Vaccination – South Sudan

Luboš Fellner from BUBO visited South Sudan. He has become actively involved with MAGNA assistance at a camp for internally displaced people and he still managed to write a blog. Read more.

After lunch we head out on the main mission, which is vaccination against polio – poliomyetilis. We don’t know how to cure polio, but we can prevent it with vaccination. Now MAGNA, a non-profit humanitarian organisation from Slovakia, is going to vaccinate 12,000 children (up to 5 years old) in 4 days. That is an enormous number and an amazing thing.

We again walk around Gumbo, which at one time was hit by cholera, but somehow it stabilised. Well, there is very much malaria in Juba, it is there everywhere despite the surrounding dryness, it is as common as flu in Slovakia or maybe even more prevalent. Mauro, the boss of MAGNA activities here in South Sudan, had malaria countless times, it’s no big deal for him. We head south-west, cross the Jebel road, and in front of us there’s the only hill in Juba, with a simple Arabic name, Jebel. “Mauro what is there to do here?” I ask about something that for comparison to Slovakia could be like Koliba is to Bratislava or like Zobor is to Nitra, a place with the most luxurious villas… “There are many snakes there, poisonous snakes, that’s all. And in December 2013 the fiercest battles took place there, and in summer 2016 too”. We pass Jebel on our right and before the main checkpoint we turn left. Now we’re in a so-called POC (Protection of Civilians) area, where Nuer people went to when the terrible murders were happening and where they now live fenced off and protected against murderers. Dinkas ran into here and they also fired from outside into the refugee camp, there were very many dead people here. Therefore, armoured UN transporters go around the camps now. It looks interesting, a huge, dangerous-looking transporter with machine guns painted white. It is tasteful. Of course, “blue helmets” guard the camps, they are mostly dudes but also women from Nepal.

First we enter the camp on the right, which is POC 3, and it is the largest camp. Entry is prohibited, but I have a special humanitarian staff visa, we have a special permit for our people and our car, and they check us 10 times. We had to submit the permit many days in advance. They take a long time verifying it, and we finally enter. And I go for the first time in my life crossing through a proper refugee camp. Well people, this really is something. Most of the people are Nuers, that is people of the Nuer tribe. The camp is located in a kind of shallow, arid little valley, one white tent next to another. There is water here, there are latrines here, which you can feel from far away, and there are an unbelievable 70,000 people. One decent-sized Slovakian town in terms of population (more people live here than in Trnava) packed into a tiny area. Naturally after so many years there are tensions, after all this is like a prison. Refugees can go out depending on what papers they have, but they return gladly, where else would they go? Outside the grim reaper is waiting. The Nuers, even if they would want to get to their people in the Jonglei area or anywhere in the Upper Nile area, would have to cross land of the Dinkas and they would obviously not survive that. Many of the people are professional refugees, they were born in a refugee camp, then after the creation of the Republic of South Sudan they became free and they left the camp, and two years later they returned to a refugee camp, even though it was at a different location. Their freedom lasted for 2 years, and they spent more time in a camp where they feel more at home. It’s a special situation, hard for us to understand. It’s like if after 30 years of being in prison a convict is set free and he immediately commits a crime just so that he gets locked up again. He doesn’t know what to do with his freedom.

We pass through the main little streets that our 2 Land Cruisers can fit into, people nod at us, children laugh, everyone is very positive. This did not happen to me out on the other side (behind the barbed wire fence). Nobody nodded at me there to greet me, actually nobody even smiled at me there. Here everyone stretches their hand out to me, and white smiles flash at me everywhere here. In the corners of the fencing and also at certain distances observation points are posted, all made of iron containers. It is artfully connected, a quite impressive invention, like it’s made of Lego, it seems that anything can be built out of containers. Refugees actually used to live in them. Then we stop somewhere, I can start taking photos. In the streets of Juba I missed that and here it’s possible, then I lose all “my people” at once. Martin will probably recognise the situation and return for me. We wear white vests with a MAGNA logo and we go on foot between white tents in very narrow little streets. There are about 5 to 7 of us, one crier, who calls out in Nuer language so that mothers bring their children to be vaccinated.

Vaccination is done orally, just 2 drops onto a tongue, which doesn’t scare the children. When someone has got vaccinated we colour their little finger on their left hand black. Children up to 5 years old get vaccinated, but the problem is that Africans don’t monitor who is how old, practically nobody knows. So children much older than 5 stand among the children who want to get vaccinated. Just for fun. They have to be excluded. How is their age found out though? First of all, it is obvious at first glance, and soon I too begin to see which children here are 5 years old, they are tiny. I have a daughter who is 7 and she is twice as tall as the children here who are 5 years old. In Africa there’s a great trick to determine age. The children have to put their right hand over their head and grab their left ear. If their fingers reach under their ear they are 6 or older, and if they just about reach then we vaccinate them because they are not 5 yet. It’s an unbelievable tip in an area where there aren’t any compulsory ID cards, registers are missing, and as I have already mentioned nobody considers it. Often everyone on the ID cards is born on 1 January.

For me, as a physician, it is a great experience. I studied medicine so that I would help, and this is kind of how I imagined it. Being totally in the field among people. A big thank you to Martin Bandžák for this exceptional experience. Plus, I have seen with my own eyes what MAGNA does. How many people have to work perfectly so that this burden in Africa is coped with. Poliomyelitis is an infectious disease that transmits the RNA virus. If a child gets the disease there is no treatment. Prevention = vaccination works amazingly. USA and Europe are officially “polio free”.

Then we sit at the new MAGNA HQ. It’s a clean building painted red, with a sheet metal roof. On the inside there are wicker walls to remind patients and staff of a family residence. Everyone at the camp is local. All of the MAGNA staff who walk with us today are Nuers. Nuer boys have 6 big scars that go across their whole forehead. Despite the evident aid that people receive here, unrest often breaks out in camps. When the ambassador of the USA came here, she had to jump into a car and flee. She only came to have a look, but everyone thought that there would be talks. They are used to sitting under a bushy tree and talking and then talking some more, and if they are refused to do so things get bad. I quite understand it, if they shut me in such a small space with such harsh conditions (a tent where it’s 80°C during the day), my brain would boil and I would go crazy within a month. They have been here for years. They cannot grow any food, they receive all of their food in sets, it’s all for free. Well, doing nothing is really not the best thing that they expect from life. Doing nothing also means zero progress. And that is frustrating.

Children here go to school, they have it good, the biggest problem is finding employment for adults. The biggest unrest is in POC 3. That’s probably because the camp was the last one to be built, the youngest refugees are here and so hormones are causing rebellious activity. Many conflicts are about women, which is a problem in every community. Then money, again a classic problem. A television connection costs $90 US a month and if you want to watch a football match that costs 50 pounds/person. And there is nowhere in the area to get money from, here people don’t officially get paid.

We enter a school. It is paid for by a Norwegian non-profit organisation. In front of the school there is a disc from a car wheel, which is used as a bell for class. There are many classes here. At some they are learning and are well-dressed. In another one at the moment the teacher is disciplining three female pupils. They fought and now they have to kneel down and listen to the preaching of the teacher. Just like Slovakian teenagers, it doesn’t faze them. They kneel down with their long legs horizontal, centred like rulers, and the teacher can say what he wants. He is lounging on a black sofa, and he explains with a raised pointing finger that people having fights with each other caused war in this country. At the school we vaccinate more children, I do the vaccinating as well, I colour little fingers, the children are enthusiastic that something is happening. Then we walk around boys who have finished school already, they are playing football, and we enter a church. I like that the building isn’t empty but the church is used during the day as a school and there are 3 classes inside it. Even a group of adults who didn’t have the opportunity to go to school before is learning. Then the refugee camp gave them the opportunity to learn. That is very impactful. They are dressed in purple and they are concentrating hard on their studies.

Apeiu is the boss of MAGNA here inside the camp. She has a huge mane of artificial hair woven into strong braids, and white, imitation pearl earrings. She is a determined, good-hearted woman, a bit plump, that’s how she seems with these skinny people around. Well, I have to say that here at the camp people look healthiest. That is also because Nuers are just “fatter”, and also because there is evidently hunger on the outside. Inflation is terrible, money is losing value. The exchange rate of the South Sudan pound fell from 3 being worth 1 dollar to 230 being worth 1 dollar. No food can be grown because of the war. Soldiers trade in development aid and only a portion reaches the hungry people. Well, here at the camp everything is under control, things work. Foreign non-profit organisations are in charge. It seems to me that all of the foreign non-profit organisations on the planet are here, as are others too. Aid is like every other business, you can improve in it, become a professional and help more effectively for the same time and same money. Very big organisations come across the same problems as huge corporations. Their employees look out for their benefits more than performance. What’s on paper is more important than work in the field. And after all a corporation is a company, which has to be profitable. Well, these organisations are not even like that. Politics and politicking becomes their foundation and the founding concern of the employees.

Apeiu sparkles with activity and spends most of her time in the POC. Even now she gives herself only a few minutes for lunch, and then after lunch she continues in doing vaccinations. Her target is to vaccinate 12,000 children, which is a decent number. In my opinion, MAGNA is the right size. It is active, I counted about 36 people that work for them here in Juba. That is already proper strength. And because I had the opportunity to compare it with others (I’ll write later) I can declare that compared with its competitors MAGNA runs as smoothly as a Swiss watch.

Sagan, football players and Slovak ice hockey players are fine. But I appreciate what MAGNA is doing for Slovakia more. MAGNA has leaped over today’s Slovakia and is giving us a very good reputation. Poor Slovakia is helping, and that’s making us richer.

* The original plan was to vaccinate 11,000 children in the vaccination campaign. Finally MAGNA workers have vaccinated up to 12 thousand children in 4 days.