Intended for healthcare professionals

Education And Debate

Sudan: in through the back door

BMJ 1998; 316 doi: (Published 09 May 1998) Cite this as: BMJ 1998;316:1446
  1. Hans Veeken, public health consultant (
  1. Médecins Sans Frontières, PO Box 10014, 1001 EA Amsterdam, Netherlands

    “Do not worry, she will survive; she has meningitis and is on treatment. You'll see it tomorrow when it is light.” William smiles confidently, sweeps his stethoscope round his neck, bends his back, and crawls out of the hut. I'm not convinced and examine the girl once more; I'm glad I brought my torch. She lies naked in the sand, obviously stiff necked, unconscious, and breathing superficially. The hut is pitch dark, and I can just see the shadows of some five relatives who cook and sleep in the same place. Except for nasogastric feeding, I have not much more to offer. I decide to follow the health worker and to re-examine the girl first thing next morning. William has received primary school education and upgraded himself to health assistant through “hands on” teaching for several years by our doctors. I feel proud but also a bit embarrassed at the ease with which he diagnoses severe illnesses so seldom seen in my home country, the Netherlands.

    Summary points

    Areas of south Sudan have been cut off for years by the civil war, making it one of the most inaccessible areas in Africa with most of south Sudan accessible only from Kenya

    The local tribes are semi-nomadic cattle herders, and even without the effects of the war living conditions are extremely harsh

    Tuberculosis and pneumonia are highly prevalent as well as kala-azar and brucellosis

    In the marshy area of the Sud malaria is an increasingly serious problem

    The most inaccessible place in Africa

    We had been dropped at the village, called Lankien, by a small plane. While landing, I noticed a crashed plane at the end of the air strip. “The pilot forgot to pull up the flaps when taking off,” the pilot explained casually. Lankien is situated in south Sudan, a “country” that is home to some five …

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