics for coloring and reading the slides to diagnose tuberculosis. One of them even managed to recognize malarial parasites.

No training possible

I went back to Marial Lou the next year to see if the work was continuing properly, and if some other tests could be added. Unfortunately only one of my students was left. Everything was uncertain there: some people tried to move, some were pressed into service by the guerillas, etc. After trying to start other people to work, I realized that as long as there was guerilla warfare, hoping for continuity in training was impossible.

In the meantime, Mons. Mazzolari in Kitale, Kenya had built a school for Sudanese teachers and catechism teachers so they could return to their country after adequate preparation. I proposed adding some rooms to this school where healthcare human resources could be prepared.

Upon my return from my new stay in Sudan, at Medicus Mundi, we studied a project to meet these needs. Thanks to the support of the Peace Council of the Township of Brescia and the Province of Brescia, the school was built.

In 1997 I met Mrs. Lina Sala and her husband Callisto, a Rwandan pediatrician who had moved to Marial Lou. She focused on taking care of tuberculosis patients, while Callisto focused on malnourished children. Their arrival in Marial Lou was decisive for the life of the sick people in this zone: the rise of these two pathologies were the main causes of death. At the same time, people realized that technical laboratory training to diagnose tuberculosis was very useful, so they started up a program for diagnosing and treating tuberculosis that soon spread to the whole country. Then again in 1997, Doctors Without Borders from Switzerland arrived not far from the mission, and created a small hospital. In 2005, that emergency was over, and the hospital’s first aid center was entrusted to the Medical Collaboration Committee (Italy)

In 2006, Lina Sala’s tireless efforts resulted in the ideation, planning, and establishment of the local NGO called Arkangelo Ali Association (AAA, whose board of directors has had a member of Medicus Mundi Italia since the very beginning). Doctors Without Borders contacted AAA as the local NGO that could handle the hospital’s healthcare services since it had been guiding the anti-tuberculosis program since 1997. Currently, AAA manages the hospital’s services and proposes enhancing this activity.

When the emergency phase is over, the issue will be improving healthcare assistance to sick people, training human resources, surgery, and the fight against infant mortality which is unfortunately still high. Medicus Mundi is going help these activities in the departments of pediatrics by preparing people on malnourished children.

I went back to South Sudan in 2005, mandated by the Rotary Club of Brescia to visit the Mapourdit hospital. It had been started in 1999 with considerable help from the Rotary Club who also helped it in activities after this. Thus I could see this first hospital in the Mapourdit diocese working at full steam. Doctor Rosario Iannucci directs it; he is a Colombian monk who had frequented our course in Tropical Medicine before going to Africa. It was quite a pleasure to find him again, doing the job he had trained for. The hospital has been open for ten years now.

During this recent visit, I could see how the diocese had overcome the serious emergency I had seen. The people had also managed to make remarkable progress in this zone, both in terms of healthcare and in terms of education and religious teaching. Over the last ten years, schools, some secondary schools, and 11 healthcare centers have been created in many districts. These centers have other activities as well, but they continue the program to fight tuberculosis, whose diagnosis is still based exclusively on finding the Koch bacillus.

Milestones in Sudanese History

Sudan is ruled by an Anglo-Egyptian government with an Egyptian governor. North Sudan is largely Muslim and Southern Sudan is largely animist and Christian.

Civil war between North and South is followed by ten years of peace after ratification of the Addis Ababa agreement in 1972. This guaranteed a sort of governmental autonomy to the States of South Sudan.

The civil war is provoked and instigated by President Gaafar Nimeiry’s decision to create a single federal state (which would also include the States of Southern Sudan, initially deprived of the autonomy guaranteed by the 1972 treaty) where the law of Sharia would be extended. The Sudan People's Liberation Army (SPLA) is established in 1983 in South Sudan, as a Marxist movement, supported by the former Soviet Union and Mengistu Haile Meriem, then the Philo-Marxist President of Ethiopia.

January 9, 2005
The Nairobi Comprehensive Peace Agreement

*Myriam Brunelli leitete als Ärztin während Jahren das Labor für klinisch-chemische Analysen am Kinderspital von Brescia. Sie war 1969 Mitbegründerin von Medicus Mundi Italien und deren Präsidentin von 1996 bis 2003. Vor ihren Einsätzen in der Dritten Welt erwarb sie sich zusätzliche Kenntnisse in Gynäkologie und Geburtshilfe. Sie hat in Uganda, Ghana, Ruanda, Goma, Zaire, Äthiopien und schliesslich im Süd-Sudan klinische Labors eingerichtet und einheimisches Personal ausgebildet. Seit 1988 ist sie mitverantwortlich für die Organisation der tropenmedizinischen Kurse von Brescia, welche Medicus Mundi zusammen mit dem lokalen Institut für Epidemiologie der Universität anbietet.